Monday, October 27, 2014

Ebola in Liberia could be different than Ebola in New Jersey

The Ebola outbreak in Western Africa has initiated panic throughout the world. Thirty-seven countries so far have implemented policies to restrict the international spread of Ebola. In the United States, governor Chris Christie has initiated additional travel restrictions implementing a mandatory quarantine of health workers returning from Liberia, Sierra Leone, and Guinea even when no symptoms are present.

Should Chris Christie be concerned about Ebola in New Jersey? In some ways New Jersey is not so different from Liberia which has already suffered 4,665 deaths according to the CDC.

New Jersey has a population of around 8.9 million people while Liberia has a population a little less than half that of 4.1 million. Both countries were established by foreigners. New Jersey was is first established by Dutch people in America while Liberia was established by Americans in Africa. Both states gained their current affiliation within 60 years ago with New Jersey entering the Union in 1787 and Liberia gaining independence in 1847. The official language of both New Jersey and Liberia is English and both governments use the dollar though one is the US Dollar and the other is the Liberian Dollar. In both states they drive on the right side of the road and the largest religious affiliation in both regions is Christianity.

I know, from this description thus far most people would find it very difficult to tell if they were in Liberia or New Jersey. Under this reasoning it seems very important for New Jersey to implement stringent rules to keep out any chance of Ebola entering its borders. However, there are some minor differences between New Jersey and Liberia that may bear mentioning.

Overall the United States is listed top 4 on the United Nation's Human Development Index while Liberia is ranked the 5th lowest in 2011 out 187 countries. Within the United States New Jersey is ranked the third most developed states. But what does this really mean?

The per capita earnings in Liberia was reported at 436 USD while in New Jersey the per capita was 54,699 USD. Thus in a year a New Jersey resident could be expected to earn more than 125 Liberians. But does this somewhat noticeable difference in earnings translate into differences in medical services?

According to the US census there was about 311 doctors per 100,000 residents of New Jersey in 2006 translating to about 27,680 medical doctors. Liberia on the other hand reported having 51 doctors in the entire country in 2006. If doctors are distributed evenly throughout both states then you are likely to find one medical doctor within every 0.31 square miles in New Jersey while in Liberia you are likely to find only one medical doctor every 811 square miles.

New Jersey residents can expect to live 80.3 years on average and struggle with different health related issues than those faced by Liberians who can only expect to live 57.4 years. In New Jersey where over-consumption presents a major concern with 60.7% of the population is overweight or obese and the chief causes of death is related to over-consumption including heart disease and diabetes. In contrast 38.5% of Liberians suffer from malnutrition with deaths caused from easily treatable diseases such as malaria, pneumonia, and diarrhea which are collectively responsible for 50% of the deaths in the country.

Overall, New Jersey is vastly more wealthy in terms of both income as well as medial expertise, New Jersey is vastly better prepared for Ebola than Liberia. Within Africa there have been over twenty outbreaks of Ebola, the majority of which have been rapidly contained despite most countries not being significantly better off than Liberia. Ebola is a reasonably well understood disease which can be rapidly controlled when appropriate steps are taken using infrastructure much worse off than that faced in New Jersey.

Despite the numerous similarities between New Jersey and Liberia, we should expect any outbreak of Ebola in New Jersey to be rapidly contained. It is unlikely that this outbreak of Ebola in Liberia will result in any significant outbreak in New Jersey or anywhere in the United States in which even our poorest areas are much better equipped than any of the countries now suffering from the outbreak.

This post thus far has been meant as a jab at the hysteria and political maneuvering that has surrounded Ebola. However, the fear of this disease is entirely appropriate if not well placed. This disease with its high mortality rate (~70%) and rapid transmission within these impoverished nations (Sierra Leone, Liberia, and Guinea) has the potential if not stopped to cause as much loss of life and suffering as the worse currently communicable diseases which plague humanity such as malaria (627,000 annual deaths) or tuberculosis (1,460,000 annual deaths).

I believe it is still possible to turn the tide of Ebola around if sufficient international aid is brought to bear in these afflicted nations. Becoming distracted with enacting useless policies which harm the ability of health care workers to travel between wealthy developed nations and West African nations not only misses the point, but actively undermines the ability of philanthropic health care workers to control this disease.


  1. "we should expect any outbreak of Ebola in New Jersey to be rapidly contained"

    Why should we expect that?

    I would expect that the average New Jersey resident can come in contact with far more people during the course of a day (e.g. office buildings, schools, malls, movie theaters, etc) and has greater mobility (planes, trains, automobiles) than the average Liberian. In other words, far more opportunity to spread the disease, confounding containment.

    1. If Liberia is anything like the other developing nations I have been in most public transportation relies upon cramming as many people into medium to large vehicles as possible. This often means direct or indirect physical contact with 10 or 20 people within 15 minutes. I have not been in NJ but I suspect that like more places in the US people tend to have a good deal of personal space. This is often not the case in developing countries.