Over the weekend, New York and New Jersey Governors Andrew Cuomo (D) and Chris Christie (R) imposed a quarantine on health care workers who treated Ebola patients in West Africa that would confine them to a government-regulated facility. This requirement is not science-based and is counterproductive. New York University bioethicist Arthur Caplan offers a nice summary of seven reasons why this policy is stupid. Here are his main points:
1. Quarantining people without symptoms makes no scientific sense. They are not infectious. The only way to get Ebola is to have someone vomit on you, bleed on you, share spit with you, have sex with you or get fecal matter on you when they have a high viral load. … 2. Quarantine is next to impossible to enforce. If you don't want to stay in your home or wherever you are supposed to stay for three weeks, then what? Do we shoot you, Taser you, drag you back into your house in a protective suit, or what? And who is responsible for watching you 24-7? Quarantine relies on the honor system. That essentially is what we count on when we tell people with symptoms to call 911 or the health department. … 5. Health care workers who take care of those who really do have Ebola at big hospitals, such as Bellevue or Emory, are at the greatest risk. If you quarantine them you are taking your best professionals offline for three weeks — and there are not a lot of replacements. 6. Who will volunteer to go to West Africa to stamp out the epidemic, if they know they face three weeks of confinement upon their return? Those who go are heroes who face hell on earth. Can't they be trusted to do the right thing and self-monitor when they get back?
On Fox News Sunday, Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases, said:
"The best way to protect us is to stop the epidemic in Africa, and we need those health-care workers, so we do not want to put them in a position where it makes it very, very uncomfortable for them to even volunteer to go."
On Monday, the two governors have had a rethink and are walking back panicked policies. Returning health workers will now merely be confined to their homes. This is still too much.
Consider that the 76 health care workers who had contact with Ebola patient Thomas Eric Duncan are not being quarantined. Instead they report in daily on their health and are asked to avoid crowded public venues. It's been 19 days since Duncan died, and so far only two nurses who took care of him when he was at his most infectious became ill. Recall also that four people lived with Duncan for at least four days as his Ebola infection worsened and none of them were infected. This suggests that it is highly unlikely that people who bowled with Dr. Craig Spencer are are at risk.
The CDC and Obama administration officials have certainly not covered themselves in glory in their responses to the Ebola situation, but grandstanding by governors is not a sensible way to develop public health policy.
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