IU experts: Ebola quarantine isn’t good science
One month ago, Thomas Eric Duncan was hospitalized for Ebola in Dallas. The immediate response of the federal government was muted and less than coordinated.
However, the recent appointments of Ron Klain as the White House’s Ebola czar and Karen DeSalvo as acting assistant secretary at Health and Human Services promised an end to this fragmented response. The Centers for Disease Control and Prevention stepped up its game with new guidance while Homeland Security’s screening at the five major gateways seemed more proportionate than politicized fear-mongering proposals to close our borders or institute wrong-headed travel bans. For a while there was the promise of a measured, national response.
That was until a Doctors without Borders physician, one of the few heroes of this tragedy, rode on a subway in New York and went bowling. The physician, who had been responsibly monitoring his condition since his return from West Africa, immediately notified health authorities and is being treated at Bellevue Hospital.
Fragmented, politicized reaction was immediate. The governors of New Jersey, New York and Illinois (all states with gateway airports) invoked their residual “police powers” and promulgated emergency quarantine rules. The rules differed in their wording, some were vague, maybe even unenforceable.
But that didn’t help the symptom-free Doctors without Borders nurse who landed at Newark and shortly thereafter found herself in an isolation tent within Newark’s University Hospital. Critical media exposure and an obviously irked White House may not have changed an unrepentant Gov. Chris Christie’s mind. But, with her attorneys prepared to challenge the order for being too broad and after her blood test came back negative, Kaci Hickox was released.
The laws and ethical principles that govern public health response require that authorities balance any infection risks to the public against harm to individual liberty rights. Specifically, these laws and principles say that public health authorities must use the least restrictive means possible to protect against an infection spread. Similarly, good ethics calls for a proportionate balance between the limiting harms to individuals and protecting the public. The only way to know what would be the “least restrictive” is to take into consideration what science tells us about how and when infections can be spread.
Ebola, while quite deadly if it is transmitted, is a very difficult virus to be infected with.
Duncan, the Liberian national who has been the first and only person in the United States to die from Ebola during this outbreak, initially was misdiagnosed at a Dallas emergency room and sent home. While home, suffering from the early symptoms of Ebola, he lived for three days in a small Dallas apartment with his significant other, their 13-year-old son, the daughter of his significant other, and a nephew. Once admitted to Texas Presbyterian Hospital, as many as 70 people were involved with Duncan’s care. Yet, of all of the people who interacted with him while he had symptoms, only two ended up getting infected. These were not members of his family, or of the general public but nurses intimately involved in his care while in isolation, when he was hemorrhaging blood, vomiting, receiving constant intravenous fluids and blood transfusions. After receiving treatment, both nurses have returned home, cleared of the infections.
Placing the Doctors without Borders nurse in a hospital-based quarantine for 21 days might have been a show of political decisiveness, but it is not supported by science. It also is a violation of individual liberty rights, is likely to stoke already inflamed prejudices, and it breaks the trust we place in government to use the best available evidence when taking action. Other governors must learn from the events of last weekend and resist disproportionate reactions when the only possible rationale is to show they are “tough on Ebola.” This is a time to be led by science and a respect for individual liberty, not to create more dysfunction by fragmenting the response, and sending mixed messages that will create more rather than less fear. At the moment science tells us we should be concerned not fearful while both law and ethics require respect for liberty rights.
Meslin is founding director of the Indiana University Center for Bioethics; Priest is an assistant dean in the Indiana University School of Nursing; Silverman is a professor of health policy and management in the IU Richard M. Fairbanks School of Public Health; Terry is a professor of law at IU’s Robert H. McKinney School of Law.