A new video game uses an epidemic model with a complex and realistic set of variables to simulate the spread and severity of a plague. Available as an app from iTunes, it has been dowloaded 25 million times. Now, with Ebola, Plague Inc., as it is called, appears to have morphed from virtual into actual reality.
"I will say that in the thirty years I've been working in public health, the only thing like this has been AIDS, and we have to work now so that this is not the world's next AIDS." After they showed Dr. Thomas Frieden, former NYC Dept of Health Commissioner (2002-2009) and now Director of CDC, making this statement on the evening news, my life partner Arnie and I just looked at each other. Clearly, the spread of Ebola is already a public health catastrophe. Meanwhile, too much of what we're still hearing from public health officials is weak reassurances and advice to stay calm.
It put into relief my own advisories to the gay community to try to stay calm and avoid panic in the earliest period of AIDS. Though panic is never a good thing, I was wrong then to be so cautious, and the health care officials who keep telling us to keep calm now are similarly wrong. With AIDS, only Larry Kramer somehow gleaned the true measure of what was happening, and the alarm he raised pulled out all the stops. CDC quickly called the emerging epidemic "the most important new public health problem in the U.S."
Simultaneously, however, CDC AIDS Task Force reps balked on issuing stronger advisories. In the absence of certainty of the cause of the epidemic, and to avoid political and civil liberties confrontations and panic, they retreated from more substantial leadership. Alas, too many of us in the gay community took our lead from CDC. The resulting excessive caution and inadequacy in issuing tougher guidelines based on probabilities, like the sluggishness of the New York Times in giving the epidemic priority coverage, is well-documented in Randy Shilts's And The Band Played On as well as in Kramer's own The Normal Heart and Reports from the holocaust.
So what's to be done for Ebloa? Airports have begun screening international passengers for fevers. That's like the advice we were giving early on for what was later identified as HIV and AIDS, to limit the number of different sexual partners and try to make sure those partners were healthy. Vastly inadequate. Consider the case of Ebola patient Thomas Eric Duncan, who traveled to the U.S. from Liberia to Texas and is now dead. He would not have been detected either in Africa or the U.S. because he was not exhibiting fever or any other signs of the virus when traveling here.
U.S. public health officials shy away from infringements of civil liberties and rightly so. I'm certainly glad they never did what Cuba did to contain HIV/AIDS -- put gays into camps. Civil liberties concerns are extremely important, but they do not always supersede much bigger life-and-death concerns. When and where quarantine needs to be implemented for Ebola, it must not be evaded but must be transparent and to the greatest extent possible implemented with the participation, cooperation and support of the individuals and communities involved. We keep getting reassurances that if the procedures that are currently in place are stringently followed, containment will be secured. Yet that security appears evermore fragile and elusive. As UN Deputy Ebola Coordinator Anthony Banbury admitted, "We need to [contain Ebola] within 60 days from 1 October. If we reach [this target], then we can turn this epidemic around ... We either stop Ebola now or we face an entirely unprecedented situation for which we do not have a plan."
Drug and vaccine trials are happening but not aggressively enough. As with AIDS, all experimental approaches in the pipeline need to be financed and expedited the way they were in the heyday of ACT UP's responses to the spread of AIDS. Crucially, medical activists need to find out what drugs and vaccines are in various stages of research and testing, and then put pressure on the FDA and drug companies to finance and speed their development.
AIDS activists sensed that gays were considered an expendable population, alongside drug addicts and (later) African nationals, and that the resulting indifference and silence from governments and society were tantamount to genocide. It isn't a big stretch to see that same history repeating itself when it comes to the black populations most affected by Ebola. The Ebola outbreak in West Africa is "unquestionably the most severe acute public health emergency in modern times," Dr. Margaret Chan, the director general of the World Health Organization, said. "When a deadly and dreaded virus hits the destitute and spirals out of control, the whole world is put at risk ... The rich get the best care. The poor are left to die."
For the moment, one can only hope that these statements of candor from Drs. Frieden, Chan and Banbury will set the stage for subsequent responses. While we may not need an "Ebola czar" per se, remember how hugely important Surgeon General C. Everett Koop's voice was as the AIDS crisis unfolded? At present, however, the U.S. has no Surgeon General. The president's candidate, Dr. Vivek Murthy, has been stalemated by Republicans not only because he was selected by Obama and was a supporter of Obamacare but because he supports gun control. So as we face a plague that could spread with the scale and devastation of AIDS, Congress is once again playing partisan and petty politics. The NRA's defense of its mass-murderous policies has now taken a quantum leap in its interference with the nation's health, from being accessory to the unnecessary deaths of thousands to potentially much greater numbers.
Lawrence D. Mass, M.D. wrote the first press reports in 1981 on the epidemic that later became known as AIDS. He is a co-founder of Gay Men's Health Crisis and the author/editor of We Must Love One Another Or Die: The Life and Legacies of Larry Kramer.