Stories about the spread of deadly diseases often, strange to say, turn on incidents that remind us of what we like about each other, and about people generally. Thomas Duncan probably got the Ebola virus when he helped to get his landlord’s pregnant nineteen-year-old daughter, Marthalene Williams, into a cab, in Monrovia, Liberia—she was ill and convulsing; she is now dead, the Times reported. Soon afterward, Duncan flew out of Monrovia, changed planes in Brussels and at Dulles, and arrived in Dallas, a city with a community of about ten thousand Liberians; he has family in America and had, according to press accounts, been waiting for a visa. He was greeted with a cookout. Six days later, Duncan went to a hospital and said that he had a fever and abdominal pain, and that he had been in Liberia. He was told that it was nothing serious and sent away. In navigating the city, he spent time with five children; he had contact, altogether, with as many as a hundred people.
Duncan’s is the first Ebola case diagnosed in the United States. There are limits to the danger, as Michael Specter has written: Ebola spreads only through contact with bodily fluids, like blood. It is not contagious when there are no symptoms, and Duncan apparently had no fever when he got on the plane. He would have been contagious in Dallas, though, raising the possibility of the first case not just spotted but contracted in the United States. (None has emerged yet.)
Because diseases spread when people interact, and the response, therefore, is to isolate patients, there is a danger that sociability itself will be seen as the opposite of health—as a hazard. There are ways this can be true; burial practices involving the cleaning of bodies are said to have contributed to the spread of Ebola in Africa. But, in a broader sense, it is isolation—abandonment—that most feeds epidemics. Mathalene Williams needed a cab to the hospital in Monrovia because no ambulance came for her. Duncan rode with her twice, because she was turned away at the hospital, both at a maternity ward and at one meant for Ebola patients, and he and her relatives had to turn around and take her home. Duncan, Williams’s brother, and her father carried her back into the house; according to the Times, the brother is now dead, too.
The hospitals trying to fight this disease in West Africa—in Liberia, Sierra Leone, and Guinea—lack the connections and resources they need. They often turn patients away because there is no room for them or caretakers. The hospitals are not fully embedded in the world health system, and that isolation kills, too. On Wednesday, the Times posted a wrenching story about a hospital in Makeni, Sierra Leone, that sounds otherworldy—not so much like a scene out of the past as from a blighted landscape after a disaster:
The hospital in Dallas is not like that. Still, when Duncan arrived at Texas Health Presbyterian Hospital, ill and with a fever, he was, at first, sent home. This happened even though he told a nurse that he had just come from West Africa, a fact that was supposed to set off a new level of scrutiny and care. Instead, as a hospital official said, it wasn’t “fully communicated throughout the full team,” and so “the full import of that information wasn’t factored into the clinical decision-making.”
“This is not West Africa,” David Lakey, the commissioner of the Texas Department of State Health Services, said at a press conference with Governor Rick Perry. “This is a very sophisticated city, a very sophisticated hospital.” People will not be dying in the streets in Dallas; the disease, again, really is hard to get. But a sense of one’s self as sophisticated can’t mean that when a sick visitor shows up at a hospital in Dallas his story isn’t heard or comprehended.
Perhaps Liberia seemed too far away to matter; it isn’t. Ebola’s presence doesn’t mean we should shut down airports or avoid Dallas, any more than the Secret Service’s failures mean that we should put the White House in a bubble. There are good and simple tools available here, like asking a man in an emergency room with a fever if he’s been to West Africa, and listening to the answer. The needs of the health workers in Africa are great, but they’re also relatively basic. Instead, this disease may spread because two people on two continents were turned away from two hospitals.
Duncan is now in a hospital, in full isolation. Four family members are subject to a legal order to stay in their homes at the Ivy Apartments, a low-rise complex in Dallas. The children are being monitored for symptoms, and are being kept out of school for twenty-one days, which is how long Ebola incubates. Their schools—two elementary, a middle, and a high school—got an extra cleaning and, according to the Dallas Morning News, will get another each evening. Some of the parents who dropped their kids off felt well informed, and some less so; but there was enough trust to keep going, for now. That sort of trust is the essential element of the best tool that public-health workers have against the spread of Ebola: contact tracing, which means asking each person who was in contact with Duncan whom he or she was in contact with, getting honest answers, and then talking to those people, too.
Part of the fear of disease is also the fear that we will ever stop helping a desperate teen-ager, or talking to the children of friends we haven’t seen in a long time. There are times when one cannot do those things recklessly: sociability can mean closing oneself in when one might infect others—to refrain from embracing. But people running apart, as if they don’t know each other, is not the answer, either. There is more than one way to be isolated, and some of them spread disease more quickly than any cab ride. Connection is still the best enemy of contagion.
