Recent mandatory quarantine policies are unscientific–and dangerous

October 28, 2014

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On Thursday, Governors Andrew Cuomo of New York and Chris Christie of New Jersey announced a mandatory 21-day quarantine for returning healthcare workers from Ebola-ravaged Guinea, Sierra Leone and Liberia. Illinois Governor Pat Quinn followed suit a day later. Other U.S. states, including Minnesota, Georgia and Connecticut, have introduced similar measures.

Kaci Hickox, a nurse and epidemiologist who had volunteered with Doctors Without Borders in Sierra Leone, was the first person quarantined under the new rules when she returned to the United States on Friday. She was held against her will until Monday afternoon at University Hospital in Newark, New Jersey.

The governors’ quarantine policies are not based on science, but fear and political opportunism.

Cuomo and Quinn, both Democrats, are up for reelection this year, and Christie is talked about as a potential Republican presidential candidate in 2016. Their “tough on Ebola” stance appears to put their political interests before those of the public’s. It also poses a risk to the health and safety of Americans — far more than returned healthcare workers do.

The best way to protect the United States against Ebola is to control the epidemic in West Africa. Washington isn’t waiting for Islamic State to attack the United States. It has taken proactive, defensive measures to address these militants in the Middle East. Similarly, the United States can’t wait for the virus to spread beyond Guinea, Sierra Leone and Liberia — as it inevitably will if Americans don’t fight Ebola at its source.

The West has to enlist more healthcare workers in this fight, but mandatory quarantines will only discourage doctors from volunteering.

I have friends now volunteering their medical services in West Africa. They are already taking steps to protect themselves against harassment and stigma on their return, whether or not they are unlucky enough to get sick. Many have taken down Facebook and Twitter accounts, so their photos won’t end up in newspapers or on television. Some are even volunteering in secret — not telling colleagues or employers where they are going or what they are doing.

Upon learning of New York state’s mandatory quarantine, a friend who had planned to volunteer with me in West Africa has now decided not to apply. She, like me, has worked on and off for years in sub-Saharan Africa. She was willing to take on the risks associated with treating Ebola patients. But she wasn’t willing to face that kind of treatment Hickox received when she returned home. After all, what kind of message does it send that New Jersey has proposed to quarantine returning healthcare workers in a former psychiatric hospital?

The mandatory quarantine is a double standard.

Doctors and nurses caring for Ebola patients in the United States are potentially at greater risk than those working in West Africa. Sophisticated medical care in this country allows us to put patients on ventilators to support their breathing and to dialyze them when their kidneys fail. Such procedures, even the simple placement of an IV, are rarely performed in West Africa — and can increase healthcare workers’ exposure to infectious bodily fluids.

Yet, there are no mandated quarantines for clinicians caring for Ebola patients in the United States.

Public health officials haven’t quarantined healthcare workers at Emory University Hospital, the National Institutes of Health, the University of Nebraska Medical Center or Bellevue Hospital. Should we quarantine Tony Fauci, the director of the National Institutes of Health, who was part of the medical team treating Nina Pham, the Dallas nurse who developed Ebola after caring for Thomas Eric Duncan?

What if you’re a healthcare worker who treats more than one Ebola patient? Must you be quarantined for 21 days each time?

The mandatory quarantines also perpetuate misconceptions about how Ebola is transmitted. It takes time after exposure for Ebola virus levels to build up in the body and produce symptoms. The virus can’t be detected in the blood until symptoms develop. That’s why someone who has been infected with Ebola can’t transmit the disease to others until they have symptoms; levels of the virus are just too low.

Craig Spencer, the New York doctor who returned from volunteer work in Guinea, did nothing wrong by riding the subway and going bowling with friends. He had no symptoms, so posed no danger to others.

Before Cuomo’s quarantine announcement, the New York City Department of Health and Mental Hygiene — which has shown itself to be a model for how to manage Ebola patients in this country — had developed a science-based strategy. The health department last week began directly monitoring people returning from West Africa by checking their temperatures twice a day and assessing them for other symptoms of Ebola.

This strategy ensures that those at risk of infection are isolated and given medical care as soon as they develop symptoms. Active monitoring strikes the right balance between protecting the public’s health and the rights of individual healthcare workers.

Legally, public health authorities are obligated to adhere to certain principles when quarantining persons for an infectious disease. Public health officials may only detain individuals when this “least restrictive means necessary” to prevent the spread of a contagious disease.

Modern technology allows us to come up with new solutions that can make quarantines — which are old-fashioned — unnecessary. We could, for example, put wireless temperature monitors and global positioning trackers (GPS) on at-risk individuals to allow for continuous or repeated remote temperature monitoring. The readings could be sent to public health officials in real-time, making sure that those being monitored receive swift medical attention if symptoms develop.

Those who have fought on the frontlines against Ebola deserve a hero’s welcome — particularly after the harrowing time they have gone through. These healthcare workers choose to be far away from family, give up their wages and risk their lives to take on a deadly disease.

For their dignity — and for America’s and the world’s health safety — they should be saluted for their efforts.

PHOTO: A New Jersey Police Department (NJPD) officer patrols inside the University Hospital where Nurse Kaci Hickox was hold in isolation for Ebola symptoms in Newark, New Jersey October 27, 2014. REUTERS/Eduardo Munoz

15 comments

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But quarantining the military for 21 day seem to be supported by everyone including Obama.
Somehow all those arguments do not apply there. Healthcare workers, despite their believes in their safety are 5% of all Ebola cases in Africa (and much worse in the US).

The only “science” behind this is CDC willing to sacrifice some number of US citizens here, in order not to discourage healthcare workers to volunteer to fight Ebola in Africa.

Posted by Yur1y | Report as abusive

This article itself is unscientific….and dangerous! She has friends that will not tell authorities where they have been? If one of her idiot friends becomes the typhoid Mary of Ebola and people die as a result of their own irresponsibility, should they put put in jail for 20 years? Yes! By the way, a small percentage of those infected with Ebola become symptomatic after 21 days and some also do not present with elevated body temperature. In addition, while her tech suggestions are interesting, are they realistically already in place? Of course not. The reason we need a quarantine is because governments screw up (example; telling US nurse with elevated temperature that it was OK to fly), hospitals do not have the systems in place (Dallas is a perfect example), people do not cooperate (that fool nurse Kaci), and human beings are imperfect. All it take is one major mistake to cause an Africa-like Ebola epidemic in other countries. Because those who volunteer are heroes, does that mean that we should lose all common sense?

Posted by Bones888 | Report as abusive

This article itself is unscientific….and dangerous! She has friends that will not tell the authorities where they have been? If one of her idiot friends becomes the typhoid Mary of Ebola and people die as a result of their own irresponsibility, should they put put in jail for 20 years? Yes! By the way, a small percentage of those infected with Ebola become symptomatic after 21 days and some also do not present with elevated body temperature. In addition, while her tech suggestions are interesting, are they realistically already in place? Of course not. The reason we need a quarantine is because governments screw up (example; telling US nurse with elevated temperature that it was OK to fly), hospitals do not have the systems in place (Dallas is a perfect example), people do not cooperate (that fool nurse Kaci), and human beings are imperfect. All it take is one major mistake to cause an Africa-like Ebola epidemic in other countries. Because those who volunteer are heroes, does that mean that we should lose all common sense?

Posted by Bones888 | Report as abusive

sorry if this is submitted more than once as website is messed up.

This article itself is unscientific….and dangerous! She has friends that will not tell authorities where they have been? If one of her idiot friends becomes the typhoid Mary of Ebola and people die as a result of their own irresponsibility, should they put put in jail for 20 years? Yes! By the way, a small percentage of those infected with Ebola become symptomatic after 21 days and some also do not present with elevated body temperature. In addition, while her tech suggestions are interesting, are they realistically already in place? Of course not. The reason we need a quarantine is because governments screw up (example; telling US nurse with elevated temperature that it was OK to fly), hospitals do not have the systems in place (Dallas is a perfect example), people do not cooperate (that fool nurse Kaci), and human beings are imperfect. All it take is one major mistake to cause an Africa-like Ebola epidemic in other countries. Because those who volunteer are heroes, does that mean that we should lose all common sense?

Posted by Bones888 | Report as abusive

The best way to handle ebola is to end the epidemic in west Africa and to not bring it here to the US. The message being put out is that this disease is difficult to catch, and yet the New York doctor, described by his co workers as meticulous, got infected despite all precautions. His story and the stories of others who have contracted the disease despite using full bio gear tend to sow doubt that all is known about the transmission of this disease. Out of an abundance of precaution, a quarantine makes sense. The people who are volunteering should be encouraged, as they are risking their health and possibly their lives to care for ebola victims, but part of their “nobility” should be for them to make every effort to prevent this disease from being established here.

Posted by zotdoc | Report as abusive

Dr. Spencer, described by his co workers as meticulous, somehow managed to catch ebola despite full protective measures. If we know all about ebola then why can’t we devise a way to prevent health care workers from acquiring the infection? I applaud The noble people who are going over to Africa to fight the disease, but they should be noble enough to take all measures, including quarantine, to prevent the spread of this virus to the US. I think it was insulting to put the nurse in a tent in new jersey as part of her quarantine, but I think she should agree to a quarantine none the less. I don’t want her taking care of my daughter until she has been disease free for at least 21 days.

Posted by zotdoc | Report as abusive

Suppose a person exposed to Ebola and refusing quarantine gets into an accident. Someone renders aid. Gets Ebola and dies. So what is the response of Obama and the the other “experts”? Oops sorry my bad!”?

The quarantives is for the safety of all. I don’t want to add a reason to watch someone die it just isn’t right.

I know there are other things to get this way but do we have to add another to guard a tempooary loss of rights for 21 days?

Posted by Jwhiskey | Report as abusive

“Should we quarantine Tony Fauci, the director of the National Institutes of Health, who was part of the medical team treating Nina Pham, the Dallas nurse who developed Ebola after caring for Thomas Eric Duncan?” Yes. Why wouldn’t we?

The hubris of the medical profession is unbelievable. If you are treating a patient who has ebola then you must consider the probability that you may contract the disease. As Yur1y pointed out, a substantial proportion of the African cases are health care workers. Two nurses here in the USA contracted the disease while caring for Duncan. It is beyond reproach that healthcare workers are subject to getting infected. Why would they not insist on being quarantined as a safety precaution and to ease the fears of the surrounding community?

It’s almost as if they think being quarantined is a disgrace. On the contrary, it should be considered another testament to the incredible service being rendered to those in need.

This is a job that shouldn’t be done halfway. Do the right thing.

Posted by aeci | Report as abusive

How can you state the quarantine regulations are unscientific? Considering the obvious gaps in knowledge regarding Ebola, your logic is flawed; seemingly based on your certainty of what is definitely uncertain. your article only proves how careless you are and you should not be allowed to volunteer help in any Ebola case anywhere. Furthermore, volunteers need to accept the fact, until world institutions have a much better understanding of the disease, a 21 day quarantine and monitoring period will be a part of the routine. Or please don’t volunteer – everyone will be better served by care workers that actually care and engage critical thinking skills.

Posted by Jjeellyy | Report as abusive

A prior post didn’t make it. I apologize if it appears later and seems repetitive.

“Public health officials haven’t quarantined healthcare workers at Emory University Hospital, the National Institutes of Health, the University of Nebraska Medical Center or Bellevue Hospital. Should we quarantine Tony Fauci, the director of the National Institutes of Health, who was part of the medical team treating Nina Pham, the Dallas nurse who developed Ebola after caring for Thomas Eric Duncan?” Yes! Why shouldn’t we?

Yur1y made a point that seems to be ignored. Healthcare workers contracting the disease is a significant statistic. Where is the ‘science’ that denies that?

The hubris of the medical community is astounding. If you are exposed to an infected individual, who is showing symptoms, you should be quarantined for 21 days. That is for your own safety and the safety of the community. If one feels a drive to volunteer service for the benefit of those infected, why wouldn’t that person feel a drive to protect those they move amongst when leaving infected areas?

Do no harm.

Do the right thing.

Or do everyone a favor and don’t go at all.

Posted by aeci | Report as abusive

If what she is saying is true, then why did she say this to Al Jazeera: WHILE THE US GOVERNMENT continues to say via press releases that Ebola is not “airborne”, Dr. Celine Gounder MD speaking live on CNN this afternoon tells America a slightly different – if more chilling – story:

“If I sneezed on you Anna and I had Ebola that could potentially transmit – exactly.”

As the CDC continues to calm the public, military men trained in biowarfare know that what Dr. Gounder is saying is the exact truth. Those who survive this disease have the potential to become infectious carriers.

We need facts, not people that want to get notoriety…..http://tinyurl.com/qxdbozu

Posted by Ruabean2 | Report as abusive

Have Gounder explain this, a study of Ebola published in August 2014….http://www.sciencemag.org/content/ 345/6202/1369.long

At the bottom of the scientific abstract is this notation:
n memoriam: Tragically, five co-authors, who contributed greatly to public health and research efforts in Sierra Leone, contracted EVD and lost their battle with the disease before this manuscript could be published: Mohamed Fullah, Mbalu Fonnie, Alex Moigboi, Alice Kovoma, and S. Humarr Khan. We wish to honor their memory.

These are not stupid, careless people…..

Posted by Ruabean2 | Report as abusive

The hypocrisy of our US government on this Ebola matter is unbelievable. Quarantine ALL military personnel who return from these areas for 21 days even though they have had NO personal contact with Ebola patients, but let the people who have had close personal contact run around freely in public.

Does that make sense to anyone? Dr. Spencer had NO symptoms for about 7 days after returning from Africa and is now in the gastrointestinal stage of Ebola. The CDC changes its protocols and guidelines almost daily, as new information comes to light regarding Ebola. In any case, “an ounce of prevention is worth a pound of cure”!!!!

Posted by AZreb | Report as abusive

Agreed!!!

As for the military – they didn’t volunteer – and they are getting paid during their 21 day slumber –

Better policy – self reporting of temperature for 21 days. Once a fever shows up – go to a pre-arranged hospital unit. No public transit for 21 days – planes, busses etc…

Posted by michaelryan | Report as abusive

The protocols and guidelines of the CDC have changed regularly since day one, so how can we trust them? ANYONE who has had close personal contact with an Ebola patient is a likely candidate for the disease. ANYONE like Hickox who puts their personal agenda ahead of the health of others is a selfish, downright egotistic little twit with no care or concern for others.

Dr. Spencer was not symptomatic for 6-7 days after his return from Africa. He had the sense to report a low-grade fever and was immediately hospitalized. Could we depend on Hickox and others of her mindset to report immediately? Only if they felt like it. After all, she might not want a hospital stay.

Posted by AZreb | Report as abusive