Ebola: Quarantines Are For Public Safety
Some states recently instituted 21-day quarantines for healthcare workers returning from Ebola virus-stricken countries. I believe this decision is prudent. After the New York physician, Dr. Craig Spencer, self-quarantined and was subsequently diagnosed with the virus, it became apparent that his measures were inadequate. Because of his incomplete self-quarantine, a cab driver and his fiancée are now also quarantined, but hopefully not infected.
Ebola infection has a high death rate, otherwise this discussion would be ludicrous. But instituting quarantines for workers who have had close contact, despite being "properly" protected, is a judicious public safety maneuver.
That the White House and the ACLU have now put pressure (see excerpted quotes below) on the governors of the states of New Jersey and New York is a testament to just how poorly understood this issue remains.
In my opinion, a 21-day in-home quarantine, for workers or people who have had documented close contact with Ebola sufferers, is not too much to ask to ensure the public safety.
I hope that politics will not overcome good science and reasonable and temporary restrictions on behavior.
Excerpts from the AMA Daily Email below:
Cuomo, Christie revise Ebola quarantine rules introduced late last week.
After receiving harsh criticism for strict mandatory quarantines, the Governors of New York and New Jersey qualified their policies on Sunday night. The New York Times (10/27, A1, Flegenheimer, Shear, Barbaro, Subscription Publication) reports that on Sunday night, New York Gov. Andrew Cuomo, “facing fierce resistance from the White House and medical experts,” announced that “people quarantined in New York who do not show symptoms...would be allowed to remain at home and would receive compensation for lost income.” According to the Times, “The announcement...seemed intended to draw a sharp contrast...to the policy’s implementation in New Jersey.”
Shortly after Cuomo’s announcement, the Wall Street Journal (10/27, Dawsey, Orden, Gay, Subscription Publication) reports that New Jersey Gov. Chris Christie also announced that quarantines could be done at home, saying this was always the plan.
In a front-page article, the Wall Street Journal (10/27, A1, Nelson, West, McKay, Subscription Publication) reports that Cuomo claimed that he had received no pressure from the White House to revise the quarantine rules he imposed last week and emphasized that New York’s precautions still go beyond what Federal officials have deemed appropriate. Cuomo is quoted as saying, “My personal practice is to err on the side of caution.”
The AP (10/27, Eltman) notes that on Sunday night, Cuomo, who “had criticized Dr. Craig Spencer” last week “for not obeying a 21-day voluntary quarantine,” referred to medical workers in West Africa as “heroes” and “encourage[d] more medical workers to volunteer to fight Ebola.”
The Washington Post (10/27, Kang) reports that earlier on Sunday, Christie and Cuomo “defended their policies, saying the potential threat was too great to leave to self-monitoring by returning aid workers.” On Fox News Sunday (10/26, Wallace), Christie said, “I don’t believe when you’re dealing with something as serious as this that we can count on a voluntary system.” Politico (10/26, Gass) noted that Christie predicted that the precautions he has put in place “will become a national policy sooner rather than later.”
On ABC World News (10/26, story 2, 1:00, Vega), Dr. Richard Besser, ABC News’s Chief Health and Medical editor, said he is opposed to mandatory quarantines, but predicted “the middle ground is coming this week.” According to Besser, “They are moving away from self-monitoring of fever and now every healthcare worker who returns will be monitored by a health department.”
The Wall Street Journal (10/27, West, Subscription Publication), the Los Angeles Times (10/27, Susman), Bloomberg News (10/27, Deprez, Klopott), the AP (10/27, Eltman), the AP (10/27, Eltman), Reuters (10/27, Wulfhorst, Mcgurty), Fox News (10/27), CNN (10/26), and the AP(10/27), cover the story.
White House developing guidelines for returning healthcare workers. On ABC World News (10/26, lead story, 3:00, Vega), correspondent Linsey Davis reported that the White House “is sharing its concerns with the Governors and working on guidelines for healthcare workers returning from Africa.” The Daily Caller (10/26, Hunter) reports that President Obama convened a meeting to discuss national guidelines on returning healthcare workers from West Africa on Sunday. Twenty-four people attended, including Ebola Response Coordinator Ron Klain and Secretary of Health and Human Services Sylvia Burwell, as well as Vice President Joe Biden and CDC Director Thomas Frieden remotely.
The Los Angeles Times (10/27, Serrano) reports that an anonymous “senior official” said the Administration “was working on new guidelines for returning healthcare workers.” The Hill (10/27, Balluck) adds that President Obama said of the guidelines, they “must recognize that healthcare workers are an indispensable element of our effort to lead the international community to contain and ultimately end this outbreak at its source, and should be crafted so as not to unnecessarily discourage those workers from serving.”
Bloomberg News (10/25, Gilblom, Klopott, Chappatta) reports that Fauci said of the guidelines, “That is something that is right now under very active discussion, and you’ll be hearing shortly about what the guidelines will be.”
FDA fast-tracks Ebola diagnostic platform. The Wall Street Journal (10/25, Burton, Subscription Publication) reports that the Food and Drug Administration on Saturday declared it would allow two new tests for Ebola that promise to halve the time in which the disease can be detected in possible patients from four hours down to two. Both tests are manufactured by the company BioFire Defense, one is for hospital use and one for lab use. The FDA used its public health emergency power to issue an emergency use authorization. The company announced the news in a press release (10/27).
The Salt Lake (UT) Tribune (10/27) reports that 300 hospitals in the United States already use BioFire’s system for identifying other diseases. The Tribune explains how the system works in greater detail: “In about an hour, the polymerase chain reaction, or PCR, diagnostic tool can analyze human blood, saliva or other bodily fluid at the molecular level, find genetic markers for various diseases and post the result on a laptop computer.”
Ebola infections surpass 10,000. The AP (10/26, Dilorenzo) reports that the World Health Organization warned that the figures “are likely an underestimate...as many people in the hardest hit countries have been unable or too frightened to seek medical care.” Reuters (10/25, Nebehay) noted that the death toll from these reported cases of Ebola has reached 4,922.
“All but 27 of the infections and all but three of the deaths” were in Guinea, Liberia, and Sierra Leone, the New York Times (10/26, Cumming-Bruce, Subscription Publication) reports, noting that one of the deaths was that of a 2-year-old child in Mali Friday, leading to the isolation of “43 people, including 10 health care workers.” Authorities have warned that the child was symptomatic “when he rode hundreds of miles by public bus,” presenting “multiple opportunities for exposures — including high-risk exposures — involving many people.”
Reuters (10/25, Diarra, Diagana) reports that Mauritanian officials said Saturday that the country has closed its border with Mali over concern about the case.
The CBS Evening News (10/25, 5:43 p.m. EDT) reported that in rural Liberia, mandatory cremation practices are “being met with strong resistance,” as it runs contrary to “ancient burial traditions which involves touching and washing the dead,” making it difficult to contain the outbreak in rural areas.
The Los Angeles Times (10/25, Dixon) noted that, in addition to unsafe burial practices, “the WHO has expressed concern that cases in Liberia are being underreported, which would mean that people are resisting treatment and keeping sick people at home.” Liberia reported its highest number of Ebola casualties for a month this past week.