The case of a doctor who tested positive for Ebola after returning from west Africa this month has raised questions among a jittery US public about whether health workers should be quarantined after visits to the affected region, but health officials and frontline medical staff say this is unnecessary and that current guidelines are sufficient.
Craig Spencer, 33, was taken to hospital in New York on Thursday after displaying symptoms consistent with those caused by Ebola, including a fever. Spencer had returned from Guinea on 17 October, where he had been working for Médecins Sans Frontières (MSF), known as Doctors without Borders in the US.
Preliminary tests confirmed he had the virus. His fiancee and two friends have been quarantined, but a taxi driver who transported him in his cab was not considered to be at risk.
MSF said it had put in place stringent protocols to protect its staff from exposure to Ebola, and to monitor the health of returning doctors.
In a statement, it outlined the procedures governing the 21-day incubation period for the virus, noting that, until Thursday, none of the more than 700 expatriate staff deployed in west Africa had developed confirmed Ebola symptoms after returning home.
On arriving back, staff are debriefed and advised to: check their temperature twice a day; finish a course of malaria drugs; be aware of the relevant symptoms; stay within four hours of a hospital with isolation facilities; and alert MSF immediately of any relevant symptoms.
“These guidelines are consistent with those provided by the CDC [US Centers for Disease Control and Prevention] to people returning from one of the Ebola-affected countries in west Africa. MSF is also implementing new federal guidelines outlining reporting requirements for people returning from Ebola-affected countries,” it added.
“As long as a returned staff member does not experience any symptoms, normal life can proceed. Family, friends, and neighbours can be assured that a returned staff person who does not present symptoms is not contagious and does not put them at risk. Self-quarantine is neither warranted nor recommended when a person is not displaying Ebola-like symptoms,” MSF said.
The incubation period for Ebola – the time between infection to the onset of symptoms – is between two and 21 days. Humans are not infectious until they develop symptoms. The virus is transmitted in the bodily fluids of people who are seriously ill, who are likely to be vomiting, bleeding or have diarrhoea.
Sophie-Jane Madden, a spokesperson for MSF in London, said the safety of staff was MSF’s number one priority. “All our staff members attend training before they leave, and are given strict instructions to alert a nominated person should they begin to feel unwell,” she said.
“In an Ebola intervention, in addition to wearing the personal protective equipment, we follow a series of strict infection control procedures,” she added. “Only essential staff are allowed to enter the high-risk area, and we restrict how long people can stay inside to just one hour … Once inside the isolation zone, our staff members always work in pairs in a buddy system, looking out for one another to make sure that their partner does not make any mistakes. We try wherever possible to administer oral therapy rather than injections, which reduces the risk of needle stick injuries, and also limits the number of blood tests that we give to our patients.”.
MSF staff are rotated every four to six weeks to ensure they are not too tired, which also reduces the risk of someone becoming infected.
As the Ebola outbreak has gathered pace, hundreds of medical staff from around the world have volunteered to go to west Africa to help battle an unprecedented crisis. More than 800 NHS doctors, nurses and paramedics have signed up to work in Sierra Leone as the spread of Ebola continues to outpace efforts to contain the virus. The first NHS volunteers are due to travel to west Africa this week. Most placements will last between six and eight weeks. As well as volunteer health workers, the UK plans to send 750 troops to Sierra Leone.
On Thursday, the World Health Organisation (WHO) said that nearly 5,000 people were known to have died in west Africa so far, but the real toll could be three times as high.
A spokesman for Britain’s Department of Health said on Friday that anyone returning from a country affected by Ebola would be screened at UK borders, and monitored closely. Their temperature would be taken and they would be required to give their contact information to health officials for any potential follow-up. The spokesman said there were no plans to consider obligatory quarantining of returning health workers, noting that transmission of the virus was possible only when a person was showing symptoms, and then only through bodily fluids.
Britain began screening passengers arriving from west Africa at Heathrow airport two weeks ago and at Gatwick this week.
Public Health England (PHE), which brings together public health specialists from across Britain, says health and public health workers returning from an affected area will need to be assessed before they can return to duties involving patient contact in the UK.
“People are not considered infectious while asymptomatic but, to maintain high standards of patient safety within the NHS, some healthcare activities may be restricted until returning staff are past the incubation period for Ebola (21 days),” it said (pdf).
PHE divides people into three categories, depending on how much contact they have had with people infected by the virus. Category three includes people who “had direct (close) contact with Ebola cases (or body fluids) while they were in the affected area, wore appropriate protective equipment/clothing (PPE), but are concerned that they may have had a breach in these protective measures or have had direct contact with an Ebola patient’s blood, urine or secretions without being protected”.
The advice for these people is as follows: “You can return to live in your own/usual home with ordinary family and social contact, attend office-based work only (not patient care areas), and can take agreed UK transport (as discussed with your monitoring team at PHE). You are required to check your temperature twice daily for 21 days after return, and to report daily to a named monitoring team at PHE, even if you don’t have a raised temperature (over 38°C) or other suspicious symptoms.”
While news of Spencer’s infection hit US stocks briefly on Thursday, hundreds of nurses and health workers have already died in Liberia, Sierra Leone and Guinea, without making headlines. The WHO said 443 healthcare workers had been infected, and 244 had died.
There was some public anger, vented on Twitter and other social media sites, that Spencer had travelled on the New York subway, gone bowling and taken a cab before he showed the first symptoms. MSF, however, said he had followed their protocols and guidelines.
“Tragically, as we struggle to bring the Ebola outbreak in west Africa under control, some members of our staff have not been spared,” said Sophie Delaunay, MSF’s executive director. “Our thoughts are with our colleague in his own struggle right now, and we sincerely hope for his quick and full recovery.”
MSF has welcomed a WHO announcement that frontline health workers will be the first to test Ebola vaccines and treatments, calling for the rapid implementation of the policy.