To Quarantine or Not To Quarantine?

As Nina Pham and Amber Vinson, the two nurses infected with Ebola in Dallas, TX, have been released from the hospital and declared Ebola free, attention has begun to shift from media fear mongering to more practical questions of how we stop the spread of the disease not only in the U.S. but abroad as well.

Many have leapt into action, proposing ideas and policies to prevent further infections. However, not all of these practices have been welcomed with open arms. Most controversial was recent action by Governors Andrew Cuomo (New York) and Chris Christie (New Jersey) to force healthcare workers returning from West Africa to be quarantined in a special facility for the 21 day incubation period. The debate started when nurse Kaci Hickox was placed in a mandatory quarantine for three days after returning from Sierra Leone with a slight fever. Upon testing negative for the virus and after “waging a media war against Republican Gov. Chris Christie’s 21-day quarantine policy”, Hickox was allowed to return home to Maine but was asked by state officials to remain in her house for the rest of the incubation period.1 Because she is still asymptomatic, Hickox has refused to quarantine herself and has been since seen outside her home.2

One of the statements Hickox has made regarding her refusal is “that public health officials — not politicians — should be making the policies related to Ebola and public safety.”3 This raises some interesting question: Should we enforce mandatory quarantines for those returning to the U.S. after treating Ebola patients? And who should be making the decisions related to policy? What role should the government play?

First of all, it’s unreasonable and unrealistic to expect that government and politicians would not get involved. While it’s true that public health experts should be a leading voice in policy, politicians have also been tasked with keeping the public safe and making sure that policies reflect the best interests of their constituents. The government can’t just “stay out of it” and if they did, the public would be up in arms. Second, politicians are elected to be the voice of the people and so in many way’s it’s their responsibility to relay the concerns of the public. Since 80% of people support Ebola quarantines, it makes sense that, especially in an election year, many government officials are also going to support quarantines.4

We must also consider how necessary these quarantines are. They do calm the fears of the public, but, as Kaci Hickox suggests, do they violate our civil rights? In Maine, Hickox’s state of residence, it comes down to whether the court believes there is an “actual or threatened epidemic.”5 This rings a bell as it is the same balancing question we ask ourselves when weighing public safety and an individual’s right to privacy. How much are we willing to give up to feel safer? Some would argue that the cost to Hickox of a 21 one day incubation period pales in comparison to the benefits of calming public fears and preventing the spread of Ebola. Others claim that the quarantine is false imprisonment and that Hickox was being held without justification because of her lack of symptoms.6

But here’s the flip side: Now that there is only one person in the U.S. infected with Ebola, it’s easy to turn our fears to other things and forget that this disease is still ravaging West Africa. The truth though is that these countries still need our help. According to an article for The Guardian, many West African countries, like Sierra Leone, do not have anywhere near enough resources and are scrambling to train workers and build facilities.7 And since a big part of containing the spread of Ebola is stopping it at it’s source, this lack of healthcare workers and resources is problematic. While these quarantines may help ease the fears of the American public, they are creating a disincentive for many U.S. healthcare professionals who would like to volunteer to treat patients abroad. As an article for the San Francisco Chronicle points out, many of these volunteers are unsure of what to expect when they come home – how soon they will be able to return to work and if they will be able to see their families and loved ones. The quarantines also mean that they will not immediately be able to go back to treating patients here in the U.S. These workers are required to use vacation days and many of them cannot afford to take time off for the trip and the 21 day quarantine period. Even though some institutions such as UCSF have set up programs that allows employees to donate their vacation time to coworkers going to West Africa, the precautions still create a disincentive to volunteering at a time when help is most needed.8 While public health officials and government workers are working together to determine the best solution, I don’t foresee the debate ending anytime soon.

This is all very timely as we prepare for our ninth online TechTable with the Reinventors Network. This table is titled “Reinvent Technology to Stop the Spread of Ebola” and will answer this question: How could the federal government more quickly leverage new technologies to stop Ebola? Panelists include Garrett Gruener, Executive Chairman at Nanōmix, Inc., Co-Founder of Alta Partners & Founder of Ask Jeeves, now Ask.Com and Simon Rosenberg, President & Founder of NDN & The New Policy Institute. Join us for this conversation on Thursday, November 6 at 11:00 AM PDT. You can read up on the framework here sign up to watch the roundtable live here.

UPDATE (Oct. 31, 12:05 PM PDT)

Maine judge has rejected Hickox’s quarantine allowing her to travel freely. Read more: http://www.politico.com/story/2014/10/maine-ebola-nurse-quarantine-112377.html

 

Resources
1 Sullivan, Gail. (30 October, 2014). Why Kaci Hickox May Lose a Legal Battle Against Ebola Quarantine. The Washington Post: Morning Mix. Retrieved from http://www.washingtonpost.com/news/morning-mix/wp/2014/10/30/why-kaci-hickox-may-lose-a-legal-battle-against-ebola-quarantine/
2 Sullivan.
3 Cohen, E., Holland, L. & Ellis, R. (27 October, 2014). Nurse describes Ebola quarantine ordeal: ‘I was in shock. Now I’m angry’. CNN. Retrieved from http://www.cnn.com/2014/10/26/health/new-jersey-quarantined-nurse/
4 Dutton, S. De Pinto, J., Salvanto, A. & Backus, F. (29 October, 2014). Do Americans believe there should be a quarantine to deal with Ebola? CBS News. Retrieved from http://www.cbsnews.com/news/do-americans-believe-there-should-be-a-quarantine-to-deal-with-ebola/
5 Sullivan.
6 Sullivan.
7 O’Carroll, Lisa. (31 October, 2014). Fighting Ebola in Sierra Leone: ‘The world is not safe’. The Guardian: Ebola. Retrieved from http://www.theguardian.com/world/2014/oct/30/ebola-sierra-leone-fight-who-disease-fight?CMP=EMCNEWEML6619I2
8 Allday, Eric. (29 October, 2014). Bay Area doctors join Ebola fight despite quarantine risks. San Francisco Chronicle: Health. Retrieved from http://www.sfchronicle.com/health/article/Bay-Area-doctors-join-Ebola-fight-despite-5856880.php

Featured image via Allday, Eric. (29 October, 2014). Bay Area doctors join Ebola fight despite quarantine risks. San Francisco Chronicle: Health. Retrieved from http://www.sfchronicle.com/health/article/Bay-Area-doctors-join-Ebola-fight-despite-5856880.php