Faith, Fear, Reason, Science, Belief, Dogma and Infectious Disease Policies on Ebola

Faith, Fear, Reason, Science, Belief, Dogma and Infectious Disease Policies on Ebola

EVERY DAY we learn that the situation in Sierra Leone is worsening.  It’s been six weeks of large numbers of new cases of Ebola.  People who had hoped that we could see elimination are slowly realizing the sober truth: there risk of Ebola becoming endemic in the population is increasing.  This outcome would be provide a constant risk of a pandemic.

Evolution_is_RealAs an evolutionary biologist in a religious world, I recognize now, much the same as did eight months ago, an urgent need to share objective information about Ebolavirus.  I am an ardent defender of science as a way of knowing, but I do not participate in the anti-religious fervor that grips some of the atheist/agnostic community in the US.  In my view, one cannot say that they hold dear the Constitution of the United States, and eschew freedoms of religion at the same time.  The value of the expression of one’s faith is not only guaranteed by the Constitution, but it is held sacrosanct.

Reconciling science and religion is likely to be found a fruitless endeavor; as any good scientist knows, there is a demarcation between the knowable and unknowable; the testable and untestable.  Religion makes knowledge claims that cannot, and will not, ever be tested by science.  On such issues not only should science be mute; the formal logic of science provides zero information on whether any particular deity might exist.

As I studied the Ebola crisis, in performing research and interviews for the book, I became a student of humanity.  The total sum of the history of how the outbreak became an epidemic involved a convoluted and contorted mess of logic knots and inputs from every walk of life.  At the center of the epidemic, time and time again, I found humanity struggling to fill the void of ignorance about Ebola with a balance of science, reason, evidence, and rational thinking.  I also saw humanity attempt to fill in the blanks with fear, belief, emotion, and faith.   Somehow, these factors all had to interact to make public policy, and to cause people to act in specific ways consistent with shutting down the spread of the disease.  I saw people at both ends of the cognitive spectrum act in ways that reveal their dogmatic positions.  I found strength and compassion at both ends, and I found people using guilt, shame, post-hoc rationalization, and dogma to justify their position.

Public health policy decisions must be made in real time.  We have not been able to sorted out the differences among the various forms of religion over the last 4,000 years.  Policy decisions cannot wait: at times when data are lacking, they must be made with incomplete evidence.    I found that some of the public health policy statements and positions made thus far in the Ebola crisis lacking in terms of logical rigor.  I also found, time and again, zealots willing to look past the fact, for the sake of pushing a particular agenda, seemingly at all costs, sacrificing reason and science for the sake of influence over policy.  Scientists have their dogma, too.

Time and againthat I witnessed dangerous ignorance amplified by incorrect public statements about the nature of the virus, I found religious dogma at the center, making things worse.  People in some countries in Western Africa are not even taught the germ theory of disease: they had to be educated by the “Ebola is Real” campaign.  Many times, their minds would fill in the blanks where existing knowledge could be very helpful to their own survival – and helpful in shutting down the spread of Ebola – with superstitious beliefs and theories of curses and witchcraft.  Today, we learned that the WHO may have delayed putting out the call for emergency help with the outbreak out of concern over appearing hostile to Muslims wishing to make their pilgrimage to Mecca in October.

At the height of the epidemic,  government officials in the US dogmatically chastised the press for asking about the likely of Ebola being “airborne”.  The book explores the issue of this question in some detail.  The logic of the statements that “there is no evidence that Ebola is airborne”, and whether it is good idea to rely on the absence of evidence, is given a thorough treatment. While “airborne” may be a misnomer, it’s really a matter of size.  The American Academy of Pediatrics recommends against the use of baby powder because of the risk of respiratory problems.  Talcum powder, at ten microns, is known to cause respiratory distress in some babies.  Ebola, at 970 nm (0.97 microns)  is ten times smaller.  One-hundred thirteen ebola viruses could be lined up, end to end, on the thin edge of a dollar bill.  Ebola is smaller than most other infectious agents that are known to be airborne; in fact, it is smaller that the flu virus.  Some have chastised others for daring the ask questions about transmission modes, and have resorted to ad hominum attacks.  It is never irrational to ask objective questions in science; it is, however, irrational to draw scientific conclusions in the absences of evidence.

Eventually, enough people died to convince most in Western Africa that Ebola is Real.  There are hold-outs; they certainly fear the truth.  But the stench of the decaying bodies and the thousands of orphans are no substitute for scientific knowledge.  Informing populations in areas where education is rare and ignorance reigns supreme, when done in a reactionary manner, is ineffective.  Ironically, progress could not be made in Guinea until the Imams were given the task of educating the faithful. The Imams’ positions in society as leaders, not their specific roles, made them key players in helping to bend the curve.  Sociologists and cultural anthropologists could have told us that.

I use the book to advocate for education about biological health risks between outbreaks.  And, I will practice what I preach. Along with copies of my book, I will be sending used textbooks on Evolution and related topics to three public libraries: one in Sierra Leone, Guinea, and one in Liberia.

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Why Sierra Leone is Raging with Ebola Again

Why Sierra Leone is Raging with Ebola Again

IN THE LONG RUN, THE ONLY THING THAT REALLY MATTERS in countries with Ebola circulating in the population is shutting down transmission.  After a continuous drop in the number of new cases per week since November 2014, we have now witnessed, for the past six weeks, a rate of spread that exceeds that of a majority of previous outbreaks.

In January 2015, Sierra Leone eased travel restrictions, and In February 2015, Liberia lifted the curfew, and re-opened its borders to Sierra Leone.  According to experts, people are becoming complacent.  Unsafe burials are being resumed.  People are letting their guard down.  Cultural norms like handshaking and hugging are more commonplace.  Instead of heading to Ebola Treatment Units for isolated health care, people are heading to regular hospitals.

There are hotspots to the east and west of Freetown in Sierra Leone.  Unfortunately, the practice of sick people hiding, and cultural misunderstandings on the nature of the illness, including belief that the disease symptoms are a result of a curse or a demon, continues to allow the virus to spread.  This renewed wave came from fisherman returning from the sea, and sharing a community toilet.  They had initially sought aid from traditional healers.

Sierra Leone has over 12,000 orphans from the epidemic.  Throughout West Africa, the CDC moved into a new phase of contact tracing as their primary mode of defense.  The UK had declined involvement of the US Army, and it is uncertain as to whether formal restrictions such as curfews and cordoned off “Ebola Resilient Capacity Zones”, which when isolated could be designated “Ebola Free Zones”.   This tactic has proven successful in other outbreaks such as the H1N5 influenza outbreaks in Egypt, Indonesia and Vietnam: it’s just easier to manage smaller, isolated geographic sections.  You can read more about this approach, and how policy decisions influence transmission risks in “Ebola: An Evolving Story” (World Press, 2015).

Hopefully the international community with step up their response and involvement.  Canada ceased their recruitment of new health care workers to help in Sierra Leone in early March.

With the uptick in cases, US pharmaceutical companies testing vaccines and treatments may have larger numbers of patients to enroll in their ongoing clinical trials.