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Should Health Care Providers Exposed To Ebola Be Quarantined?

Kaci Hickox
Nurse Kaci Hickox was discharged from quarantine in New Jersey and is now in her home state of Maine. (Photo: Associated Press)

By Brad Broker

Should travelers returning from Ebola-stricken countries be subjected to a mandatory quarantine? New Jersey, New York and several other states say yes.  The White House says no.  The CDC says maybe.

Doctors Without Borders nurse Kaci Hickox flew back to the U.S. last week from Sierra Leone, where she was on a humanitarian mission treating Ebola patients.  When she arrived at Newark Liberty International Airport in New Jersey, she was immediately quarantined as per guidelines set by the state.

“This is an extreme that is really unacceptable, and I feel like my basic human rights have been violated,” Hickox told CNN on Sunday.

On Monday, after determining that Hickox was “symptom free for the past 24 hours,” the New Jersey Department of Health released Hickox, who went home to Maine, which also wants Hickox to remain quarantined.

“I understand that she didn’t want to be there, she made that very clear from the beginning,” said New Jersey Gov. Chris Christie. “But my obligation is to all of the people of New Jersey, and we’re just going to continue to do that.”

Hickox has hired a civil rights attorney, who said that Hickox has no plans to honor Maine’s 21-day quarantine and will stay home “for maybe a day or so.”

ABC News reports that New York, Illinois and Florida have also imposed mandatory quarantines for anyone exposed to people infected with Ebola.

The White House does not agree with mandatory quarantines or any regulations that may discourage healthcare providers from traveling to help others in need of medical assistance.

“These individuals are heroes, and their commitment to their common man and to their country is one that should be respected,” White House press secretary Josh Earnest told The Hill. “And we believe that we can both show them the respect that they have earned while also ensuring that we have protocols in place to protect the American people.”

CDC director Tom Frieden, MD, MPH, echoed those statements. “If we do things that make it very difficult for people to come back, if we turn them into pariahs, instead of recognizing the heroic work they are doing,” healthcare workers will be less likely to treat Ebola patients.

The CDC issued its own set of guidelines Monday calling for a more individualized approach rather than an across-the-board quarantine. Each person will be categorized as high risk, some risk or low (but not zero) risk.  Criteria and actions differ depending on the classification.

Healthcare workers providing direct care to Ebola patients in countries with widespread transmission, such as Hickox, would automatically be classified as “some risk,” even without showing symptoms of the virus. According to the CDC guidelines, the protocol for this group is to “implement rapid isolation with immediate contact of public health authorities to arrange for safe transport to an appropriate healthcare facility for Ebola evaluation.”

4 comments

  1. Preventing the spread of Ebola in the us is working fine right now. It’s working without banning all incoming passengers from West Africa. It’s working in spite of bringing Ebola-infected American home for treatment. NONE of those brought into the US for treatment has caused a single other case of Ebola. NONE. So, what we’re already doing is working just fine, isn’t it?

    Duncan’s family lived with him for at least three days while he was very contagious. Duncan sat in an ER waiting room for hours with other people while contagious. Neither his family, others in the ER waiting room or ER staff (on either visit) got Ebola and he had an active Ebola infection.

    Writebol’s husband lived with her for almost 4 days when she was having symptoms. And she had an active Ebola infection. He never got Ebola.

    Sawyer was vomiting in a plane and in Lagos airport. And he was dying from an active Ebola infection. So he would have had a high vocal load, spewing infectious vomitus, No one on the plane or in the airport got Ebola. No one who cleaned the plane or airport (and weren’t using Ebola-recommended PPE) got Ebola.

    Amber Vinson, lived with relatives and flew on a plane with an active Ebola infection and no one got infected.

    Dozens of US healthcare workers have returned from West Africa (I personally know two who did so) who were treating Ebola patients. They and their staffs, came back around July 1st, were never even tested for Ebola and weren’t required to even do temp checks then. None of them and none of their families got Ebola.

    Kaci Hickox has no symptoms, has tested Ebola negative at least once. She worked for MSF treating Ebola patients, using appropriate PPE gear. MSF has a very low rate of Ebola infection in their health care workers.

    None of the health care workers who treated Ebola patients (while wearing PPE, like Hickox) in Atlanta, Nebraska or at the NIH hospital have been quarantined after the same kind of exposure to Ebola patients. None of them and none of their families, has developed Ebola.

    Among all of the above, they have had tens of thousands of contacts with other people since being “Ebolasized” and have had contacts with bowling balls, door knobs, coughed and sneezed on buses, visited bridal shops, gone to work, to movies, picked up the kids at sporting events, cooked and served meals, took cruises, etc. Among them, no one has developed Ebola and no one has spread Ebola to anyone else.

    To the other doctors posting, how many Ebola patients have you seen? How many have been diagnosed in your city? State? Of those confirmed Ebola patients in your area, how many have spread Ebola to others? I thought so.

    Please, tell me again, why do we even need to discuss quarantine in this situation?

    • Robert Frischer, M.D.

      d3clark, when you have an infectious disease that has a kill rate of 60%, shows no symptoms for up to 21 days and apparently can not be tested for prior to the development of symptoms one would be smarter to be on the safer side of treatment and 21 days of quarantine is not an undue time span. When the space shuttle pioneers came back from the moon they too did a 21 day quarantine. The NYC doc I am sure tried to protect himself with the appropriate gear in Africa and still got the disease, trecked all over with it in NYC like an idiot too. The soldiers returning from Africa will do a 21 day quarantine. I may be completely wrong on the risk of infection spread but I would tend to err on the side of safety on this one. I don’t particularly trust the CDC either. But let me ask you this one. You get bitten by a dog that escapes. Would you get a rabies series? Or trust to blind luck? Besides the MD I also have a degree in Microbiology so I am not a complete dunce in infectious disease.

  2. Robert Frischer, M.D.

    This nurse is willing to possibly spread this serious illness to people in the U.S.because she doesn’t want to be in quarantine for 21 days. I salute her for her service in Africa but she she has no right to endanger Americans because she doesn’t like her quarters under quarantine. And yes, you do not have “civil liberties” when under quarantine. Apparantly our soldiers coming back will all have 21 day quarantine.

  3. I understand and appreciate what she is doing to help the people in Africa but I also think she should be willing to “take one for the home team” and relax in her house for 3 weeks to be ABSOLUTELY sure that she isn’t infected. I’m sure her loved ones and others she may come in contact with would feel the same way. What about their basic human rights?

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