October 24, 2016

The Unfair Treatment of Ebola Workers

American health care workers contributed enormously to the successful effort to stop the Ebola epidemic in West Africa that flared up in 2014, but they were treated horrendously when they came home. The reason: Irrational fears and politicians eager to show toughness in protecting constituents led to needless quarantines on doctors, nurses and other workers, even when they had no symptoms of the disease and no chance of infecting others.

The Ebola virus does not spread easily. To become infected, a person has to come into direct contact with the bodily fluids of a highly infectious individual or a newly dead corpse, as during African burial ceremonies. Infected patients do not transmit the virus until after symptoms appear, so there is no need to confine them before then. Even so, governors in New Jersey, New York, Connecticut and other states ratcheted up the panic by imposing mandatory or virtually mandatory quarantines on people they thought were potentially exposed in West Africa.

Laura Skrip, a Yale student, in the apartment where she was quarantined after returning from Liberia in October 2014. She had not worked with Ebola patients, but state-imposed restrictions for health workers and other people often exceeded federal guidelines.Ebola Crisis Passes, but Questions on Quarantines PersistDEC. 2, 2015

A report issued by the Yale Global Health Justice Partnership and the American Civil Liberties Union last Thursday found that at least 40 people in 18 states received quarantine orders related to Ebola and were confined to their homes for up to three weeks, the maximum period in which symptoms might develop. More than 200 others entered voluntary quarantines, because they were under pressure from authorities, the report said, or wanted to avoid recriminations from the public. None of the people quarantined developed Ebola.

A nurse, Kaci Hickox, was quarantined in New Jersey in 2014 after returning from Sierra Leone. Credit Kaci Hickox
There are measures short of quarantine that can prevent the spread of the virus. Health care workers can monitor their own temperatures and report to health authorities should their temperatures start to rise. That’s what Dr. Craig Spencer did after returning to New York City from Guinea, where he had treated Ebola patients. He reported his first signs of fever and was promptly isolated and treated for Ebola at Bellevue Hospital Center. His fiancée and two friends were quarantined, but they never developed symptoms.

Public health officials can also monitor a health care worker’s temperature and symptoms by phone or by direct observation via home visits. And people’s movements can be restricted without chaining them to their homes — by letting them take solitary walks, for example, but having them avoid large gatherings and public transportation.

Instead of helping, quarantines actually made the fight against Ebola more difficult by discouraging health care workers from going to Africa. Quarantines and monitoring also needlessly strain state and local health budgets without making the public any safer than self-monitoring would.

Health experts around the world are assessing the epidemic in West Africa for clues about how to respond to the next outbreak of an infectious disease that could spread to other countries. Health officials in the United States should study our own response to the epidemic for lessons about what should — and should not — be done when the next germ threatens to hit these shores. NY Times

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