Editorial: Ebola

The American public, along with state and federal government officials, had sufficient cause to be frightened when the first case of Ebola knocked at its doorsteps. Amidst the panic and frenzy in response to the Ebola outbreak, a controversial quarantine was issued against 33-year-old nurse Kaci Hickox, who had served Ebola patients in West Africa before being held under a 21-day quarantine after her arrival in Newark.

The Princeton Public Health Review’s editorial board believes that while the principle behind issuing a mandatory quarantine against nurse Kaci Hickox was a valid one, the haphazard manner in which the Model State Emergency Health Powers Act was carried out suggests the need for enforcement to be improved and better amended to deal with the health risk at hand.

Following New Jersey and New York’s quarantine mandate, health officials from the Centers for Disease Control and Prevention backlashed against the detention of Hickox, arguing that policies regarding quarantines ought to be a reflection of science, not public opinion – and their claims are sufficiently justified. Transmission of Ebola via bodily fluids can only take place after the patient is symptomatic (i.e. fever, vomiting, and fatigue). Furthermore, a fever precedes the virus’s contagious stage by two to three days, rendering a 21-day isolation period inefficient.

Of course, public opinion is not reason in and of itself to support a strict quarantine of all health workers working with Ebola patients. However, in an exclusive interview with NJ Advance Media, Nobel Prize-winning doctor and researcher Dr. Bruce Beutler suggests that the information that the CDC is offering up to the public is somewhat misleading, and that quarantines could be justified based on scientific evidence.

“It may not be absolutely true that those without symptoms can’t transmit the disease, because we don’t have the numbers to back that up,” said Beutler, “It could be people develop significant viremia [where viruses enter the bloodstream and gain access to the rest of the body], and become able to transmit the disease before they have a fever, even. People may have said that without symptoms you can’t transmit Ebola. I’m not sure about that being 100 percent true. There’s a lot of variation with viruses.”

Beutler’s claim holds true when looking at the data the CDC cites when referring to the claim that “Ebola is not communicable in patients without symptoms.” The study, which was published in September by the New England Journal of Medicine, included a sample size of 3,343 confirmed and 667 probable cases of Ebola. The results showed that 13 percent of the time, the Ebola patients did not exhibit any fevers.

Considering the gravity of the potential health consequences, the CDC’s intent to prevent, or at least alleviate, public panic is understandable. Yet, this in no way justifies a public health policy that is based upon the generalization that asymptomatic patients cannot transmit the virus. Princeton Public Health Review believes that the variation in the NEJM study’s data is significant enough to warrant the use of quarantines to eliminate any future risks.

However, the quarantine that was placed upon Hickox is not the kind of quality quarantine we hope state officials will implement in the future. In her letter to the editors of Dallas News, she recounts her time in quarantine as being treated “as if [she] was a criminal.” Hickox lacked access to basic amenities, and the treatment she received was not one would expect officials to give a volunteer who worked abroad saving lives of Ebola patients.

A well-run quarantine and health inspection system can satisfactorily alleviate some of the most pressing concerns, such as the shortage of volunteers following public reaction to Hickox’s letter. Rather than a mandatory quarantine within the confines of a hospital, a residential quarantine would be more appropriate for the living conditions of the volunteers. Residential quarantine coupled with routine inspections from local health officials to check on quarantined individuals’ temperatures would be a more adequate solution to the issue.

Doctors, nurses, and health volunteers are indeed medical experts, but that fact does not exclude them from the risk they could potentially pose to the public. Fevers, headaches, and the typical symptoms for Ebola are not predictable in the way that other types of sickness are, and it is impossible to rule out the possibility of any at-risk individual developing symptoms at a given time. Even in the case that an individual is monitoring his health, if he begins to experience symptoms while in public, he risks infecting other individuals before he can return home.

The Ebola outbreak has been shadowed by uncertainty and uneasiness, and implementing quality quarantines in collaboration with the full assistance of federal, state, and local health officials is pivotal in developing the most holistic approach against Ebola. At the same time, the quarantine process must be conducted in a humane manner. While stopping the spread of the virus in the U.S. is critical, we should avoid stigmatizing the doctors and nurses who have put their lives on the line in aiding patients in west Africa–these individuals deserve the same respect as other heroes in our community, such as police officers and firefighters.