“The governors’ action is like driving a carpet tack with a sledgehammer: it gets the job done but overall is more destructive than beneficial,” the editors of the influential New England Journal of Medicine wrote in a commentary.
“This approach, however, is not scientifically based, is unfair and unwise, and will impede essential efforts to stop these awful outbreaks of Ebola diseases at their source, which is the only satisfactory goal,” they wrote.
VIDEO: Mandatory Quarantine of Ebola Workers Going Too Far? Nightly News
From the Infectious Diseases Society of America to the director of the National Institutes of Allergy and Infectious Diseases, there was an unusual degree of solidarity against the idea of keeping people at home for three weeks if they aren’t sick.
New Jersey Governor Chris Christie has pushed back hard. “You can’t take chances on this stuff and allow people who may in fact be contagious to travel,” he said. Christie has been under fire for his state’s decision to forcibly quarantine 33-year-old nurse Kaci Hickox, who railed very publicly .. http://www.nbcnews.com/storyline/ebola-virus-outbreak/new-jersey-releases-nurse-quarantined-suspected-ebola-n234661 .. from an isolation tent inside a New Jersey hospital complex, where she was held after her return Friday from volunteering with Doctors Without Borders in Sierra Leone.
There are four main arguments against simply making all recent travelers stay home for 21 days.
The fever gives you a chance to act
“We now know that fever precedes the contagious stage,” Dr. Jeffrey Drazen and fellow editors of the New England Journal of Medicine wrote in their editorial. The fever gives a traveler a chance to seek isolation and help, they argued.
“What happens as someone begins to become ill with Ebola, they develop an increase in symptoms,” Centers for Disease Control and Prevention director Dr. Thomas Frieden agreed. “Early on, tests such as a blood test may be negative because there is such a tiny quantity of virus in their body.” So even as Dr. Craig Spencer .. http://www.nbcnews.com/storyline/ebola-virus-outbreak/who-new-york-ebola-patient-craig-spencer-n232961 .. traveled around New York City, there was almost no chance of his spreading virus. The real risk comes as people get very ill. “It is not as if someone is going to be completely healthy one moment and the next moment emanating huge quantities of virus,” Frieden said.
No symptoms equals no risk
“When there are no symptoms, there is no risk,” said Dr. Daniel Diekema, an infectious disease specialist at the University of Iowa and president of the Society for Healthcare Epidemiology of America, a medical association for experts in infection control and prevention.
“The science is very clear that catching Ebola requires direct contact with someone who is ill. We have not seen any spread that is from contact with someone who is not ill,” Frieden said.
“This point is supported by the fact that of the nurses caring for Eric Duncan, the man who died from Ebola virus disease in Texas in October, only those who cared for him at the end of his life, when the number of virions (particles of virus) he was shedding was likely to be very high, became infected,” Drazen and colleagues added.
In years of studying Ebola in Africa, it’s been shown time and time again that the people who became infected were directly caring for very sick people or handling their bodies – including their corpses. Even people sharing homes and meals with patients often did not become ill.
VIDEO: Christie on Quarantine: 'We Are Not Going to Take Any Risk' NBC News
Draconian measures don’t control spread
“The reasons to do it have largely been political and to control the fear and perception of risk,” Diekema said. An international team of researchers including Alessandro Vespignani of Boston’s Northeastern University made a computer model showing that trying to block travelers form Ebola-affected countries would be futile. “Traffic reductions are shown to delay by only a few weeks the risk that the outbreak extends to new countries,” they wrote in the journal Eurosurveillance.
“The downsides are real and include the reluctance of health care workers to provide care for Ebola victims, not just primarily in the outbreak zone, which needs help, but also to volunteer in our hospitals to be part of the team to care for domestic patients,” Diekema argued.
“If we add barriers making it harder for volunteers to return to their community, we are hurting ourselves,” Drazen’s team wrote.
And it means people won’t be able or willing to go fight Ebola at its source – in turn, putting the world at even more risk as the virus spreads. “The risk of being quarantined for 21 days upon completion of their work has already prompted some people to reduce their length of time in the field. Others will be less inclined to volunteer in the first place,” said Sophie Delaunay, executive director of Medecins Sans Frontieres (Doctors without Borders) USA. “This will present significant operational disruptions at the field level for MSF and other organizations, and lead to an overall shortage of desperately needed health workers, precisely when the Ebola outbreak is as out of control as ever.”
First published October 28th 2014, 11:00 am
Maggie Fox is senior health writer for NBCNews.com and TODAY.com, writing top news on health policy,... Expand Bio
A cleaning crew wearing personal protective equipment clean the apartment of a US doctor returning from west Africa. Photograph: Eduardo Munoz/Reuters
Quarantine measures imposed on travellers to the US from Ebola-affected countries who have had contact with the disease could discourage health workers from going there to fight the epidemic, a medical official has warned .
“I don’t want to be directly criticising the decision that was made, but we have to be careful that there are unintended consequences,” Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases, said of the measures imposed by four US states: New York, New Jersey, Illinois and Florida.
“The best way to stop this epidemic is to help the people in west Africa. We do that by sending people over there, not only from the USA, but from other places,” Fauci told NBC’s Meet the Press, adding that such quarantines were “a little bit draconian”.
In Australia, an 18-year-old woman who arrived in Brisbane from Guinea was isolated after she showed signs of fever. She was taken to the Royal Brisbane and Women’s hospital. She arrived in Australia 11 days ago with eight members of her extended family, all of whom were placed under home quarantine. A first test result was negative, but she is expected to undergo a second test on Wednesday.
Meanwhile, Samantha Power, the US ambassador to the United Nations, arrived in Guinea’s capital, Conakry, on Sunday, and plans also to visit Liberia and Sierra Leone to see the global response to the Ebola epidemic first hand.
Florida joined three other US states on Sunday in imposing a 21-day mandatory quarantine period for anyone arriving with a risk of having contracted Ebola in Sierra Leone, Liberia or Guinea. They are the three west African countries that have borne the brunt of an epidemic that has killed nearly 5,000 people. The policies were abruptly imposed after a New York City doctor was diagnosed with the disease on Thursday following his return home from Guinea, where he had been treating patients.
A nurse, Kaci Hickox, who returned on Friday through New Jersey’s Newark airport, after working in Sierra Leone with Ebola patients, strongly criticised the quarantine policy on Saturday, describing hours of questioning and then transfer to a hospital isolation tent. She called her treatment a “frenzy of disorganisation”. She said on Sunday she planned to mount a legal challenge to the quarantine order.
Fauci reiterated that the disease is spread only by contact with body fluids of people with symptoms. Four cases of the disease have been diagnosed so far in the US.
“The science tells us that people who are not sick, if you do not come into contact with body fluid, if someone comes back from wherever, Liberia, and they’re well, they are no danger to anyone,” Fauci said.
But New Jersey’s governor, Chris Christie, asked to respond to Fauci’s comment that it is not good science to quarantine people when they are not symptomatic, said: “I don’t believe that when you’re dealing with something as serious as this that we can count on a voluntary system.”
“This is government’s job. If anything else, the government’s job is to protect the safety and health of our citizens,” he told the Fox News Sunday programme.
Asked whether the new rules would discourage health workers from going to west Africa, Christie added: “Folks that are willing to take that step and willing to volunteer also understand that it’s in their interest and in the public health’s interest to have a 21-day period thereafter if they’ve been directly exposed to people with the virus.”
Ebola has killed almost half of more than 10,000 people diagnosed with the disease – predominantly in Liberia, Sierra Leone and Guinea – although the true toll is far higher, according to the World Health Organisation.
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