By Patrick J. Brennan
On Oct. 23, Dr. Craig Spencer, an obviously compassionate and responsible young man, recognized the onset of fever during the incubation phase since his last exposure to patients with Ebola in Guinea. He acted quickly to minimize his contact with others, reporting his illness to his sponsoring organization, Doctors without Borders. His subsequent management by New York City authorities was swift and effective.
Similarly, two nurses in Dallas closely tracked their temperatures and symptoms following Thomas Eric Duncan's death from Ebola on Oct. 8. When the fever came, they also quickly reported the onset of illness and were hospitalized and isolated.
Contrast this with the visceral and politically charged reaction of the governors of four states, including Gov. Chris Christie's shameful authorization to quarantine nurse Kaci Hickox after her return from West Africa, where she was treating Ebola patients. Rather than calming fears of contagion, the governors' actions show a reckless disregard for medical evidence and public health and inflame the discourse on the handling of Ebola.
Hickox, who is not ill, was nonetheless held in quarantine in a tent at a New Jersey hospital after her return. Last week she was released and allowed to travel to Maine, where she is again confronting quarantine orders. Accurate temperature measurements have shown that she has no fever, and laboratory tests have demonstrated that Hickox has no evidence of Ebola in her system. But her release came only after speaking out publicly against her quarantine. An unapologetic Christie stands by his decision, which means it could easily happen to others.
To order quarantines without a plan or scientific rationale leaves little question about the motivation for these actions, and they have had their desired effect. This needless quarantine did not make New Jersey a safer place. It merely thrust governors into the forefront of a public-health issue about which they appear to know little.
Should Christie's shortsighted approach become the norm, it is likely that American support for global effort to contain Ebola will be impeded. That, in turn, will slow containment and worsen the epidemic. At a time of such public concern, America doesn't need aspiring politicians setting public-health policy on the fly in defiance of science and civil rights.
Public-health law permits the incarceration of individuals who pose a threat to society through their negligence. Those who harbor transmissible illnesses may be legally quarantined when their refusal to receive treatment places others at risk.
While I was director of tuberculosis control for Philadelphia in the late 1990s, our office sought and obtained orders for the isolation of people who refused treatment, often for highly resistant strains of TB. Their willful avoidance of therapy subjected their families and others to possible infection and illness. In such cases, quarantine was warranted and granted by the courts until the threat passed.
If an Ebola patient was well enough to refuse isolation and elude treatment, he or she should be treated in a similar fashion. Ebola, sadly, is so profound that patients are often left prostrate and fully dependent on others for sustenance and care. But, prior to the onset of symptoms, they are not contagious.
In contrast, what we have seen in the example first of Christie and Gov. Andrew Cuomo of New York, and later Govs. Rick Scott of Florida and Pat Quinn of Illinois, is the willful disregard of medical evidence and a violation of civil rights. Happily, reasonable voices seemed to have tempered Cuomo's position. Not so Christie's.
In every example to date of a health-care worker presenting with Ebola in the United States, the affected person has promptly self-reported his or her illness. Furthermore, there has been no evidence of significant exposures to the general public.
Health-care workers should not be subject to the degrading conditions Hickox received in New Jersey. Health-care workers responsible enough to travel overseas to apply their skills, or wade into hot zones in this country, deserve better than the spectacle of incarceration at the whim of ill-informed politicians.
The capricious policy of quarantine implemented in four states should not be repeated in other jurisdictions and should be reversed where it is in effect before further harm is done to the effort to combat this illness.
The Philadelphia Inquirer