Co-author: Steve Schlozman, MD
On September 30 the first case of Ebola was diagnosed in the United States. The patient, currently being treated in Dallas, had recently visited Liberia and had been back in our country for a few days before symptoms began.
Understandably, the coverage if this news was pervasive. Although it seemed inevitable that a case in the United States would eventually emerge, the story still ignited a fair bit of hand wringing among just about everyone who heard the story.
Additionally, in the United States there have been some novel infections that have ignited increased concerns in recent weeks. Enterovirus-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 at this point may or may not be related to Enterovirus-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 a virus even as scary as Ebola, and some doctors are quick to point out that viruses like Respiratory Syntital Virus (RSV) and influenza are much more likely to cause greater harm, as these viruses do every year (http://www.nbcnews.com/health/cold-flu/afraid-ev-d68-another-deadly-viru... )
This of course begs an important question. If Ebola, as scary as it is, poses a relatively minor threat to the United States, and if the current cases of Enterovirus-68 have not had a single fatality, and if the current unknown contagion that appears to be causing paralysis has only happened in a very small population of kids, then why the massive reaction in both news and among worried parents? Intellectually, at least at this point, all indications are that there is little danger to our children and to ourselves. Why, then, do we get so frightened?
Well, let's start with this confession.
We know, intellectually, that the threat is minor. But since when has intellect played a leading role in the emotionally driven process of threat assessment? And especially with regard to infectious diseases, since when has anyone other than the most statistically driven scientists been able to preserve perspective? We’re not saying we should massively worry, or even that we will change our instructions to our kids or to our patients with regard to 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 a bit shaken up.
We know that we as a society think about germs a lot. Hollywood especially knows we think about germs a lot. 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 the other movies as well. There’s Dawn of the Dead (in 19878 and then again 2004), Outbreak, Carriers, Contagion, The Crazies (in 1973 and again in 2010), Quarantine, Quarantine 2, and most recently World War Z.
Movies are a double-edged sword in these circumstances. We need stories to put our fears into displacement 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 starts to look like the movies themselves.
And this is all because of our biggest fear of all.
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 recent news with regard to these new diseases bare all the hallmarks of classical 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 worse possible scenario. None of us wants to be caught unprepared should things really, however unlikely, go south.
Gene vividly remembers the polio epidemic in 1952. From then through the late 1950s he was not allowed to go swimming in friends’ pools. It is not as if kids didn’t go swimming in the ‘50’s. It’s just that Gene’s uncle had polio with subsequent paralysis of his legs. While his uncle overcame his challenges and actually became a physician, Gene’s parents knew about the many thousands who had been 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, in less than a decade polio was largely eliminated from the United States and around most of the world.
What does this tell us?
We’ve seen many horrible epidemics and we’ve seen miraculous efforts towards prevention – from vaccines, to anti-viral medications, to sound and careful approaches towards treating and diminishing spread of infection. We have seen, especially in our country among others, effective ways of treating patients in isolation and preventing spread of infection.
But how do we respond to these events, and still not succumb to the Doomsday Prepper’s 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 get the most accurate information you can about Ebola, and do 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 by close contact with bodily fluids of an infected individual
• Your information and reaction clearly will have a powerful effect and impact on your child
• So it is really important to stay positive and take note of your emotional reactions (remember that anxiety is “catching” and even the youngest kids pick up on it). If you stay calm, the likelihood is that your kids will feel reassured.
2. What can you say to your children?
• First, think developmentally.
• Younger school-age kids should hear things differently than adolescents. They need to know:
o That they are safe and those taking care of them are safe
o That their parents are similarly safe
o That our healthcare system is among the best in the world and we have the means to take care of both kids and families.
o That Ebola is rare, and is not 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 that no one can become infected.
o That doctors and researchers are working hard to find ways to prevent or cure this illness.
o That we will teach you about safe ways to keep yourself free of disease, and these are things that are familiar and not hard to do. We will remind you to wash your 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 how to help those around you to stay healthy.
o That it is 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 need to know these facts, but may have additional questions and conversations. Look for them to be curious about:
o What caused the problem, and will this continue? Teens need to know that most infectious diseases are studied thoroughly and that the means of transmission, prevention and treatment are being examined very carefully and diligently.
o Whether this will affect the rest of their lives. We have been through many epidemics over the course of history, and have made incredible progress, even when the 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:
o Let them ask questions, and if you do not know the answers. seek them together, by going online to reputable sources, such as the CDC
o 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 is not terribly difficult for anxious teen 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.
As parents, we are always concerned about the wellbeing of our kids. And when it comes to infectious diseases, particularly if it appears at first that there is little we can do, the knee jerk reaction may well be unbridled fear.
But, we’re not doing ourselves or out patients any favors if all we feel is terrified. We need to keep in mind that this is not the first contagion threat we’ve encountered, nor will it be the last. At the end of the day, medical advances and sound public education have been impressively effective in containing these illnesses.
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 from the job of any parent. It’s just that we have to keep our own irrational fears in check.
The authors wish to thank Stephen Calderwood, MD, Chief, Division of Infectious Disease, Massachusetts General Hospital, and Mark Pasternack, Chief of the Pediatric Infectious Disease Program, the Massachusetts General Hospital for Children for their invaluable review of and editorial suggestions for this blog.
This blog first appeared in CommonHealth.org and is also posted on the MGH Clay Center for Young Healthy Minds www.mghclaycenter.org