If you go by media coverage and public sentiment, the most important public-health problem in the United States right now is Ebola. Though the virus has infected only two people here, a recent poll found that forty per cent of Americans see Ebola as a “major or moderate threat” to public health, as Michael Specter points out in this week’s Comment. Meanwhile, over the past month, another infectious disease, Enterovirus D68, has made its way into the headlines. The virus causes respiratory problems, often severe, in children, and, in rare cases, kids infected with the virus have come down with muscle paralysis (it’s still not known whether the virus is actually causing the paralysis). So far, almost six hundred children, in forty-five states, have been infected by the virus, and though most have recovered quickly, five have died. Anxiety among parents has grown so much that some now wonder if we’ve been worrying too much about Ebola, and not enough about enterovirus.
In reality, we’re worrying too much about both Ebola and EV-D68, and too little about an infectious disease that is much more likely to inflict serious damage on the U.S. I’m talking, of course, about the flu. We know, based on past experience, that the upcoming flu season will kill thousands of Americans and send hundreds of thousands to the hospital. Yet the press seems relatively diffident about raising an alarm about this threat; its flu coverage has none of the high-pitched anxiety that suffuses writing about Ebola or EV-D68. EV-D68 has provoked headlines like “How Well is Sacramento Prepared for Ebola, Enterovirus Outbreak?” and “What Scares You More—Enterovirus D-68 or Ebola?” No one is asking “What Scares You More: Ebola or the Flu?”
They probably should. As we know, the flu can be deadly—according to the Centers for Disease Control and Prevention, the average annual death toll from influenza between 1976 and 2007 was more than twenty-three thousand. And unlike Ebola and EV-D68, for which there are no vaccines or real treatments, flu can almost always be prevented, or at least mitigated, if you get a flu shot. Stoking public concern about the flu could actually do some good, by encouraging people to get vaccinated. Instead, the media cover EV-D68 and Ebola as if they’re massive threats to our well-being even though they likely aren’t, and even though the average person can do little to prevent them anyway.
The reasons for this difference in coverage reveal how we think about risk and how our thinking shapes public-health outcomes. The Enterovirus isn’t new—it was first identified in 1962—but this strain is novel; we’ve never seen an outbreak of this size before (and that is, to be sure, something that should worry public-health officials). Novelty can make a problem scarier, and more newsworthy. And while Ebola has received more attention than EV-D68, the fact that the two diseases have appeared in the U.S. at the same time, and that we don’t have a vaccine for either one, has contributed to the sense that we’re being beset by new invaders. Finally, the fact that EV-D-68 affects children almost exclusively makes it seem more threatening. As Daniel Levitin writes in his new book, “The Organized Mind: Thinking Straight in the Age of Information Overload,” we have a “culturally universal and innate” impulse “to protect our young, even the young of those not related to us.”
The flu, by contrast, is all too familiar: many of us have had it. And, while we wouldn’t want to get it again, if we’re in good health we can feel confident that we would survive it. The fact that past flu crises (such as swine flu in the nineteen-seventies, or H1N1 in 2009) turned out to be less devastating than experts predicted has made us skeptical about flu-related warnings. The fact that most flu fatalities are adults (in particular, the elderly) somehow makes the disease less alarming, even though it’s almost certain that more children will die of the flu this year than of EV-D68. Paradoxically, knowing that we have good ways to combat the flu makes us less concerned about the damage it does. You might think it newsworthy that, even though we have an easily accessible flu shot, the disease still sends hundreds of thousands of people to the hospital and, in some years, tens of thousands of people to the morgue. Instead, we consider flu fatalities to be one of those unfortunate facts of life.
At work here is the curiously divergent and inconsistent way most of us think about risk. As a myriad of studies have shown, we tend to underestimate the risk of common perils and overestimate the risk of novel events. We fret about dying in a terrorist attack or a plane crash, but don’t spend much time worrying about dying in a car accident. We pay more attention to the danger of Ebola than to the far more relevant danger of flu, or of obesity or heart disease. It’s as if, in certain circumstances, the more frequently something kills, the less anxiety-producing we find it. We know that more than thirty thousand people are going to die on our roads this year, and we’ve accommodated ourselves to this number because it’s about the same every year. Control, too, matters: most of us think that whether we’re killed in a car accident or die of heart disease is under our control (as, to some degree, it is). As a result, we fear such outcomes less than those that can strike us out of the blue.
These attitudes toward risk are irrational, but they’re also understandable. The real problem is that irrational fears often shape public behavior and public policy. They lead us to over-invest in theatre (such as airport screenings for Ebola) and to neglect simple solutions (such as getting a flu shot). If Americans learned that we were facing the outbreak of a new disease that was going to do what the flu will do in the next few months, the press would be banging the drums about vaccination. Instead, it’s yesterday’s news.
