Ebola is an extremely vicious health and social threat. It has the definite potential to incapacitate or kill its victims, as documented through the large number of fatal Ebola cases in Liberia. As of today, the virus is considered to spread from person to person only through direct contact with the body fluids of a person with an active Ebola infection. The World Health Organization (WHO) and U.S. Centers for Disease Control and Prevention (CDC) are monitoring the advance of this virus every day on a worldwide basis.
At least two efforts to develop a human vaccine against Ebola currently are underway. Similarly, control procedures, such as quarantine, can be implemented when active cases are suspected or discovered. However, it is imperative that effective response planning occur now. Mental health and substance use services are essential components of that response planning.
A Potential Scenario
The following scenario is entirely hypothetical and is intended to motivate action, not to frighten anyone.
Today, one or more air travelers bring Ebola to New York City from West Africa. The CDC employs screening and quarantine procedures for these air travelers, but these procedures are not fully effective, and the virus escapes into the population of New York City through one or more people with an Ebola infection, but who were not actively ill at the time of arrival.
Within three weeks, New York City hospitals are confronted with active Ebola cases. CDC traces other people who have been in contact with these persons with active cases, and identifies several hundred people who potentially have been exposed, including some children. Shortly thereafter, New York City schools consider closing to prevent the spread of the virus, and many workers want to stop going to work to avoid potential exposure on the subway system, in their offices, and in restaurants. Essential police, fire, and infrastructure services, such as electric power and telephone, are very difficult to maintain because personnel are frightened of being exposed to Ebola in the course of their work. Help from other cities and states also is very difficult to mobilize because they too are fearful. Society, as we know it, quickly begins to become disorganized because of fear.
So how do we prevent this scenario from ever occurring? Immediate planning is necessary. A complete description of all the components that will be required for this planning is far beyond the scope of this short commentary. However, some essential steps can be outlined for mental health and substance use services.
The Field's Role