SH is a freelance Senior Editor for and All

SH is a freelance Senior Editor for and . All other authors declare no competing interests.
In 1950, Merrill Flood and Melvin Dresher of the RAND Corporation developed a theoretical model of cooperation and conflict, which was later formalised by Albert W Tucker as the prisoner\'s dilemma. This model represents a situation in which two prisoners each have the option to confess or not, but their sentencing outcomes depend crucially on the simultaneous choice of the other (). Fittingly, it has become the paradigmatic example of individual versus group rationality and is an often used heuristic when conveying introductory social Ro 31-8220 methanesulfonate cost to students. Although not a homologous predicament, the Ebola virus disease suspect also faces a consequential dilemma (). The ‘rational’—that is, not informed by superstition or baseless rumour—aversion to West Africa\'s ill-equipped and poorly sanitised hospitals was described even before the 2014–16 Ebola outbreak. This characterisation could a fortiori be extended to those Ebola virus disease suspects who eschewed presentation to an Ebola treatment unit, especially those units that offered little in the way of aggressive intravenous resuscitation or management of electrolyte disturbances. Consider the situation in which you are an Ebola virus disease suspect (you have fever, vomiting, muscle pain, and headache), but don\'t know whether you have Ebola virus disease: (1) if you have undiagnosed malaria and stay at home, your chance of dying is 0·2%; (2) if you have undiagnosed malaria and go to an Ebola treatment unit, your chance of dying from Ebola virus disease is 16·1% (around 25% chance of nosocomial Ebola virus transmission with 64·3% mortality); or (3) if you have Ebola virus disease, stay at home, and self-isolate, your chance of dying is 70·8%. Given equal chances of having malaria (West Africa is the region with the world\'s highest incidence of malaria) or Ebola virus disease, your overall mortality risk for staying at home is 35·5% versus 40·2% for going to a Ebola treatment unit. Thus, you would be acting in your rational self-interest by staying at home, since the suspect who is uninfected might become so nosocomially through ambulance transport with actual cases or unsafe triage at an Ebola treatment unit—not factoring in (1) rational desires to die at home rather than in (or in the queue in front of) a far off tent; (2) rational fears that you might never see your family again; (3) rational responses to the pervasive messaging that Ebola has no cure; or (4) the irony that, once admitted to an Ebola treatment unit that does not offer intravenous volume replacement, a rational decision might be to deliberately infect yourself with malaria: emerging evidence suggests that parasitemia offers a greater survival benefit than the oral rehydration approach used at many Ebola treatment units in 2014. And therein lies the Ebola suspect\'s dilemma—at least according to the rational choice lens that refracts the world around us into binary options for our moral retinas. Now consider a Special Report by the WHO Ebola Response Team. In it, the authors rightly—if not tautologically—suggest that shortening the delay to isolation of Ebola virus disease suspects would lead to quicker overall outbreak containment, yet they fail to adequately discuss the reality that suspects will continue to be “unwilling to seek medical care,” when such care is non-existent. Indeed, our extensive interviews with survivors of Ebola virus disease and their families reveal—among a variety of reasons for Ebola treatment unit avoidance early in the outbreak—the common suggestion that international non-governmental organisations in future epidemics not be allowed to set up Ebola treatment units if they do not provide intravenous resuscitation as standard of care. Conversely, if Ebola suspects maximise their chances of survival (by staying at home in the case above), they risk—according to the methodological individualist framing of a multitude of after action reports—being dubbed “superspreaders” (or rather “vectors” if they actively flee admission to an Ebola treatment unit). Such terminology perniciously diverts us from structural determinants of Ebola virus transmission by positing bounded individuals and their unconstrained, calculating agency—or its contralateral blinder, fear-related behaviour (a term originally applied to lab rats)—as the engines of transmission, and potentially engenders stigmatisation towards patients with Ebola virus disease, including posthumously. We find the descriptor, personal protective equipment (PPE)-bereft care-nexus, more appropriate, both anthropologically and philosophically. It highlights the fact that Ebola virus disease is a caregivers\' disease that thrives in underdeveloped and historically plundered regions, and that the use of terms such as superspreader or vector factitiously implicates marginalised individuals as sources of outbreaks, instead of lending analytical weight to how social forces (ie, the complex fields of power in which we are all nodes) become embodied as pathology.