Ebola Politics

There’s much in the news this week of a nurse who is refusing to stay in quarantine after her return from caring for patients with Ebola in West Africa. So many issues here. Hard to know where to begin.

First, the nurse is correct in her statements that there is no scientific evidence that she should be in quarantine. She has twice tested negative for the virus. She has no symptoms (a forehead temperature registered high at the airport when she first arrived in the United States, but follow-up temperature readings have been normal). The disease is not contagious until people are symptomatic. And again, she has tested negative twice so far.

The fact that she has valid scientific points does not mean that her manner of spurning authority is the most useful strategy or the wisest thing to do in this particular case.

The fear surrounding this particular disease is intense. The vitriol directed toward those who contract the disease when caring for the people afflicted by it is mind-boggling. There is a lack of logic and common sense regarding this disease which is maddening. So adopting a tone that appears belligerent is not necessarily the best way to calm fears, educate people, and work with the scientific community and government officials in a cooperative, productive and helpful way.

Thousands of people have died in West Africa due to this Ebola outbreak – about 5 thousand at this point, out of about 13.5 thousand total cases, in countries whose populations total about 22 million. The medical infrastructure is not present to adequately treat the people there and control the disease. We need more facilities and healthcare personnel to contain the outbreak. The bigger the outbreak becomes, the higher the likelihood that people with the disease will end up in the United States, so even if some people don’t have deaths of people in another area of the world high on their personal radars, the outbreak will have some effect here – it is a global issue. We need people to work together in a smart way.

Ebola is spread through contact with bodily fluids of a person who is actively sick. Casual contact with someone who does not yet show signs of disease has not been shown to transmit the virus. Monitoring people who have come in close contact with actively ill Ebola patients (i.e., healthcare workers, people who are cleaning the bodily fluids of those who are ill, etc.) through the potential incubation period (the time it takes from exposure to disease development, in the case of Ebola 2 to 21 days) is fairly easy to do when there is a small number of people to monitor. When we send large numbers of military personnel to help with the crisis overseas, it will be more difficult to monitor everyone individually on their return, and so a three week quarantine from time of last exposure makes logistical sense.

We are not quarantining every doctor, nurse, lab technician, or custodial worker involved in the care of Ebola patients and their environments. We are monitoring. We are using common sense. We are looking at the data – this is not a new disease, and we have observed the patterns of transmission.

The nurse who is fighting her quarantine has brought in lawyers. She is figuratively kicking and screaming about her rights being violated. The general public is looking at her reaction and saying, “How selfish! What a spoiled brat! How dare she put me at risk?! Three weeks is no big deal. She should err on the side of caution and be done with it!” Her belligerence invokes anger, not understanding or alliance. Her dismissal of people’s fears does not promote an environment of respect and teamwork.

The nurse’s lawyers and the state of Maine’s lawyers are currently trying to work out a compromise. This is beyond ridiculous. Why are lawyers negotiating a public health issue? The state’s public health department has authority here. The federal government, through the CDC (Centers for Disease Control and Prevention), has authority. If the state’s public health department has said “quarantine,” then the quarantine should be respected. If the state has its information wrong, the CDC can step in.

The nurse in this case is well within her rights to cry “foul” to a policy that is grounded in fear rather than scientific reality. But the crying should be done smarter.

She should have called Doctors Without Borders, with whom she’d been volunteering. She should have called WHO (the World Health Organization). She should have called the CDC. After speaking with these organizations and getting official confirmation of appropriate protocols, she should have spoken with the state authorities with whom she disagreed. If they didn’t listen to the advice from WHO and the CDC, the nurse then should have gone to the newspapers and TV networks.

I understand and agree with the stance of not blindly going along with inappropriate policy. When reality/facts/science are ignored, bad things happen. People are ostracized. People are vilified. Already, a child was kept out of school in Connecticut because she had visited Nigeria (not an epicenter of this disease, and she had not come in contact with any sick people) for a family wedding.

The school defended its decision by saying “some of the other parents were scared.” This makes about as much sense as keeping a kid out of school in the Midwest because he had visited his family in Texas, and someone in Texas had Ebola. That school ignored facts and made poor decisions based on ill-informed fears. The nurse in our story is trying to prevent such poor decisions.

If she had just said, “whatever,” and stayed inside for three weeks (or in her original quarantine tent for three weeks) she would have not suffered any long-term negative effects, but she would have been complicit in the propagation of such ridiculous events as transpired in the Connecticut school. She would have been complicit in allowing fear-generated policies to stay in place that would discourage anyone from helping those in desperate need of medical help. She, a healthcare professional, would have been complicit in bad medicine.

But by simply showing defiance and going straight to the lawyers, she, a healthcare professional, says that it’s ok for people to defy public health authorities.

So here’s an alternate unfolding of events:

Nurse gets off plane. She discloses her work with patients with Ebola. Forehead temperature scan reads high. She denies any symptoms. Because of the high temperature reading and an abundance of caution, she goes to the hospital for temporary observation. All subsequent temperature readings are normal and the nurse remains free of symptoms. Lab tests for Ebola are negative. Nurse calls Doctors Without Borders and gets contact information of their infection control experts. Nurse calls CDC and WHO and gets contact information for their Ebola gurus.

Infectious disease team at hospital talks to Ebola gurus from CDC, WHO, and Doctors Without Borders. They reach consensus. They make recommendation to local health department. Local health department makes decision based on evidence, expert consensus, and known data, rather than on TV news sound bites of the fears of random citizens with no science or health background or training. In the meantime, the nurse waits for the appropriate people to deal with the issue. And she abides by the answer.

The media circus was unnecessary. The lawyers were unnecessary. What was needed was communication among all the experts – those on the front lines, those with the epidemiology background, those with the infectious disease expertise. And the government entities needed to listen to those with the knowledge. And a healthcare professional should have recognized the need for this type of communication facilitation, and should have respected the public health entities by working appropriately through the correct channels.

Lastly, keep in mind that tens of thousands of people in the U.S. die from complications of influenza every year. Get a flu vaccine. Measles is one of the world’s most contagious diseases, and it’s contagious from four days before a rash shows up. Get your kids vaccinated. These are issues the media should be headlining in this country right now.


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