Ebola is scary, but antibiotic resistance should scare us more

Ebola is the stuff of nightmares. It causes profuse bleeding and organ failure and has a high mortality rate. But while the grim spectacle of dying patients in treatment centres in the affected African countries has stoked fears, cases in the west have been extremely rare in spite of a spate of false alarms across Europe and the US.

New Jersey governor Chris Christie has imposed a quarantine on healthcare workers returning from Guinea, Sierra Leone and Liberia, despite the policy being unsupported by any scientific evidence. Donald Trump has declared that American citizens who are known to be infected should be denied re-entry to their home country, despite their posing a minimal threat to the health of the general public if established infection control protocols are followed.

Context is vital when assessing the risks that Ebola presents outside the main epidemic areas. First, Ebola is not especially contagious. The current outbreak has an R0 of 1-2, meaning that each case infects on average between one and two other people. By contrast, measles has an R0 of 18, a staggering figure worth remembering for those debates with people who still question the importance of MMR vaccination.

Ebola is not spread through the air, but through the bodily fluids of patients. There is no evidence it can be spread by an asymptomatic patient, but it can however still be transmitted after a patient has died, which is often what perpetuates outbreaks because funeral rites involving touching and kissing the deceased are common in West Africa.

Despite the perception that Ebola is bringing Africa to its knees, it is important to note that the current outbreak is confined mainly to Sierra Leone, Liberia and Guinea, which constitute only a tiny, desperately poor fraction of the continent’s population. In these countries low levels of literacy and education have contributed to the epidemic.

Despite the media fixation with this disease and the recently released Band-Aid single, the reality is that despite its high mortality rate, far more Africans die from malaria, tuberculosis and malnutrition.

Ebola will not gain a foothold is Europe or America, as Dr Marc Sprenger, director of the European Center for Disease Prevention and Control, makes abundantly clear:

There is no risk in Europe that this disease will spread. It could happen that some cases show up, but then we know what to do – isolation and good treatment. Ebola will not spread in Europe. Absolutely not.

Media stories about health issues have a disproportionate effect on whether people seek medical attention. This is especially apparent following the diagnosis of a celebrity with an illness and the ensuing coverage. When the Australian media covered Kylie Minogue’s breast cancer diagnosis, mammogram bookings rose 40%, with a 101% increase in bookings for previously unscreened women.

In the UK, the death of the Big Brother celebrity Jade Goody from cervical cancer in 2009 markedly amplified the number of women getting smear tests. In March that year alone, the demand for testing increased 70% above baseline levels. This increase was predominantly seen in younger women, many of whom asserted that awareness of Goody’s situation had led them to get tested. These effects flow and ebb with the urgency of media coverage, so despite the measurable increase in testing at the time of Goody’s death, by 2012 smear test uptake in the UK had fallen to a 10-year low. Media coverage is transient, and so too it seems is its impact.

In a similar vein, we cannot afford to forget the MMR vaccine debacle, where fears that the vaccine could cause autism were widely asserted, despite there being not an iota of decent scientific evidence to support this. This long-since-discredited conjecture was sustained and abetted by media coverage, which drove vaccination rates down and contributed to serious outbreaks and fatalities, such as the Swansea outbreak last year.

While the researcher Andrew Wakefield is rightly held ultimately accountable for much of this, media coverage certainly affected people’s judgement. The mainstream press, which once lauded him as a “champion of patients”, must take its share of the blame.

The converse of this is that things that present a real and present danger to us are often ignored because they are not deemed particularly newsworthy. Through all the sound and fury over the exceptionally unlikely scenario of Ebola taking hold in Europe or the US, we fail to heed warnings about genuine threats, such as the ominous words of the WHO’s Dr Keiji Fukuda concerning the growing danger of antibiotic resistance:

… without urgent, coordinated action by many stakeholders, the world is headed for a post-antibiotic era, in which common infections and minor injuries which have been treatable for decades can once again kill.

This is not some hypothetical eventuality in an unwritten future – it is already happening. Once treatable diseases such as gonorrhoea, pneumonia, E coli, Staphylococcus and tuberculosis have acquired immunity to many classes of antibiotic, and are again claiming lives on a scale unprecedented since these drugs first became available.

The Centers for Disease Control and Prevention in the US estimates that two million Americans a year develop a serious antibiotic-resistant infection and 23,000 die as a result, with similar numbers succumbing in Europe.

This is but one example of something that truly will hurt us being eclipsed by something that will not. The simple fact is that people are poor at reckoning risk, and irresponsible media coverage skews our judgment yet further.