Originally posted October 21, 2014 on the Huffington Post
As most know by now, the response in the U.S. to Ebola has been mixed at best. On the one hand, the infectious disease has not spread uncontrollably. Despite serious snafus, the health system is learning how to manage the disease. On the other hand, the health system should have known from the very beginning that it was dealing with a disease and a situation that demanded a true systems understanding and appropriate response. The appointment of an “Ebola Tsar” is a belated acknowledgement of the fact that Ebola must be managed systemically or it cannot be managed at all.
Let me address briefly some of the many systems factors.
First, of all, without exception, all crises are due in large part to the fact that a series of key assumptions that we have been taking as fundamentally true prove to be completely invalid, if not outright false. But more than this, virtually all of the key assumptions on which we depend collapse all at once and in their entirety. Most of us can live with the collapse of one or two of our basic assumptions, but few can still function when our entire belief systems collapse. This is precisely why crises are so devastating.
Thus, a basic taken-for-granted assumption was given that hospitals essentially know how to contain infectious disease that originate within their immediate boundaries, they would be equally good at containing severe infectious diseases that not only originate from outside, but from afar. Obviously this was not the case.
Another key assumption was that encasing humans in state-of-the-art astronaut-like protective gear from head to toe was more than adequate in protecting aid workers from catching and spreading the disease. That is, current protective gear and procedures were more than satisfactory. As we now know, protection has had to be revised so that it has become even more stringent. Even more parts of the human body have had to be encased.
Next, there was the assumption that government agencies were not only sufficiently well-coordinated and would thus work together, but that they knew how to present the message that Ebola was a serious health threat, but that there were no reasons to panic. In other words, how do we “scare people enough to get their attention, but not enough to cause wide-spread disruption and panic?” The international airline industry has seen the result in lost revenues as people are afraid to fly.
The international transportation system is of course a big part of the problem, and as such, the disease. How indeed are passengers to be monitored and induced to report that they may have been exposed to dangerous viruses? Threatening to embargo all flights from West African countries is not only simple-minded, but actually is counterproductive. It just induces people to enter the U.S. by other less monitored means, and by doing so, just adds to the danger. But then, fear is never wholly rational.
A truly systemic approach to Ebola and the next inevitable animal to human transmitted disease would start by listing as much as is humanly possible the key assumptions upon which we are basing our recognition of the disease and our efforts at controlling, better yet coping, with it. But even more, a truly systemic approach would recognize that the various assumptions are interdependent, not independent. They affect one another in ways that we are struggling to understand.