Stricter quarantines for dealing with potential Ebola cases in the U.S. could discourage health workers from volunteering in the impacted West African countries, thereby making the outbreak harder to contain, experts say.
New York, New Jersey and Illinois announced mandatory 21-day quarantines for those arriving back in the United States after having direct contact with Ebola-infected individuals in West Africa. The outbreak — the largest in history — has left more than 10,000 people infected and nearly 5,000 dead, the World Health Organization announced Saturday. But experts say the quarantine could end up having major unintended consequences.
Appearing on ABC‘s “This Week” and NBC’s “Meet the Press” on Sunday, Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said that as a physician and scientist, he would have recommended against a quarantine.
“The best way to protect us is to stop the epidemic in Africa, and we need those health care workers so we do not want to put them in a position where it makes it very, very uncomfortable for them to even volunteer to go,” he said, adding that active and direct monitoring can accomplish the same thing as a quarantine because people infected with Ebola do not become contagious until they start showing symptoms. Ebola is transmitted through direct contact with the bodily fluids of an infected person.
Dr. Lawrence O. Gostin, a global health professor at Georgetown University Law School and an adviser to the World Health Organization, told the Washington Post that although quarantining medical workers might sound reasonable, it is an overreaction that if widely adopted “will come back to haunt us.”
Quarantine not consistent with federal guidelines
The new measures go beyond the current guidelines issued by the Centers for Disease Control and Prevention, which call for voluntary quarantine and self-monitoring in most cases. Now, many are concerned that the quarantine policy will be so burdensome that health care workers and other aid workers in the U.S. will change their minds about going to West Africa.
“The deep worry here – and I think this is what we’re going to see is that medical volunteers are going to be less likely to want to sign up to go to West Africa to fight the outbreak,” Dr. Jennifer Nuzzo, Senior Associate at UPMC Center for Health Security, told NPR on Friday.
“The more we make it difficult for health workers to stem the epidemic in Sierra Leone, Guinea and Liberia, the more at risk we are,” Dr. Gostin added. “Because in the modern global world, you’re not going to be able to put those three countries in cellophane wrap. People will travel to other parts of the world and come in through different countries.”
The new mandates are also worrisome since people in the general public may be less likely to come forward if they have symptoms because such measures will increase the stigma surrounding the virus, experts say.
Sharp criticism from quarantined nurse
A health care worker — who treated Ebola patients in West Africa and is being quarantined at University Hospital in Newark, N.J. — tested negative for Ebola on Saturday, health officials said. The nurse revealed her identity as Kaci Hickox in a first-person story published Saturday by The Dallas Morning News, where she criticizes the treatment she received when she arrived at Newark Liberty International Airport on Friday.
Hickox characterized the experience as chaotic: “No one seemed to be in charge. No one would tell me what was going on or what would happen to me,” she said. “I am scared about how health care workers will be treated at airports when they declare that they have been fighting Ebola in West Africa. I am scared that, like me, they will arrive and see a frenzy of disorganization, fear and, most frightening, quarantine.”
Responding to Hickox’s experience, Doctors Without Borders issued a statement Saturday arguing that “there is a notable lack of clarity about the new guidelines announced yesterday by state authorities in New York and New Jersey.” The statement also said the group is “very concerned about the conditions and uncertainty she is facing and is attempting to obtain information from hospital officials.” It goes on to say that workers’ rights must be respected.
In announcing the new quarantine mandates, New York and New Jersey said they will work to establish an interview and screening process to determine a person’s risk level by considering where they traveled and their level of exposure to the virus. “Depending on the risk level, a person could require mandatory 21-day quarantine, or at a government-regulated facility,” New York Gov. Andrew Cuomo said. “Low-risk would be regularly monitored for temperature and symptoms. Others will have a protocol developed to fit their particular circumstances.”
But the hazy details of how such quarantines will be handled are drawing sharp criticism as infectious disease experts say enforcement logistics are up in the air. Cuomo on Saturday acknowledged that the policy might be hard to enforce, according to the New York Daily News. The governor said officials had never considered whether people refusing to go along with the order could face prosecution or arrest, adding “It’s nothing that we’ve discussed, no,” the newspaper said.
NYC doctor followed guidelines to prevent transmission
The quarantine measures were announced after a New York physician, Craig Spencer, working for Doctors Without Borders returned from Guinea was admitted to Manhattan’s Bellevue Hospital Center earlier this week to be treated for Ebola. Saturday night, New York health officials said Spencer had entered the “next phase of his illness, as anticipated with the appearance of gastrointestinal symptoms.”
Gov. Chris Christie, R-N.J., said he concluded the quarantine was necessary to protect public health in his state and that he thinks the Centers for Disease Control and Prevention “eventually will come around to our point of view on this.” Christie said he didn’t trust “a voluntary system with folks who may or may not comply.”
But Dr. Fauci pointed out that Spencer did exactly what he should have done by putting himself in isolation as soon as he developed a fever. “No one came into contact with his body fluids,” Dr. Fauci said. “The risk is essentially zero, vanishingly small.” Furthermore, said Dr. Fauci, the health care workers returning from treating Ebola patients are responsible and know that if they have symptoms there’s the possibility of transmitting the disease. “They don’t want to get anyone else infected,” he said.
As for the unintended consequences, he said, “If we don’t have our people volunteering to go over there, then you’re going to have other countries that are not going to do it and then the epidemic will continue to roar.”