A physician I know recently returned from Africa after caring for patients with Ebola. One evening his patient of 18 years tearfully told him that her two grown daughters warned her that, if she kept her appointment with him, she would not be able to see her grandchildren for three weeks. The hospital where he delivers babies also barred him from coming for the same time. Elsewhere, a teacher in Kentucky who had traveled to Kenya resigned rather than submit to a three-week ban from her school, even though she was 3,000 miles away from anyone with Ebola.
Separation of individuals—proven, presumed, or potentially contagious—has been a common response to reduce the spread of disease for centuries. During the epidemics of the Middle Ages, one of which killed 25 percent of the European population, no microbial science yet existed that could identify agents of causation, define incubation periods, or discern modes of transmission. Is it clothes? Skin? Water? An odor in the air? Isolating individuals for 40 days, a quarantina of time, was based less on fact and more on the religious significance of 40 days in Judeo-Christian theology as a time of cleansing and purification.
In the Middle Ages, when so little was known about contagious disease, coupled with high likelihood of death, uninformed fear contributed to whole towns being forcibly walled off. Though the rich could often fled to safer climates, the poor carried the heaviest burden of disease, and were often blamed for its spread because of their “unclean” habits. “Plague doctors” were usually young physicians and surgeons with no established practices of their own. Forced to display a cross that labelled them “unclean,” they were unable to mingle with others and were distrusted by the population.
The current Ebola crisis is the most recent iteration of contagious disease, following SARS in 2003 and swine flu in 2009. It is uncanny how the same themes return as we deal with the largest outbreak of Ebola since it first emerged in 1976. Facing the fear of fatal disease, it is not surprising that our base reactions remain the same. But each time our collective souls are bared by these moments of vulnerability, we have the opportunity to respond with truth and compassion. What are we doing with what we know—which is quite a bit, thanks to the understanding of current science—combined with a significant truth about life revealed to us by God?
For whoever wants to save his life will lose it, but whoever loses his life for me will find it. What good will it be for a man if he gains the whole world, yet forfeits his soul? Or what can a man give in exchange for his soul? (Matt. 16:25)
Let me offer three considerations.
Recognize the danger (but at the appropriate level). Ebola is a highly dangerous disease. Although it is not as easily spread as viruses airborne or in food and water, it only requires minimal contact—unlike HIV, which needs intimate contact—and remains alive in body fluids and on inanimate surfaces for a significant period of time. It is also highly virulent, with death rates averaging 70 percent. Though there is no cure, supportive care does increase survival rates. We know its incubation period does not exceed 21 days, and we know people are contagious only when they are symptomatic—and mostly when they have many symptoms, not just a small fever.
So what does this mean practically? That we have ways to identify true danger, especially recognizing that those who have travelled to and from the hot zones of Africa, but do not have symptoms, are not contagious. That the risk of disease in a country like the United States is extremely small, unlike our friends living with plague in the past, and quite unlike our global neighbors living in Africa who have such limited resources for preventing spread. Though Ebola threatens our sense of invulnerability and impenetrability as a modern nation, on the range of scale of what could hurt us, we should not be running scared of it.
Reveal the lie. The basic lie is that we can reduce our risk to zero. There are numerous negative consequences of believing this lie, producing both over-confidence and paralyzing fear. And when cases arise, which they will, we are prone to a harsh and wrong application of blame. The Liberian man who died in Texas was infected in his country, likely at the time when he gave aid to a sick pregnant woman. He came to see his son graduate from high school. Though he was unaware he was ill until five days after arriving in the United States, he was demonized for being the first case of Ebola in our country and falsely accused of having hidden his condition so that he could get on the plane.
Someone who responds compassionately to the pains and perils of another, and dies for his actions, would normally be a hero. But instead we blamed the victim, just like in the 1500s. And we likely will again, whenever we falsely believe we can separate ourselves from the dangers of life and use “quarantine” as a weapon of control, keeping everyone who might be dangerous confined to another space in another place. The approach of some would be to wall off entire countries, as if that were possible. Despite great suffering for the people there, they reason, at least it will be there and not here—and after a defined number of deaths, surely no more than the populations of these countries, the epidemic will end. Until the next one! But then what kind of people will we be, alive and safe in our risk-free world?
Remember the truth. We were made for caring, but we cannot care without risk. Control comes through separation, but caring love always strives to bring back together the things separated by the efficiency of control. We strive for careful care, between not going near and assuming no risk, and directly touching and assuming great risk. Nurses and doctors in Texas struggled to express love to a dying man through their layers of protection. All followed careful protocols of prevention, yet two nurses became infected. Thankfully both have survived. Five hundred health care workers in Africa have been infected, and more than three hundred have died. Some from this country are considering going to Africa to care. They need all the protections available. So do African health care workers.
We live in a global community. Both for our own safety and for the sake of compassion, we cannot turn away from the problems of poverty and poor health in other parts of the world. If we truly want to stop Ebola here, we must fight it there. Yet after it is all done, the cost must be counted—some will be infected and some may die. May it be so very few, and may this epidemic end so very soon—but never at the cost of losing our humanity. For if we truly want to live, we must be willing to die (Matt. 16:25).