Written as I’m reading that some 3500 US troops are winging their way to West Africa.

Not all scourges require aggressive action. I got to thinking about this being exposed to organizations like the Cato Institute from one of my conservative acquaintances, advocating nil to minimal government intervention. The Ebola bug (EVD) exploded into our news consciousness over these last few weeks. Generally, I’ve been a staunch advocate of the CDC, waving it before my conservative friends, as a shining example of necessary government work: who else to generate standards for treatment and limiting spread of infectious disease, where would we be without the CDC, that joins the triumphs of modern medicine with the organization of government to limit suffering and saves lives, etc. I saw Chelsea Clinton, with her newly minted Oxford doctorate in healthcare policy, literally right out her delivery room, on the Fareed Zakaria show, learnedly expounding on Ebola and that got me thinking too. Then President Obama appointed Ron Klain a non-medical political operative as Ebola czar. At that point there was  no doubt even to this politically naive person, that what I had witnessed another media frenzy, the likes of which I’d mentioned in some of my previous offerings, OJ Simpson, Monica Lewinsky etc where due to hyper news coverage, the public can’t even get a glimpse of the truly true, what’s right, what we ought to do, where too much media coverage casts nearly everything into a cloud of doubt. We have everyone trying to be famous and nothing gets settled.

Add to that all the faux pas made by organizations aiming to limit the spread of this dread disease. I presume that organizations like Medicines Sans Frontieres long admired from afar, that send in courageous and knowledgable practitioners to brave dangerous conflicts and quell epidemics, disease and famine, at their own considerable  risk, act out of the deepest altruism, but what of governmental bodies and other private parties? According to an article in Online Forbes, Ebola has killed more than 200 Doctors, nurses and other healthcare workers since June, including some  16 of the staff of Medicines Sans Frontieres, which appears to be the most skillful and careful organization, and the famous instance of Dr. Sheik Umar Khan on the front lines in Sierra Leone who stayed and died treating patients. Healthcare worker deaths are a good proportion civilian deaths, nearing 5000.

Ebola is like many recent infectious diseases, highly likely, without treatment, to be lethal.  Bugs that kill all their hosts after a short illness will die out on their own. If all infected persons die in some obscure place and their bodies decompose, pretty soon they will no longer be infectious. It is true with Ebola, the disease can be spread for some time by the process of disposal of victims, but a policy of quarantine  and careful cremation or burial could well halt the spread of disease. EVD quite probably has arisen as a zoonosis (disease harbored in some unknown animal) that has caused up until now a small number of tiny point source epidemics which without anyone’s particular intervention have a better than even chance of ending on their own. Our past  is littered with huge number of probable animal centered epidemics that burnt themselves out, never having been detected by rigorous CDC  or WHO sponsored networks of epidemic detection, all for the better. It is a rule of nature that the worst rapidly fatal epidemics disease, like the hottest blue-white stars, are quickest to burn themselves out. Since we have no cures for the disease most efforts should be centered on quarantine, vigorously limiting the spread of disease.

You can ask what are the elements that smart or successful bug? The smart bug will have, “learned” to cause relatively mild, chronic disease. The model is the Herpes family of viruses that includes Epstein-Barr, CMV and others. Herpes viruses persist silently in almost everyone, causing mild, if any disease for most, except for a few with weakened immunity. A huge number of organisms, viral, bacterial and what have you, live as commensals or symbiotes, so much so that in the most instances we and the bugs have a mutually beneficial relationship in which they go on merrily reproducing inside and outside us in huge numbers (translate that as biological success story) and voila we have what is now a hot topic of discussion in scientific media, the so-called human biome. Chances are Herpes virus, E. Coli and many others have co-evolved with humans, much like our canine friends, in mutually beneficial relationships, over thousands of years. They may have started as unwelcome invaders. In the case of our microscopic symbioses this co-evolution occurs by way of a number of factors. Invading organisms in most instances cross over to us from animals in close contact. Invaders in their most virulent form, kill their host and don’t spread much and thus don’t survive, but those bugs harboring mutations that result in less virulent disease, are the ones that are more fit (better at reproduction) as parasites and become the predominat form. We humans also adapt. Those that develop immunity survive the initial disease or fail to get it at all, and those with the most aptitude for becoming immune pass that genetic trait to their children. Thus any disease entity that persists over long periods of time in human populations, has a tendency over long periods, to become less and less virulent. Overly aggressive virulent organisms will lose out.

Relatively few organisms have joined the “big leagues” the likes of smallpox,TB, Malaria, HIV. Instructively these are all organisms that have been treated by medical interventions, most newly HIV which has morphed, from being universally fatal, to a chronic illness now likely destined for a smoldering eternal coexistence with humankind. HIV has recently entered the hallowed halls of successful scourges. It might as well, left to its own devices, have become as widespread in Eurasia, and the Americas as it has become, with minimal intervention, in Africa.  In Africa HIV persists in a large percentage of population whereas in non-African wealthy countries, due to the brilliant and heroic efforts of medical scientists, the virus is relatively rare.  We cannot know whether medical interventions have helped.  Due to other societal influences such as i.v. drug use and sexual practices that accelerate the spread of HIV,  the medical interventions seem to have saved millions. Smallpox has now been eliminated entirely due to relatively old practice of vaccination. If not some pathological social and religious factors polio seemed destined for the same, in what has to be one of the proudest accomplishments of humankind, the complete eradication of a disease.

Enter modern scientific medicine which has come of age in the later twentieth century, and health care policy, along with WHO, NIH, FDA, CDC, MSF, and finally Chelsea Clinton who seems to have appeared 10 minutes ago. We have witnessed over the last few weeks an aggressively interventionist approach to a viral mini-epidemic. Scientists are more likely than politicians to learn from their mis-steps. Not all intervention has had salutary results. The latest EVD epidemic still implicates relatively small numbers of people but might have ended of itself, had there been no intervention at all. The first response was inept and seems to have caused increased spread of disease, certainly to health care workers, trying to contain it. Also in many instances had infected persons been allowed to die untreated in their own relatively isolated environment, the disease would have been prevented from spreading to others. Admittedly this is a callous assessment that involves standing by while people die, but then there might well have been a smaller number of deaths overall. It is better to bring in a few people who know what to do and not to act rashly.  Aggressive interventions by third parties and the very large number of workers professional and non professional that have entered the fray by this time could well backfire and result in massive spread of the disease. It is true some original caretakers who have survived are now immune and have served as valuable resource in caring for new cases and a source of serum for treatment. The worst outcome, is the importation of the disease to distant cities like Dallas and New York, planes, trains and cruise ships, that had nature been left to take its course should never have had to deal with the disease at all. Now all our hospitals even in the US have had to gear up and prepare for the relatively unlikely appearance of EVD. The issue of containment has been and continues to be paramount.

Everybody makes mistakes.That’s one way to learn.  We need to cast aside emotions and especially hysteria to meet each challenge with a measured rational response.  I am advocating here that our response be not always vigorously interventionist. In some cases one may smartly opt to let well enough alone.   There are many similar situations where it is better to let nature take its course.  President Obama has seen fit many times not to intervene militarily in military situations where our own interests are not clearly in focus or the threat is small, or we might hurt ourselves or cause death by overreaction. I can see that argument.  Now he seeks to send our military into an epidemic, with a medical intervention to be run by generals and politicians. This seems unprecedented,  but I wish our troops every success. Deciding when and how vigorously to act, takes finesse, admitting that sometimes in failing to act, things can get out of hand. Calibrating a measured response will be most challenging. I learned that years ago studying our own immune system which, like the brain, is a model of complex dampers and controls, yet still often acts with too much vigor. A too vigorous response might just  as well kill the host as the invader.