Some Thoughts on De Facto Ebola Quarantines

With Ebolamania in full swing, a phrase that has really bothered me is ‘understandable fear’, because most of the Ebola-related fears are not understandable at all.

Here’s an example of understandable fear. You’re on the subway, and the guy next to you projectile vomits, then turns to you and says, “Boy, that trip to Liberia really knocked the wind out of my sails!” You would be a dope to not be concerned (to say the least).

An unreasonable fear is thinking someone who has no symptoms, especially no fever, can give you the disease–because that can’t happen. At all. The only ‘good’ thing about Ebola virus is that we can identify who can transmit the disease (feverish) and, important, who can’t. Avoiding someone who has no symptoms will protect you as well as changing the motor oil in your car would.

That is to say, not at all.

Over the weekend, I discussed the utter inanity of isolating an asymptomatic nurse who had worked with Ebola patients. While most of the attention was focused on New Jersey, in part because New Jersey Governor Christie’s default personality setting is “asshole” and in part because New Jersey seemed utterly unprepared, other states have also instituted overly strict regulations that are unnecessary. Consider D.C. (boldface mine):

By contrast, local health authorities in Washington on Friday began implementing a more aggressive voluntary isolation procedure, notifying all licensed health-care providers returning from Ebola-affected regions to isolate themselves for 21 days, including from public places such as mass transit, grocery stores and bowling alleys, and to limit physical contact with spouses or others.

Essentially, this is an at-home quarantine for no reason at all. We are denying those who have risked much (or all) their basic freedoms because some of us are foolishly afraid, not because there is a legitimate medical reason to do so. Here’s what that means (boldface mine):

Or look at the case of Kaci Hickox, the Doctors Without Borders nurse detained at Newark Airport. This is what she thought about while she was held, in a tent, even after her Ebola test came back negative:

I recalled my last night at the Ebola management center in Sierra Leone. I was called in at midnight because a 10-year-old girl was having seizures. I coaxed crushed tablets of Tylenol and an anti-seizure medicine into her mouth as her body jolted in the bed.

It was the hardest night of my life. I watched a young girl die in a tent, away from her family.

Imagine coming back from that experience and being told: You cannot see anyone you care about. You cannot go out in public. You will stay alone in a tent, too. You will spend the next three weeks without any human contact whatsoever. You cannot see your spouse, your kids, or your friends. And, by the way, thanks for your service.

“Nurses and doctors everyday risk their lives for patients,” says Linda Greene, an infectious disease specialist and board member of the Association for Professionals in Infection Control and Epidemiology, which opposes Ebola quarantines. “Our approach to them, when they return, is punishment. Three weeks is a long time.”

To its credit, the CDC’s new guidelines would require daily monitoring–which should be done–but do not call for at-home quarantine, if the worker is asymptomatic and cooperating with authorities.

Leaving the curtailing of civil rights and the basic indecency of confining people for no goddamn reason, these stricter measures clearly haven’t been thought through:

On the off chance she does have Ebola, will the State of New Jersey [or the District] force hospital personnel to remain in quarantine as well? What about all of the people who interrogated her? Will they be quarantined as well? …Most importantly, have they even considered this question?….

In Nebraska, it took forty to sixty people to care for a single patient. We’re going isolate at-home all those medical workers without cause? If we had multiple cases, we would start to run out of trained workers.

Unnecessary fear incurs unnecessary costs. Though if you’re not the one paying those costs, I suppose no sacrifice upon the altar of needless fear is too high…

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16 Responses to Some Thoughts on De Facto Ebola Quarantines

  1. Gingerbaker says:

    ” thinking someone who has no symptoms, especially no fever, can give you the disease–because that can’t happen. At all. “

    Can one really say that when this disease is so incredibly infectious?

    You can be infected if a single virus particle enters your system. And there is an indefinable point when someone has symptoms and is not contagious, and when they have symptoms and are contagious. When do they shed their first virus particle? Do we even know the answer to that question?

    • dr2chase says:

      Compared to all the other risks that you willingly, even happily, subject yourself to, yes, we can say this. You’re more likely to get shot by the police, killed by a bee, run over by a car, struck by lightning, slip and fall in the tub, fall out of bed, etc. You could choke on a hotdog. Perhaps you’ll eat some contaminated lettuce or juice, E. coli O157H7 can do you in. If you don’t get enough exercise and/or eat wrong or rolled the wrong genetic dice, your heart could crap out and then where would you be?

      That guy in Texas, who should have been admitted to the hospital the first time he showed up, and was sent home and got sicker — none of the people in his family, exposed to an already symptomatic guy with ebola, DID NOT CATCH IT.

      Get over it and quit being such a terrified little bunny. Turn off the TV — if you want better information, read this blog instead. Those fuckers on the tube are just trying to get you all agitated for their own political and financial purposes.

      • Gingerbaker says:

        I don’t have cable. I asked a specific question, and it had nothing to do with fear. Read what I wrote,and respond to it, unless your motive is is simply to spout something that makes you feel superior.

        • The answers to your questions have already been answered by a plethora of experts who have studied this and have experience with this sort of thing, and how these things work, all throughout the media (even the hysterical media). If you found your way to this web site, you can find all that.
          So it kinda does seem odd that you need to come here, specifically to this blog, and this blog post, to “just ask questions”, spreading misinformation as you get excited about “a single particle”. Which doesn’t even make sense.

          A certain amount of particles of rat shit is allowed in the sugar you buy in the store.
          So what?

          • Gingerbaker says:

            1) Rat particles don’t give you ebola, einstein. “So what” is an absurd response. It’s important because – as I said, you can expect to be infected and come down with disease if a single virus touches a mucous membrane. For a disease with a 50-70% mortality rate, that is unusual and scary as hell.

            And do you really not understand the problem with the idea that you have no worries “At all” if a person is not showing symptoms?!? They don’t turn color, you know, like litmus paper when they go from no symptoms to subclinical symptoms to mild symptoms to full-blown symptoms.

            2) I REALLY REALLY doubt if we know enough about ebola to know when virus first begins to shed. We didn’t know for many decades – the conventional wisdom was wrong – when herpes virus actually began to shed, and it is 10,000 times easier to study than ebola. This is still early early days.

            3) And that is why the OP’s statement was worthy of criticism, imo. The combination of incredibly high infectiousness, lack of knowledge about earliest viral shedding, and the OP’s overly optimistic attitude about symptoms is a recipe for problems.

            4) Exactly what “misinformation” did I spread, you prick?

            • dr2chase says:

              Sounds like you’re very concerned about this problem.

              • Sounds like an abusive hostile name-calling troll who knows exactly what they’re doing.

              • Gingerbaker says:

                I’m not. I am concerned about the the words “at all” used by the OP. And, as well, by the defensive attitude of you and watermelonpunch, who seem determined to define me as the ‘other’. I’m trying to talk about science – and you two are trying to go ad hominem and politically correct.

                • dr2chase says:

                  For someone who’s trying to “talk about science” you are being selectively pedantic about risk. You claimed this disease is “incredibly infectious” — based on what science? And I’m not going politically correct, I am going correct.

                  • Gingerbaker says:

                    Do you understand the difference between “Infectious” and “contagious”? The fact that very few virus particles are needed to infect someone means that Ebola is a VERY infectious disease. It is not very contagious though, because it is not (yet) able to be transmitted through the air.

                    But – according Dr Steven Hatfield, people have contracted the disease by touching the bed of a person who had died hours previously. And live virus can be swabbed off of people’s skin for a long time.

                    AND -> 12-15% of people who get Ebola never get a fever, <- and fever is the major early symptom. Also, it is felt that it is possible that an infected patient may be able to sneeze or cough an aerosol which is infectious. There is little data on this, but African protocols include the proviso of never going within 6 feet of an infected patient without protective clothing.

                    So, Mike's statement that:

                    "An unreasonable fear is thinking someone who has no symptoms, especially no fever, can give you the disease–because that can’t happen. At all…"

                    is not well considered. Can you see that now?

  2. “On the off chance she does have Ebola, will the State of New Jersey [or the District] force hospital personnel to remain in quarantine as well? What about all of the people who interrogated her? Will they be quarantined as well? …Most importantly, have they even considered this question?….”

    Oh yeah, tons of hysterics have thought of that already:

    http://www.nytimes.com/2014/10/30/nyregion/bellevue-workers-worn-out-from-treating-ebola-patient-face-stigma-outside-hospital.html?_r=0

    But of course they haven’t CONSIDERED it.

    I’m sure once some private enterprises are significantly inconvenienced by over-kill measures, their bean counters run the numbers on a cost-benefit analysis, there will be significant push-back to the politicians via their lobbyists.
    Then it will be an internal struggle between lobbyists of businesses that suffer financially from unnecessary panic-costs, and lobbyists of those who benefit financially by an inflamed public.

    • Oh, and the tragedy of that NYT story is the implications of even being associated or in proximity to possible ebola patient health care workers.

      It won’t be just the 60 doctors, nurses, technicians, & housekeepers – but everyone associated with them.
      There will need to be leper colony style handling to satisfy some people.

      And even if they were to find that certain people had immunity to ebola (like there are those with immunity to HIV & possibly bubonic plague), fearful people would still be convinced that those people would be carrying pieces of shit away from the hospital on them.

      And why wouldn’t they think that. ob/gyn operating rooms in the U.S. are staffed by nurses who habitually wear hair-caps which they bring from home… and take back home with them.
      Just the fact that hospital workers wear their SCRUBS to & from home on public transport certainly doesn’t give the appearance that scrubs are hospital-only wear that’s not contaminated.

      And loads of people eat at restaurants, where they think the workers should not be paid enough to be able to stay home when they’re sick w/ flu, instead of sneezing into their food.
      Yet they want hundreds of people to be paid to stay locked up for 3 weeks for no good reason.

  3. BobC says:

    “Yet they want hundreds of people to be paid to stay locked up for 3 weeks for no good reason.” Just to be clear, is this 21 day quarantine period a paid leave of absence or unpaid? I think a lot of us would be willing to stay at home for 3 weeks with full pay [netflix marathon, woohoo!] so I’m thinking she must not be getting compensated for it.

    • I don’t know if Nurse Hickox is getting paid during this time.

      I mention the paid part because when people mention that 3 weeks is a pretty onerous amount of time… Lots of hysterical people say, “Well then pay them for it, but keep them locked up.” and such.
      For example, I was listening to the radio & a radio host on a local (music) radio station said something like that. And then I listened to a podcast (it may have been Diane Rehm show or maybe that On Point show), and some caller into the show was saying that, and so did one of the guests.

      And while it might not sound bad to some people. People who are home-bodies anyway say. Or perhaps people with sizable homes or nice views out the window, or porches they’d be able to use… it’s different if it’s forced. And some people have tiny apartments with few windows. Some of these people who might be effected don’t have much at home. They may be health care housekeeping workers who live very spartan lives at home, and for whom most of their free time is spent with extended family & friends, sociably.

      And who is going to pay their family to stay home too?
      What if the person has a spouse, 2 kids, and an aunt living with them?
      If they all live in the same house, these people want them ALL to be quarantined for the 3 weeks. (And then the relatives an additional 3 weeks if the original party develops the disease, presumably.)

      This is what I’ve been hearing & reading suggested.
      To quarantine every last person who comes from Africa.
      And definitely quarantine every person who works in a hospital with, or even near, the patients with Ebola. (In fact, I’ve seen comments suggesting that anyone who worked in the hospitals with the ebola patients, and their families, should all be quarantined for 3 weeks.)

      So no, it’s not just a case of – oh, let’s quarantine this one person and pay them.
      You’re talking about paying all their family members?
      And how about all the people on duty guarding them all?

      It’s a very expensive proposition for no good reason, let alone treating people like criminals for no good reason.

      And then if you say that to these people (as I’ve heard people respond)… then they say well that’s why they shouldn’t go to Africa, or that’s why we shouldn’t let them come home at all.

      Of course I’d love to know if these people who want all these people locked up are the same people who would argue against mandatory sick time, and expect anyone from fast food workers to factory workers to be fired at will for missing time from work with the flu.

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