Ebola: Why Quarantine?

A handful of states, in response to the Ebola outbreak, are imposing a mandatory quarantine on health care workers returning to the United States from Ebola zones amid fears of the virus spreading outside West Africa.[1]

New Jersey Governor Chris Christie and New Jersey officials now require that travelers coming through Newark Liberty International Airport be categorized as either high risk, some risk, or low risk. Those with no symptoms will still face either a 21-day monitoring, mandatory quarantine order, or home quarantine. Those who are at “some risk” would be subject to a mandatory quarantine.[2]

Other states involved in the new quarantine policy mandate include Illinois and New York. Many of the new detailed guidelines set forth go beyond those of the Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO), whose baseline recommendation guidelines specify that individuals who may be potentially affected by the Ebola virus be quarantined for 21 days and have their temperatures checked twice daily.[3] Various state and local officials have the prerogative to set more stringent health care policies.

The number for the suggested quarantine days was calculated based on the incubation period – or the time before symptoms arise – of the Ebola virus, which is 2-21 days after infection. Although it is true that the longer the quarantine is imposed, the less likely the risk of infection upon others, the costs of mandating the quarantine must be balanced with the costs of releasing the individuals, which is where the intersection lies on the graph below:[4]

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Professor Charles Haas, head of the Civil, Architectural, and Environmental Engineering Department at Drexel University who sought to find where the numbers came from by examining the incubation periods calculated for previous outbreaks, found that WHO estimated the mean incubation period for the first 9 months of the current west African outbreak as 11.4 days, with an upper limit (95% confidence) of 21 days.[5]

President Barack Obama and his administration called for governors to renounce their state policies appealing, “”If we’re discouraging our health care workers who are prepared to make these sacrifices from traveling to these places in need, then we’re not doing our job in terms of looking after our own public health and safety,” Obama said. “We can’t discourage that, we’ve got to encourage it and applaud it.” Many have expressed that returning health care workers should not be stigmatized, but supported and encouraged.[6]

Many of the new policy regulations are scientifically unjustified and unnecessary according to many health experts, the United Nations, and medical charities. Rather than impose stricter and lengthier quarantine sentences to all low-to-high risk persons, it makes more sense to determine according to the specific individual at that specific time.[7]

However, these regulations remain enforced because of its popularity with the general public. In an NBC and Wall Street Journal poll, more than 70 percent of Americans supported the policies for a mandate on quarantine for health care professions who have treated Ebola patients even if they showed no symptoms.

It should also be noted that support for the quarantine policy varied based on party affiliation, age, and educational level. Most notably, those with lower levels of education more likely to support quarantines – specifically 80% of those with a high school degree or less are in favor of quarantine mandates than 63 percent of those with a post-graduate or college degree.[8]

Nurse Kaci Hickox of New Jersey, who arrived from treating patients in West Africa and tested negative for Ebola twice, was forcibly quarantined and has now hired a lawyer and spoken out publicly about her confinement. Hickox expressed shock at how Governor Christie, who has no medical training, could diagnose that she was “obviously ill”. [9] Health experts have said that an individual can only transmit Ebola if the individual is actively ill and expressing symptoms such as fatigue, vomiting, and diarrhea. Others are at risk of Ebola only if they ingest or are in other close contact with bodily fluids from such a patient.[10]

Endnotes:

[1] Dawsey, Josh. “New Jersey Details Ebola Quarantine Policy.” Wall Street Journal 1 Nov. 2014. Wall Street Journal. Web. 27 Nov. 2014.

[2] Ibid.,

[3] “Infection Prevention and Control Recommendations for Hospitalized Patients with Known or Suspected Ebola Virus Disease in U.S. Hospitals.” Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 02 Nov. 2014. Web. 27 Nov. 2014.

[4] Haas CN. On the Quarantine Period for Ebola Virus. PLOS Currents Outbreaks. 2014 Oct 14. Edition 1. doi: 10.1371/currents.outbreaks.2ab4b76ba7263ff0f084766e43abbd89.

[5] Ibid.,

[6] “Obama Pushes against Mandatory Ebola Quarantines.” CNBC. N.p., n.d. Web. 23 Nov. 2014.

[7] “U.S. CDC Says Returning Ebola Medical Workers Should Not Be Quarant…” Mail Online. N.p., n.d. Web. 27 Nov. 2014.

[8] “NBC/WSJ Poll: 71% Back Mandatory Quarantines for Ebola Health Workers.” NBC News. N.p., 2 Nov. 2014. Web. 23 Nov. 2014.

[9] “New Jersey Releases Nurse Quarantined in Ebola Scare.” CNN. N.p., n.d. Web. 27 Nov. 2014.

[10] “So Really, How Do You Get Ebola? Coming Days Are Critical.” NBC News. N.p., 6 Oct. 2014. Web. 27 Nov. 2014.