This post was originally titled, “Ahhh!!! The stupid, it burns! (Ebola edition)”. I decided to retitle it to better reflect what motivates my thinking. As I noted in an earlier post, I worked for about 15 years on chemical and biological warfare defense-related projects. I wrote a number proposals for R&D funding which started off “The primary tenet of nuclear, chemical, and biological defense is contamination avoidance.” (The other two are force protection and decontamination.) Anyhow, “The primary tenet of nuclear, chemical, and biological defense is contamination avoidance.” is where I’m coming from. Spread of highly contagious and lethal diseases like Ebola don’t follow from malicious intent like a bio-warfare attack but, from a public health standpoint, there’s no difference in what constitutes an appropriate response.
MY ORIGINAL POST:
From the NY Times, Doctor in New York City Tests Positive for Ebola:
A doctor in New York City who recently returned from treating Ebola patients in Guinea tested positive for the Ebola virus Thursday, becoming the city’s first diagnosed case… Dr. Spencer had been working with Doctors Without Borders in Guinea, treating Ebola patients, before returning to New York City on Oct. 14, according to a city official.
Please explain to me why the @#$% Dr. Spencer was not put immediately into quarantine when he showed up at U.S. Customs? He was treating individuals with a highly contagious and lethal disease for chrissakes. Checking his temperature is all well and good but people infected can be asymptomatic for up to three weeks. Stupid. Stupid. Stupid. And, yes, I support denying entry to persons who have been to CDC Level 3 countries within the past 21 days. Have Customs check passports. If you’ve been in a CDC Level 3 country with the past 21 days then straight to quarantine. No discussion. No debate. Sorry for the inconvenience.
Another thought: Multidrug-resistant tuberculosis. Federal air travel restrictions for public health purposes are applied to people with TB. Granted, TB is more easily spread than Ebola during the asymptomatic phase but why not apply the same “for the good of public health” logic in assessing whether it’s appropriate for someone to travel?
Under section 361 of the Public Health Service Act (42 USC § 264), the CDC Director may apprehend, detain, examine, or conditionally release persons believed to be carrying certain communicable diseases that are specified in an executive order of the president. This list of diseases currently includes cholera, diphtheria, infectious tuberculosis, plague, smallpox, yellow fever, viral hemorrhagic fevers (Lassa, Marburg, Ebola, Crimean-Congo, South American, and others not yet isolated or named), severe acute respiratory syndrome, and influenza caused by novel or reemergent influenza viruses that are causing, or have the potential to cause, a pandemic (executive orders 13295, April 4, 2003, and 13375, April 1, 2005).
UPDATE 10/24/2014: NY, NJ Govs Issue Mandatory Quarantine for Travelers Who Treated Ebola Patients. That’s more like it.
UPDATE 10/25/2014: Doctors Without Borders says that a 21 day quarantine is unnecessary. They do however ask their volunteers not to return to work for 21 days:
“Self-quarantine is neither warranted nor recommended when a person is not displaying Ebola-like symptoms,” the organization said in a statement on Thursday.
Doctors Without Borders does ask workers not to return to work for 21 days, however, both because they need to rest and because of the risk of contracting an illness that could generate symptoms easily mistaken for Ebola.
In a statement on Friday, the group said it was still reviewing the New York and New Jersey guidelines.
Whatever their recommendation is on the NY and NJ guidelines I’ll take it seriously. In my reading over the past few weeks they come across as having as good a practical understanding of infection control as anyone out there. That said, I believe that the strongest argument in favor of a 21 day quarantine is that it’s a good risk mitigation strategy. If someone is infected and doesn’t know it then, if they’re quarantined, they won’t expose others to risk during the period where they transition from asymptomatic (and apparently not contagious) to symptomatic (and are contagious). Yes, it’s a conservative approach but I’m a firm believer in “An ounce of prevention is worth a pound of cure.”
Update on Dr. Spencer’s condition, New York Ebola Patient Enters More Serious Phase of Illness, Officials Say.
UPDATE 10/27/2014 AM:
If people put into quarantine are treated badly then it is reasonable to expect that people potentially affected will attempt to avoid it:
Ms. Hickox, who is being kept in an isolation tent with a portable toilet, but no shower or television, had not planned on speaking to the news media but changed her mind after Mr. Christie said on Saturday that she was “obviously ill” when she knew she was not.
What’s the rational basis for keeping her in an isolation tent with portable toilet and nothing else unless she has tested positive for Ebola which, apparently, she has not. Putting her in that environment without a medical basis is just being obnoxious. The purpose of putting someone in isolation is that they don’t expose anyone if and when they become contagious. Yes, I still favor quarantine but this implementation sounds really @#$%ed up.
UPDATE 10/27/2014 PM:
A sensible policy revision (emphasis mine):
Hours after New York’s governor announced a quarantine policy based on home stays, rather than confinement in a medical facility, the New Jersey Governor’s Office released a statement saying its policy is similar.
“The protocol is clear that a New Jersey resident with no symptoms, but who has come into contact with someone with Ebola, such as a health care provider, would be subject to a mandatory quarantine order and quarantined at home. Nonresidents would be transported to their homes if feasible and, if not, quarantined in New Jersey,” said spokesman Kevin Roberts. The governor’s office said this was not a change in policy.
UPDATE 10/28/2014 AM: