October 2014
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Ebola, Honesty and Competence

by Jonathan Wallace jw@bway.net

I can make no prediction whether Ebola is a very big threat or will prove a flash in the pan like SARS ten years ago. But the emergent situation and non-stop news coverage has me thinking rather feverishly… A significant component of civilization is a consensual hallucination of safety. In fact, more accurately, an illusion of safety is a primary psychological component of every-day life. In order to perform our daily tasks without dissolving in anxiety, we have to stop worrying, or deter our fears, or compartmentalize them somehow, or we would never be able to leave the house (of course, even inside the house, you can still worry about asteroids and earth-quakes and fatal airborne diseases). When I was in my early twenties, I woke at four a.m. to sirens and went outside to watch firefighters putting out flames in a brick building around the corner from us. I was one of twenty or thirty spectators, and afterwards thought about the phenomenon that allows us to think we are safe viewing a fire or other disaster scene from outside the human cordon created by cops and firefighters. I realized that we have a fantasy of a perimeter of safety, in many cases with our uniformed people (soldiers too) forming a cordon.

How tenuous the perimeter is I personally experienced on September 11, 2001, when the cordon of troops and intelligence agencies failed to predict or prevent the hijacked planes from crashing into the World Trade Center and the Pentagon. As a result, 300 firefighters, thirty cops and eight EMT’s, our local uniformed perimeter, died (and thousands of civilians). Running away, I paused on the Brooklyn Bridge abutment and briefly considered going back in to try to help other people. At that moment, I was imagining that there would be a cordon of safety around the towers, and that I could work just outside it. I decided not to, principally because I couldn’t get a cell phone signal to tell my wife I was all right. I am aware of some other stories of people who made that same analysis, went back in and died, including volunteer ambulance people and a doctor. I am certain none of them went in expecting to die; they simply assumed a perimeter of safety would exist that never really did, and then the buildings cascaded down right across the line they had imagined.

Ebola is a similar instance of the tenuousness, the fictionality, of the barrier. In a world constantly in motion, with seven billion people each behaving like an ocean water molecule, the idea of keeping out Ebola victims by closing down air travel is rather absurd. So we resort to telling each other it can’t happen here, won’t come here, that it isn’t really that contagious because not airborne. Having worked on New York City ambulances in the 911 system for some years after 9/11, I can tell you that “airborne” is as “airborne” does. Droplets of blood, saliva, sweat, vomit and feces, even microscopic ones, fly through the air with perfect ease. Saying that Ebola is not “airborne” simply means that it doesn’t form spores or particles which can float on a breeze. That’s fine, but it doesn’t really mean that you couldn’t get splashed by droplets on the subway or in Times Square (and possibly not even know it). As in EMT, I once took AIDS medication for a week waiting for slow test results to come back on a stabbing victim. I had taken a splash of something, I wasn’t sure what, while doing CPR. All the recent talk about “protocols” is nonsense. After the authorities blamed the first two nurses who were infected in Western hospitals, I was glad the Texas nurses spoke up indignantly to tell us there weren’t any protocols. Whenever we carried MRSA patients on my ambulance, we knew we were supposed to wear the crinkly facemasks and paper gowns. We did with a sense of absurdity because a splash of any large amount of liquid would have torn through, or gotten around, either. The gowns didn’t cover our legs or shoes and the masks covered only our lower face. The “protocols” seemed to be of semiotic significance only, preserving the appearance of knowledge, integrity and compliance while providing no real world protection.

Long after I retired from ambulances, I had my own mysterious MRSA infection; unless it had incubated for five years, I have no idea how or from whom I got it. The protocols said I needed to be isolated and that anyone attending me wear mask and gown. Even after the ER doctor said, “Its probably MRSA”, I continued to lie for hours on a gurney in a public hallway, dripping from a large, inadequately bandaged wound. Once I was admitted, I was not isolated--I shared a room--nor did anyone take any precautions when visiting me. And I was discharged after four days, while the protocols say I should have been hospitalized until no longer infectious, about three weeks. But seriously, who could have afforded to keep me that long? Insurance wasn’t going to pay for it. Instead, I was told to self-quarantine, like a lot of those exposed to Ebola today. MRSA is in some ways an Ebola-like disease--it chews you up like the virus--which has killed hundreds of thousands of people worldwide without much press or attention, probably in large part because it kills mainly older people and the immune-system-challenged. The hospital is in fact a great place to get MRSA.

Regardless of how fast or far Ebola spreads-- the TImes yesterday reported a prediction that there will be ten thousand new cases a week by December, but of course the vast bulk of these in Africa--there are some lessons to be be learned about honesty and competence. I imagine a sort of honesty/competence grid or chart. In the lower left are instances of low-competence low honesty societies, and the high-competence high-honesty societies are in the upper right.My question for you is, how did the U.S. get to be in the lower left hand corner? To pick just two important and fatal events from recent history, the Iraq invasion and Hurricane Katrina, we messed up and then lied about it. Our delusive conditions of victory appear to be, not actually winning wars or saving lives, but hanging banners saying “Mission Accomplished” or telling Brownie he’s doing a heck of a job. Entire books have been written on this topic, but elevating rhetoric over realities and reassurance over truth is what puts you in the lowest possible quadrant of the grid. Late stage capitalism also plays a role, in which marketing is more important than quality, and human life--consumers, employees, the general public--is far less important than anything. I was very pleased that the nurses blamed the impact of the profit motive on the American health care system for the fact that there are no protocols, that nobody really cares if they live or die. Protocols cost money, and moon-suits even more.

“Do the best you can, and be truthful about it” is a pretty good guide to life. There is no doubt in my mind we can do better-- the hospital I had my MRSA in, which is a pretty good one, should have isolated me and protected its people better. But we can also stop lying to ourselves, and to others. For most of human history, people knew how tenuous the barriers were, and lived in awareness, strength and readiness. One of the threshold questions, in the analysis of whether this is a democracy we live in or not, is the extent to which our leaders tell us the truth even when the truth is grim--about war, climate change, pollution, disease, energy. I remember an extraordinary moment in the training we EMT’s received in how to administer injections against nerve gas. “If there is an attack,” the instructor told us-- not just that one, I heard it a few times--”the first three hundred of you to respond, will die.” That was frightening, but strangely bracing, because it was nice not to be lied to for once.