Recent mandatory quarantine policies are unscientific–and dangerous
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