New York doctor Craig Spencer is now Ebola-free and released from quarantine. And last month, Maine officials decided to allow Kaci Hickox to roam free. Hickox—the Doctors Without Borders nurse who was initially quarantined in a tent near Newark Liberty International Airport in New Jersey after returning from treating Ebola patients in Sierra Leone—had twice tested negative for the virus and had defiantly fought attempts to limit her movements, first in New Jersey and then in Maine.
These two health care workers may now be healthy and home but the question remains of whether it makes sense to automatically quarantine health workers when they return from an Ebola tour of duty—as New York State is also doing for anyone who has been in direct contact with an Ebola victim. In both New York and New Jersey the 21-day quarantine is mandatory—including for returning persons who show no symptoms (and therefore are not contagious)—but can be served at home. Georgia, Illinois and other states have also enacted mandatory quarantines.
Doctors Without Borders (MSF) and other international health organizations argue that such quarantines are unnecessary and hinder efforts to combat Ebola. The prospect of being forcibly detained and a focus of public fear, they say, is making previously gung ho health recruits think twice about volunteering.
A chilling effect
According to Margaret Aguirre, head of global initiatives of the International Medical Corps, roughly 25 percent of the organization's prospective volunteers to work in Ebola-stricken regions have reconsidered. “We have had many people who have been forced to back out and many people who are really rethinking it,” she says.
The quarantines have also hindered MSF operations. People have “chosen not to go to the field because of the restrictions they may face upon their return,” Sophie Delaunay, executive director of the organization said in a statement prepared last week. In addition to quarantine, she noted, returnees are facing prejudice and discrimination from their communities, with some reporting having to find to alternative living arrangements.
Hickox has been widely ridiculed for ducking the quarantine, and the scorn and restrictions volunteers face on their return are compounding what is already a difficult recruiting task, Aguirre adds.
Many people were already reluctant to volunteer both because of the risks involved in caring for Ebola patients in an underdeveloped west African health system and because of the necessary time commitment. The large scale of the crisis has led the International Medical Corps to ask volunteers to commit six to eight weeks, double the time normally requested in an emergency. “Add on top of it a potential quarantine or travel restriction and for many people this simply becomes unworkable,” Aguirre says.
This cutback in volunteering is especially devastating for operations that, like the International Medical Corps, depend on only a very small pool of volunteers in the U.S. to go abroad and train local communities in medical practices. “The way Kaci Hickox has been treated doesn’t inspire a lot of confidence in the people who are stepping up to do this work,” says Joia Mukherjee, associate professor of medicine at Harvard Medical School and chief medical officer of Partners in Health. “Particularly with the holidays coming up we’re really worried about people feeling like they might get stranded and not helping out,” she says. “There’s going to be as much Ebola in December as there is now, if not more so.”
No scientific merit
Mukherjee says there’s no scientific merit to the quarantine orders in effect in New York and New Jersey, and calls them an inappropriate restriction on civil liberties. “When you have a slight symptom, like a fever, you have very, very, very little circulating Ebola virus,” she explains. That amount can make the test show positive “but you’re not vomiting Ebola, you’re not having diarrhea with Ebola, you’re not sweating Ebola”—which means you are effectively not contagious.
Aguirre agrees: “People have serious misconceptions about the nature of Ebola and the way it’s passed.” Such mistaken notions may also inhibit health workers from volunteering to care for other diseases such as typhoid and malaria. A school in Kentucky, for instance, recently asked a teacher to take leave after she had returned from Kenya—a country in east Africa thousands of kilometers from the Ebola outbreak.
The people who object to the states’ measures are not saying that returning medical volunteers should skip all precautions. Rather, they say, the quarantines currently being imposed are an overreaction. Most international medicine organizations require volunteers to agree to a quarantine process based on what is known about the Ebola virus when they sign on for the mission. “We have extremely strict protocols. We are checking people daily and we are being enormously rigid and careful,” Aguirre says.
Partners In Health, for instance, has specific protocols for returning volunteers based on the individual's risk of having contracted the virus. Even people at low risk take their temperatures twice daily and people who are “low intermediate” risk receive in-person checks on their health. Such intense monitoring ensures that the virus is detected long before an individual becomes a threat to the public. We want to create an environment “where people can feel that they’ve done their part—and we laud them for their bravery and solidarity and we take care of them when they’re sick,” Mukherjee says, not one “where people have to go underground and hide and be treated as a criminal.”