By Gene Beresin, MD and Steve Schlozman, MD
On Sept. 30 the first case of Ebola was diagnosed in the United States. The patient, who is currently being treated in Dallas, had recently traveled to Liberia, and was back in this country for a few days before symptoms began.
Understandably, the coverage of this news is pervasive. Although it seemed inevitable that a case in the U.S. would eventually emerge, the story still ignites a fair bit of hand-wringing among just about everyone who has learned of it.
Additionally, our country has experienced some novel infections that have ignited increased concerns in recent weeks. Enterovirus D-68 has made its way across the nation, causing severe cold-like symptoms, and, in some children with conditions such as asthma, the need for hospitalization. There’s also a potentially new contagion on the horizon that appears to cause varying degrees of muscular paralysis, and may or may not be related to Enterovirus D-68.
But, as public health officials are eager to stress, a nuanced and thoughtful approach to these issues has been as necessary as it has been fleeting. Experts agree that our medical infrastructure is well-equipped to handle even a virus as scary as Ebola, and some doctors are quick to point out that viruses like respiratory syncytial virus (RSV) and influenza are much more likely to cause harm than these new ones.
This raises a critical point:
Ebola, as scary as it is, poses a relatively minor threat to the United States; and the current cases of Enterovirus D-68 are far out-numbered by the RSV and influenza cases we experience on a yearly basis. And the currently unknown contagion that appears to cause paralysis has only happened in a very small population of kids.
So why the massive reaction in the media and among worried parents? Intellectually, at least at this point, all indications point to little danger for our children and ourselves. Why, then, do we get so frightened?
Well, let's start with this confession: We’re frightened.
We know, intellectually, that the threat is minor. But, when has intellect played a leading role in the emotionally driven process of threat assessment? And, especially with regard to infectious disease, when has anyone other than the most statistically driven scientists been able to preserve perspective? We’re not saying that we should massively worry, or even that we’ll be changing our instructions to our kids or our patients on how to behave with these new bugs dancing around.
What we’re saying is that germs, especially new germs, are scary. We have a long and probably evolutionarily derived tendency to fear disease, and when new ones rear their heads, we get alarmed.
Germs In Hollywood
As a society, we think about germs a lot — and nowhere, perhaps, does that play out more than in Hollywood. The 1954 novella "I am Legend" has been made into no less than three movies ("The Last Man on Earth," "The Omega Man" and the more recent movie of the same title as the written work). You can rattle off other movies as well — there’s "Dawn of the Dead" (in 1978 and again in 2004), "Outbreak," "Carriers," "Contagion," "The Crazies" (in 1973 and again in 2010),
"Quarantine" (and "Quarantine 2") and most recently "World War Z." You get the picture.
Movies are a double-edged sword in these circumstances. We need stories to displace our fears so that we can better grapple with our darkest concerns. But these stories also provided fertile ground for our imaginations when real diseases emerge. In fact, sometimes the tail seems to be wagging the hysterical dog; the news coverage begins to look a lot like the movies themselves.
And, this all stems from our biggest fear of all: our kids getting hurt.
When Steve had his first child, he asked his Aunt Mary when he could stop worrying.
“You don’t,” she said, smiling. “Not ever.”
In that sense, we’re writing this post as much for ourselves as for our readers. We need to break down what happens when threats emerge with such frightening and dramatic imagery.
Social scientists have defined mass hysteria in different ways, and to that end, it would not be proper to refer to the current concerns as actual hysterical reactions. However, many of our current responses to the recent news of these diseases bear all the hallmarks of classic mass hysteria. Most important is the cognitive process of catastrophic thinking. This describes the over-reaction that we all seem prone to engage in despite our ability to know better. Catastrophic thinking is, in fact, a defense against the worst possible scenario. None of us want to be caught unprepared should things really, however unlikely, go south.
Gene vividly remembers the polio epidemic in 1952. From then through the late ‘50s he was not allowed to go swimming in friends’ pools. It’s not as if kids didn’t go swimming in the 1950s; it’s just that Gene’s uncle had polio with subsequent paralysis of his legs. While he actually overcame his challenges and managed to become a physician, Gene’s parents knew about the many thousands who had become paralyzed or even died from the disease. They just wanted to protect him — and before the advent of chlorine, they were probably doing the right and rational thing. Still, to this day, the concerns about polio and its ravages scare the daylights out of Gene.
Importantly, Gene finds himself scared despite the fact that he “knows” better.
In fact, Gene has to actively remind himself that soon after this parents’ prohibition against swimming, we had the famous Salk vaccine, followed by the Sabin oral vaccine. In short order, polio was largely eliminated from the United States and much of the world in less than a decade.
So, how do we respond to current events and still not succumb to the Doomsday Preppers’ messages on reality television? As parents, how do we talk with our kids about the dangers of infectious disease, and Ebola in particular?
Tips for Parents:
1. Take care of your own reactions first. This means to get the most accurate information you can about Ebola, and to not react with irrational fears. We know:
• Ebola is not very contagious. It is, in fact, hard to “catch” Ebola. The chances of you or your children becoming infected are slim.
• It is only transmitted via close contact with bodily fluids from an infected individual.
Your information and reaction will clearly have a powerful effect and impact on your children. So, it’s really important to remain positive and take stock of your emotional tendencies (remember that anxiety is “contagious” and that even the youngest of children can pick up on it). If you stay calm, your kids will in all likelihood feel reassured.
2. What can you say to your children? Think developmentally. Younger school-age kids should hear things differently than adolescents. They need to know:
• That they are safe, and that those taking care of them are safe.
• That our healthcare system is among the best in the world, and we have a means of taking care of both kids and families.
• That Ebola is rare, and does not exist everywhere. When cases are found, the person with the infection is taken to a safe place to be cared for so that he or she can get better and not make anyone else sick.
• That doctors and researchers are working hard to find ways to prevent or cure this illness.
• That we will teach them safe ways to keep themselves free from disease. We’ll remind them to wash their hands, to avoid sharing food with others, and to engage in good personal hygiene. This is not just about Ebola, after all, but also about how to stay healthy and help those around them to stay healthy.
It’s a good idea to restrict young kids from media and news stories about Ebola. You can decide what information you want to share, but remember that kids think what they see on TV is happening outside their doors. Help them to understand where, in fact, these stories are taking place.
Adolescents, on the other hand, need to know the facts, but may want to ask additional questions and engage in conversations. Look for them to be curious about:
• What caused the problem, and will it continue? Teens need to know that most infectious diseases are studied thoroughly, and that the means of transmission, prevention, and treatment are being examined carefully and diligently.
• Whether this will affect the rest of their lives. We have seen many epidemics over the course of history, and have made incredible progress — even when answers were not at first known. Talk about diseases such as smallpox, the plague, HIV/AIDS, and polio.
Then, let your teens drive the conversation. If they ask questions that you don’t know the answers to, seek them together by going to reputable sources such as the CDC.
For kids who are especially anxious, limit media exposure, particularly media that sensationalizes stories about Ebola and illness. Some may not fare well watching horror films, particularly those involving contamination. Certainly a zombie film is far different than an Ebola outbreak, but it’s not terribly difficult for anxious teens to make the leap from World War Z to the current Ebola outbreak. If they do make this connection, carefully remind them of the clear differences.
Keep Calm, Carry On
Most importantly, our children rely on us to remain calm. This means that it is incumbent on us to remain well-informed and willing to talk with our children in developmentally appropriate ways. This is, of course, no different than the job of any parent. It’s just that in this case, we have to keep our own irrational fears in check.
The authors wish to thank Stephen Calderwood, MD, Chief of the Division of Infectious Disease at Massachusetts General Hospital, and Mark Pasternack, MD, Chief of the Pediatric Infectious Disease Program at the Massachusetts General Hospital for Children for their invaluable review of and editorial suggestions for this blog.
Dr. Gene Beresin is executive director of The MGH Clay Center for Young Healthy Minds and professor of psychiatry at Harvard Medical School. Dr. Steve Schlozman is associate director of The Clay Center, and co-director of medical student education in psychiatry at Harvard Medical School.