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Opinion Northwest

Join the informed writers of The Times' editorial board in lively discussions at our blog, Opinion Northwest.

October 28, 2014 at 6:03 AM

U.S. Ebola workers should self-quarantine before coming home

There’s something completely more frightening about a doctor coming down with Ebola than someone from the general public.

New York Governor Andrew Cuomo (L) speaks, as New York Mayor Bill de Blasio (R) listens, during a news conference on the status of Ebola patient Dr. Craig Spencer and New York's new Ebola policies October 26, 2014.  (EPA / JASON SZENES)

New York Governor Andrew Cuomo (L) speaks, as New York Mayor Bill de Blasio (R) listens, during a news conference on the status of Ebola patient Dr. Craig Spencer and New York’s new Ebola policies October 26, 2014. (Jason Szenes / EPA)

More than anyone else, physicians know how to protect themselves from deadly contagions. That’s why the latest case of Ebola in America is so troubling.

About a week ago, New York Dr. Craig Spencer returned to his home in the most populous city in America after spending a month treating patients of the contagious killer in Guinea.

You’d think that someone whose occupational ethos is “first, do no harm” would take extraordinary precautions. Instead, Spencer followed existing protocols, answering airport questionnaires and registering his possible exposure with U.S. immigration and health officials when he returned to the only American metropolitan area with 20 million inhabitants.

Once home, he monitored his temperature twice a day for any change. That change came Thursday. He notified local health officials of his worsening condition, and was whisked into isolated care.

I’m no epidemic chicken little, but monitoring and testing for infection after entry to the U.S. seems too passive and reactive a policy for an active epidemic killer.

While denying U.S. admission to anyone coming from the affected West African countries is extreme and counterproductive, a 21-day quarantine of any person who has come into regular contact with Ebola patients before they’re allowed into the U.S. seems a reasonably protective measure for the general population.

New York Gov. Andrew Cuomo and New Jersey Gov. Chris Christie had similar thoughts last week after Spencer became the first reported case in metro New York. However, with the doctor having already returned and traveled extensively in the area, they opted to impose a mandatory involuntary quarantine on anyone suspected of Ebola exposure upon arrival.

That led to nurse Kaci Hickox being forced into quarantine Friday after returning to New Jersey from a month in Sierra Leone, even though she showed no symptoms.

Federal officials, who themselves had considered instituting similar protocols late last week, pressured both states to allow the quarantines to take place in people’s homes and the governors relented.

Hickox, who was released Monday, said her involuntary quarantine violated her human rights. That may be true. But what about the human rights of the people who might come into contact with her, or anyone else who could become actively infected after returning to the U.S.?

Knowledgeable health care specialists, such as Dr. Jeffrey Duchin, King County’s chief of communicable diseases and chairman of the Infectious Diseases Society of America, make compelling civil liberties and financial arguments against such “overkill.”

Duchin notes that about 100 people travel from Ebola-affection nations to the United States each day. To address that volume before entry, 2,100 people would have to be quarantined at any given time. That certainly would be very costly, and logistically complicated.

President Barack Obama gives a hug to Dallas nurse and Ebola survivor Nina Pham in the Oval Office of the White House Oct. 24, 2014 in Washington, D.C.  (Olivier Douliery/Abaca Press/MCT)

President Barack Obama gives a hug to Dallas nurse and Ebola survivor Nina Pham in the Oval Office of the White House Oct. 24, 2014 in Washington, D.C. (Olivier Douliery / Abaca Press)

Still, where’s the harm in taking the extra precaution of sequestering anyone exposed for the three week Ebola incubation period, in the source country of the exposure, and before setting foot on U.S. soil?

Duchin reminded me of Americans’ over-the-top reactions in the early days of HIV and SARS. Then, when little was known about the ailments, swimming pools were drained and disinfected after someone with HIV swam in them, and scores of people began wearing surgical masks in an attempt to avoid airborne SARS.

In hindsight, none of that was necessary, or even effective.

But they did help people feel safe. And a preliminary monitoring quarantine of people exposed to Ebola is far from an ineffective, over-the-top precaution.

“It’s rather predictable that with a new disease that’s scary and unpredictable, people have a lot of fear and mistrust,” argued Duchin. “There is a kind of predictable time period that the public needs to become comfortable with the facts, to understand that the risk is not as high as they imagine it to be.”

To hasten that learning curve, last week President Barack Obama hugged an Ebola survivor from Dallas in an attempt to calm fears.

Experts worry that mandatory entry quarantines will discourage professionals from going to help contain the outbreak.  And the need for medical workers in those nations is clearly great. But I question why any health care worker would engage in behavior that could potentially spread – not stem – the spread of Ebola.

It’s additionally troubling that aside from the first reported Ebola case in the U.S., all subsequent cases have been health care workers – the very people who should be best protected and should take extra precautions to protect their exposure being spread to anyone else.

U.S. Ambassador to the United Nations Samantha Power, who travelled to Ebola-affected nations in West Africa Sunday, said returning health care workers should be “treated like conquering heroes and not stigmatized for the tremendous work that they have done.”

She’s right.

But those health care workers should also recognize that they’re taking a voluntary risk that they have no right to impose on their fellow Americans.

Comments | Topics: ebola


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