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Ebola in the US: A Single Case Should Not Distract Us from the True Crisis in West Africa

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The author wrote this post in collaboration with Lawrence O. Gostin, Faculty Director, O’Neill Institute for National and Global Health Law.

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On September 30, 2014, the Centers for Disease Control and Prevention (CDC) announced the first diagnosis of Ebola made in the United States (previous US cases were medical evacuees, who were already known to be infected). The patient, Thomas Eric Duncan, had traveled from Monrovia, Liberia to Dallas, TX to visit family.
On Mr. Duncan’s first visit to a hospital emergency room, he was advised to return home after being diagnosed with a “low-grade, common viral disease”—despite informing a nurse of his recent presence in West Africa. After two symptomatic (and thus contagious) days in public, he returned to the emergency room after his symptoms worsened. Here, finally, the hospital recognized his possible Ebola infection and isolated him. It seems likely that his infection was contracted while helping transport an Ebola-infected woman in Liberia to and from a hospital.
CDC has sent a team to Dallas to assist in containment efforts. Mr. Duncan is currently believed to have come into direct contact with between 12 and 18 people, including schoolchildren and first responders who assisted Mr. Duncan. Another 60 to 70 are being monitored out of an abundance of caution (many, for instance, came into contact with Mr. Duncan’s family or had only passing contact with the patient). Direct contacts are being quarantined and closely monitored. The immediate family of Mr. Duncan has been legally compelled to stay at home and submit to regular blood tests until the conclusion of the virus’s 21-day incubation period. While a few additional cases in Dallas are possible, a full-blown outbreak or spread beyond the city is highly improbable. CDC Director, Tom Frieden stated categorically, “I have no doubt that we will control this importation, or this case of Ebola, so that it does not spread widely in this country.”
Two important lessons can be learned from the first case of Ebola diagnosed in the US. First, the failure of the Dallas hospital to immediately isolate Mr. Duncan is symptomatic of critical gaps in public health preparedness. Although the symptoms of Ebola in the early stages are non-specific, a person who had recently been in West Africa should have been immediately isolated until a diagnosis of Ebola could be excluded. Had the hospital done so, the risk of spread would have been greatly diminished.
Second, this case has received extraordinary media attention. Alarmist headlines in major media outlets have been the norm. In fact, there is little cause for concern. Despite the Dallas hospital’s failure to identify the case, the hospital, Texas Health Department, and particularly the CDC, have acted admirably—according to standard protocols of case identification, contact tracing, watchfulness for symptoms among the exposed, and isolation of the infected.
Ebola is highly unlikely to gain a foothold in a strong, modern health system like that in the United States. The sad lesson, which unfortunately recurs again and again in international crises, is our failure of to focus on the real health hazard: the West African Ebola epidemic, which has been allowed to spin out of control. A single US case has generated a media firestorm, while nearly 7,200 West Africans have fallen ill, 3,330 of whom have died. And that is only the number of recorded cases; the actual toll is believed to be far higher. The media’s reaction in this case plays on a largely baseless fear. As the US deals with its single case of Ebola, we ought to focus on how best to assist the millions in West Africa for whom this fear and suffering is far more acute—and well-founded.

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