Ebola: The Great Quarantine Debate
“Fear is a powerful thing, and it’s often not rational. That’s when reliance on science and fact really has to be our North Star.” – Dr. Mary Travis Bassett, New York City Health Commissioner
On Friday October 24th, against the persistent stance of health officials battling the spread of Ebola, Governors Chris Christie and Andrew Cuomo of New Jersey and New York, respectively, announced a mandatory 21-day quarantine of all health-care workers returning from the areas of West Africa hit hardest by the deadly epidemic. Predictably, these proclamations were met with immediate criticism from, among others, Doctors Without Borders, the White House, and Kaci Hickox: one very unhappy camper not at all appreciative of her involuntary role as the guinea pig for the new policy (I use the word “camper” as she was literally housed in a tent). After just two days of this negative publicity, as well as a severe undermining from both the mayor and the health commissioner of his state’s largest city, Cuomo relaxed his strict guidelines to include a home quarantine. He was soon followed by the unexpected buckling of Chris Christie’s largesse, who earlier today also announced that Hickox would be transported to her home in Maine.
These drastic measures, the latest apex of widespread Ebola fear, are of course the aftermath of New York’s first diagnosis of the disease last Thursday, and originate from an equally widespread misunderstanding of its infectious characteristics. Advocates of the mandatory quarantine severely overestimate the ability of the virus to spread, remaining unaware (even ignorant) of well-established facts about Ebola, such as the impossibility of a carrier to infect others during the incubation period. Ebola is only infectious when its hosts are symptomatic, beginning with a fever and becoming more and more infectious as the severity of the symptoms increase – a patient near death is when the disease is most threatening.
Politicians such as Christie, Cuomo, as well as other likeminded concerned citizens, also cite their skepticism of voluntary quarantines and the responsibility of health-care workers potentially exposed to Ebola. But while the controversial activities of Spencer and Nurse Amber Vinson from Dallas certainly raised eyebrows, officials from all major health organizations involved in combatting the virus are stressing the more responsible aspects of their behavior, such as meticulous temperature monitoring and close contact with the CDC, in addition to the asymptomatic state of their infections. ‘I think the risk is close to zero. I would even say it’s zero because none of those people had any contact with his body fluids,’ said William Schaffner, chairman of the Department of Preventive Medicine at the Vanderbilt University School of Medicine, referring to Dr. Spencer’s New York City travels. ‘I would feel no concern had I been standing next to him on the subway’
But what exactly is wrong with a mandatory quarantine? Isn’t this the most effective route in ensuring that the public is not exposed to any potential carriers of Ebola? The answer is actually much more complicated than what many have called “common sense.” Both the CDC and World Health Organization fear such a quarantine or flight restriction would greatly reduce the amount of aid workers, crucial to the containment of the disease, from traveling to West Africa, and could lead to many others lying about their travel history, rendering infected travelers far more difficult to track. Doctors Without Borders, one of the most hands-on and heroic organizations throughout this entire ordeal, has gone so far as to state: ‘Forced quarantine of asymptomatic health workers returning from fighting the Ebola outbreak in West Africa is not grounded on scientific evidence and could undermine efforts to curb the epidemic at its source.’ As the fear continues to rise in the international community, so can we also expect the frustrated tone of health workers and officials risking their lives to save the lives of others. We should remember, as scary as Ebola is, we haven’t seen it. They have. Let them handle it.