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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Ebola: An Evolving Story (World Scientific)

Ebola: An Evolving Story (World Scientific)

Today, Liberia announced that it has released what appears to be their last EVD patient, a 58-year old teacher named Beatrice Yardolo.  This is a good sign, no, a great sign if it’s true… but that’s the catch.  The question now of Ebola is whether it will become endemic in the human population in West Africa.  I personally don’t think it will become part of the normal daily existence, but it is a virus.  It does evolve.  Right now the task is to track down all of the contacts via contact tracing.  That, along with the ending the practice of bring suspected cases to hospitals, seems to have helped turn the tide. For now.  Upticks in the number of new cases per week in Sierra Leone are troubliing.

Today I also received an updated look at the cover of the book from World.  It’s been less two months since I contacted World Scientific, and they have been doing all they can do to get the copy editing done as fast as possible.   The number of new cases per week peaked in September 2014 (at least we hope that’s the is highest we’ll see with this outbreak).  Let’s hope that they trend down again and stay down for 4-5 weeks more.

Naturally, I have mixed feelings about the book.  I wrote it because of the confusing mess of information in the press, in the testimony on the hill, mixed messages from experts.  The need for a clear, logical analysis was clear to me (and to many of my colleagues), and, thankfully to World Scientific.  They were the second publisher I approached with the book concept.  My editor replied with a simple “Yes, we will publish your book”.  World Scientific has been excellent to work with.

The mixed feelings come from my seemingly eternal position in life of dealing with the pain of loss due to death.  Every page of the book was written with the lost in mind, and their surviving loved ones, especially the orphaned children.  No one should have to try to make it in life without their own mom and dad.  Hopefully my colleagues will see the deep compassion and respect for everyone involved I felt for all involved, including the public, the scientists, the policy makers, and the politicians, whom I hope will digest and take to heart one of the messages of Ebola: that fear is not always a bad thing, sometimes it is necessary, and, odds are, it exists because it helped our ancestors survive in the face of danger.  It is important to keep in mind the difference between decisions made from fear expressed in an overly reactionary, emotional manner out of fear “which some call terror”, and decisions made from fear based on rational knowledge of the high risks of injury and death, which some call “respect”.

I’m fairly happy with the book as a window for the general public to see into the world of science and public health policy.  As confusing as the initial reaction to the outbreak and epidemic was, It seems to have provided a springboard of sorts into a new area of analysis of how we do research, how medicine is practiced, and how policy is (or, frequently) is not based on the most solid and best results of science.   Even before I finished Ebola, I found a new book forming on the side on the relationships between research, medical practice and public policy.  World is mulling over the second book.  I’ve completed a few chapters, but they will have to wait.  I have some galley proofs to review, and I have to get back to them on the cover.

Thinking of Liberia today, a boost in morale.

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