Ebola’s media outbreak: lessons for the future Free

On 8 August 2014, the World Health Organization (WHO’s) Emergency Committee declared the Ebola virus disease (EVD or ‘Ebola’) outbreak a Public Health Emergency of International Concern. On 6 October 2014, the first case of EVD contracted in Europe was diagnosed.¹ A healthcare worker was infected, after providing treatment to an Ebola patient in Spain. This secondary case, like those that occurred in Dallas, tested both the responsiveness of the healthcare system, and the attitudes and skills of the population, the health professionals and the media.

Virulence and infectivity are epidemiological characteristics that define the magnitude and significance of an infectious disease. EVD virulence is evident as shown by its lethality. The number of cases this time exceeded past outbreaks suggesting people that infectivity was greater.² These factors coalesced to generate social alarm.

Unlike EVD, transmitted by direct contact with an infected patient or contaminated material, virus fear can spread in many different ways, particularly when, as in this case insufficient, inaccurate or contradictory information is disseminated. Unnecessary precautionary measures taken beyond the available evidence³ also contributed to fuelling the fear.

In Spain, the media became the main source of information about EVD, its transmission mechanisms and even about its treatment. The media took on the role of the Public Health authorities, circulating information that was sometimes alarming and inaccurate and which led to public scepticism regarding the official recommendations issued by organizations such as the Centres for Diseases Control or the WHO.

EVD international protocols and their adaptations to our institutions were presented to the public as immutable ‘tables of the law’ instead of the evidence based set of general recommendations and rules on how to act that they are. When news on protocol adaptations were published or differences between relatively close centre were highlighted, alarms were sounded, contributing to a loss of trust by the public and, even more alarmingly, among some professionals.

This EVD crisis has not been different to other public health crises in our country and in other parts of the world. The response to avian influenza or SARS, also fuelled by media pressure, resulted in a compulsive, excessive and unnecessary intervention, in an attempt to counter public fear. The media have later acknowledged these circumstances as well as the existing lack of proactive risk management by health authorities.

Although it may be argued that the Ebola cases in the USA and Europe will help raise social awareness, cooperation with African countries and funding for research to prevent future deaths, we should note that fear of infection can bring about unacceptable attitudes of rejection of contact towards low and high risk patients and can favour gratuitous treatment of healthy patients¹ or a source of political confrontation.⁴

The EVD media epidemic will pass but EVD will still require an appropriate and proportionate response based on available knowledge that we hope will continue growing. Healthcare professionals should not be panic. Local adaptation and revision of the EVD protocols is undoubtedly the correct practice. Nevertheless protocols are not self-implementing⁵ and we must not forget that the EVD protocols have singular characteristics which make them different: a rare disease in our environment, involvement of different levels of care from the public health system, interdisciplinary coordination between different health professionals and the need for protective measures which, while not new, are unfamiliar to local staff.

The alarm generated among professionals by this mediatic Ebola crisis is worthy of attention. Conventional patterns for protocol optimisation are no different for Ebola. The development and updating of protocols involves identifying aids or controls that need to be included in order to secure the procedures provided. The implementation process should take into account the human factor,⁶ the ‘hurry-up-syndrome’⁷ and the context in which the activity takes place. The interaction of these factors can be the underlying cause behind more than ¾ of all protocol implementation errors.⁸

Training health care professionals in accordance with directive 90/679/CEE on the protection of workers from risks related to exposure to biological agents at work and introducing human factor⁹ checklists designed to help professionals review those precautions, memory aids and quality control procedures that anticipate risks and errors (such as the proposal of the CDC in the USA,¹⁰ or those that have been developed for health centres and hospitals in Spain) should be the way forward.

The EVD Protocols protect professionals from risks associated to healthcare work. However, this time they have raised suspicion and doubts among professionals. The guarantee of its feasibility is a learned lesson.

Conflicts of interest: None declared.

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