Applying the lessons of Ebola to the COVID-19 pandemic

The world’s second-largest Ebola outbreak has ended. The outbreak started in 2018, infected at least 3,470 people in the Democratic Republic of the Congo (DRC), killed 2,243 of them and was the first to be battled with vaccines.

The COVID-19 pandemic has currently infected over 2.6 million Americans and killed more than 127,000 of them. Potential vaccines are being developed at rapid speed. But even once they arrive there are important lessons to be learned from the DRC for the fight against COVID-19 in the United States.

At this point in history, Ebola is not a new disease. There is a general understanding of the practices needed to control an outbreak, including early detection, surveillance, contact tracing, isolation and best practices for caring for infected individuals and burying the dead. The Ebola outbreak saw a rapid buildup of public health capacity to fight the disease, which is now available to fight other outbreaks. Conversely, COVID-19 is a novel disease, and we are learning more about it as the pandemic continues.

For both humanitarian reasons and as a form of self-protection, the United States should invest both domestically and overseas in public health infrastructure and capacity to take effective measures against infectious disease. The goal of these investments is to rapidly detect and contain outbreaks while they are still overseas, and to be prepared for potential pandemics. The repeated nature of outbreaks like Ebola or COVID-19 in global hotspots suggests that we can expect more potential epidemics and pandemics in the future. These efforts would look a lot like the PREDICT program, which was recently extended, or the recently ended NIH grant focused on researching coronavirus in bats. The return on these investments could reduce damages significantly. 

The effectiveness of preemptive investments depends upon community trust and engagement. This is understandably limited in locations like the North Kivu and Ituri provinces of the DRC, which have been or currently are host to armed conflict. Citizens’ lack of faith that the government has their interests in mind made fighting Ebola more complicated and likely prolonged the outbreak. People in low- and middle-income countries face a tradeoff between their livelihood and fighting an outbreak with limited savings. They may fear that any data they provide will be used against their interests or for nefarious purposes. Investments that are made before an outbreak provide the opportunity to build support before outbreaks by providing regular medical services and other outreach efforts. Absent and sometimes in spite of these relationships, we’ve seen the tragedy of armed attacks on health care workers that disrupted efforts to treat infected individuals.

A parallel can be drawn in the United States, where conspiracy theorists are peddling misinformation via social media during the current pandemic. Among other theories, conspiracists suggest that the COVID-19 pandemic was planned by philanthropic organizations or the Chinese government, or that wearing masks to reduce transmission is a part of a government conspiracy. This disinformation finds fertile fields on social media with people who are skeptical of public health officials. Belief in these theories may cause people not to social distance, providing a reservoir population for COVID-19 to spread. Asymptomatic or pre-symptomatic people who refuse to wear masks silently spread the disease. Arguments that downplay the severity of the pandemic discourage the very efforts that can mitigate its tremendous economic cost. Given the obvious benefit, efforts to ensure accurate, timely and true information should be bipartisan and non-controversial.

Political polarization and misinformation spread by President Trump has caused the United States to struggle in its battle against COVID-19. There is frequently conflicting messages about the effectiveness or importance of social distancing, wearing masks or restrictions on businesses to protect public health. Governors respond to political pressure when deciding to impose mask mandates or how quickly to reopen economies. A lax approach, fueled by mistrust of health experts and partisan polarization, is speeding the arrival of a second wave (or prolonging the first wave).

Additionally, over time the continual mixed messaging from officials is degrading the trust individuals have in any individual message from their government. The recent Ebola outbreaks have shown that the ability to engage in prevention and control measures depends on the public’s willingness to participate. This trust is easily lost and difficult to regain.

Additionally, if political reality necessitates relying on voluntary compliance with measures like masks, individuals need trusted and correct sources of information. Similar problems emerge when individuals place their hope in discredited or dangerous treatments. When people are faced with authorities making conflicting and competing claims, some will make the wrong decision, and the results can be catastrophic.

An additional lesson can be learned from Ebola in the DRC. While the country’s 10^th outbreak has ended, the 11^th outbreak has already begun in the Mbandaka province. It is also simultaneously battling COVID-19 and a Measles outbreak. There is no shortage of potential pandemic diseases, and the probability of a spillover event has not meaningfully changed since COVID-19 emerged in Wuhan, China. We can mitigate these risks, but only through investment in public health and efforts to build and maintain public trust.

Kevin Berry is an assistant professor of economics at the University of Alaska Anchorage. He is an author on seven peer-reviewed academic papers on prevention and infectious disease. Follow him on Twitter @kberry6788.