The Question About Ebola Restrictions That Is Still Unanswered

It’s bad enough that healthcare workers who treat Ebola patients in the U.S. are now being stigmatized. In part, this stems from too many state governors and other political figures* caving due to unreasonable fear.

But what I don’t get about the restrictions is this: if we had an outbreak they wouldn’t work. To treat the patients in Nebraska, it required forty to sixty people. Suppose we get another Ebola case. If we’re going to isolate people who were exposed to an Ebola patient, these workers will have to undergo a 21-day isolation/quarantine. Now imagine two weeks into that quarantine, there’s another patient admitted to the same facility. Will these workers be called back in? Will a new set of forty to sixty workers be ‘spent’ treating the new case? If we call back the previous workers, they will have gone months without having any chance to live an ordinary life for no reason at all (if there is no fever, there is no transmission–that’s the only ‘good’ thing about this damn virus).

Mind you, the CDC regulations don’t call for isolation of asymptomatic healthcare workers who are compliant with a fever monitoring regime (which is reasonable). But it’s pretty clear that the states have not thought this through at all (that New Jersey stuck a possibly ill person in a tent on a cold night without heat tells you all you need to know about our ‘preparedness‘).

These isolation policies are a farce. Worse, they are distracting us from real questions, such as how did WHO react so slowly and so poorly.

*To their credit, the only prominent politicians with authority to do something and who haven’t been idiots are President Obama, MA Gov. Deval Patrick, Texas Gov. Rick Perry (no, really), and NYC Mayor DeBlasio.

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7 Responses to The Question About Ebola Restrictions That Is Still Unanswered

  1. crestwind24 says:

    So true! I completely agree! I wish politicians, and people in general, would listen to the science… and the logistics, as you perfectly point out.

  2. Iaato says:

    So let me get this straight. You’re arguing that if we follow quarantine policies, we won’t have enough healthcare workers (which is already the case, even before flu season, much less EVD). So we shouldn’t quarantine exposed healthcare workers, who are either low risk, or high risk, depending on how one interprets the doublespeak coming from our politically-directed healthcare guidance organizations?

    Do we prioritize freedom or public health, and should we politicize the most dangerous epidemic to emerge in the past century? And why are our politicians claiming the high ground based on science and evidence, when the guidelines are changing on a daily basis, and are still nowhere near adequate to protect hospitals and public health? Politicizing this issue leads to muzzled required responses, and it could be a huge, deadly mistake for the United States.

    From the ECDC’s latest guidance:

    “Occupational exposure of a healthcare worker, including laboratory workers, involved in caring for a confirmed EVD patient using appropriate personal protective equipment. Contact with EVD patients using appropriate personal protective equipment is considered to be low-risk exposure. However, given the continuous nature of the occupational exposure involved in caring for patients, such exposures should be dealt with as high-risk exposures.”

    Here are today’s changes to WHO recommendations, which are significant. Will our fossilized, over-extended bureaucracies be able to respond to any of this?

    http://afludiary.blogspot.com/2014/10/who-video-updated-recommendations-for.html

    • Vene says:

      “You’re arguing that if we follow quarantine policies, we won’t have enough healthcare workers (which is already the case, even before flu season, much less EVD).”

      If you follow fear driven quarantines, yes. If you follow evidence driven then you’re fine.

      “Do we prioritize freedom or public health, and should we politicize the most dangerous epidemic to emerge in the past century?”

      1) There is no conflict as Ebola only can spread when there are symptoms. No fever means there is no rational reason to quarantine.
      2) Everything is political.
      3) Look up the Spanish Flu of 1918. Far, far more dangerous than what is going on today.

    • In your concerns about high risk or low risk, you ignore one thing…
      That people with no symptoms are not a risk to others.

      You seem to be interpreting that quote as anyone with a risk of exposure, is themselves a risk to others.

      And that’s simply not what that says at all.

      Health care workers who deal with patients with symptoms… that means the exposure may be treated as a risk – to the health care worker. It doesn’t make the health care worker simultaneously a risk to everyone else. Not unless & until they have symptoms themselves.

      • Iaato says:

        Be careful using the word “evidence” as a dogma, Vene. The evidence on transmissibility with this disease is weak. What we know for sure is that the disease becomes more transmissible as patients get sicker, through routes that expose caregivers, primarily.

        My concern about how we categorize HCW level of risk has to do with the bigger picture, WP. With surge capacity and our ability to react, and HCW and hospitals as a vector for further spread as this gets rolling.

        • Nobody’s suggesting not monitoring health care workers who work with sick patients.

          But unless and until they have symptoms, they are not “vectors”.

          And monitoring for elevated temperature will catch the very first earliest symptom.
          It’s not an either/or proposition. It’s not quarantine or nothing. Monitoring is an adequate something.

          Unless you really think that health care workers are going to “carry it out” with them somehow. Considering how relatively infrequently health care workers without protective gear & little oversight in their practices carry any diseases to or from the hospital, I think it’s unreasonable to think that health care workers under extreme protective gear & monitoring conditions are going to accidentally carry the virus out of the hospital with them.

          I really don’t like how hospitals, in nothing other than an effort to save money, make health care workers wear their work clothes to & from home and wash their own work scrubs at home with their family’s laundry, or at the laundromat.
          If nothing else, the appearance of that seeming impropriety is damning, and probably adds to people’s fears of germs being spread.
          I know I find it off-putting.
          And I hope if nothing else, the Ebola scare changes this worker-unfriendly public-image-tarnishing practice.

          But this just isn’t going to happen with Ebola protective gear. It’s just not.
          Nobody’s going to be wearing the plastic smock with patient vomit on it out of the hospital.
          They’re not going to be walking out of the patient room & out into the street with their protective booties.

  3. anon says:

    Yes, you stay overly cautious on isolation with a healthy, probably unnecessary, margin of error to prevent the disaster of the virus getting a foothold in the country. Obviously, if the worst happens and we have 1000+ cases, those rules would have to be altered to the bare minimum safety standards to keep healthcare workers on the job.

    With 7 cases we can schedule special flights for patients, put them in hazmat suits, and transport them to isolation centers that are equipped for 3 patients like Emory. With a 1000+ cases we couldn’t afford to do that either. Rules and responses cannot be static. They should reflect the most sensible reaction relative to the current state. If conditions change on the ground, our response will have to change.

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