This article was published in Scientific American’s former blog network and reflects the views of the author, not necessarily those of Scientific American
Today a judge in Maine ruled that quarantining nurse Kaci Hickox is not necessary to protect the public from Ebola. Hickox, who had been in Sierra Leone for a month helping to treat people infected with Ebola, had earlier been subject to a mandatory quarantine in New Jersey upon her return to the U.S., despite being free of Ebola symptoms (and so, given what scientists know about Ebola, unable to transmit the virus). She was released from that quarantine after a CDC evaluation, though if she had stayed in New Jersey, the state health department promised to keep her in quarantine for a full 21 days. Maine state officials originally followed New Jersey's lead in deciding that following CDC guidelines for medical workers who have been in contact with Ebola patients required a quarantine.
The order from Judge Charles C. LaVerdiere "requires Ms. Hickox to submit to daily monitoring for symptoms, to coordinate her travel with state health officials, and to notify them immediately if symptoms appear. Ms. Hickox has agreed to follow the requirements."
It is perhaps understandable that state officials, among others, have been responding to the Ebola virus in the U.S. with policy recommendations, and actions, driven by "an abundance of caution," but it's worth asking whether this is actually an overabundance.
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Indeed, the reaction to a handful of Ebola cases in the U.S. is so far shaping up to be an overreaction. As Maryn McKenna details in a staggering round-up, people have been asked or forced to stay home from their jobs for 21 days (the longest Ebola incubation period) for visiting countries in Africa with no Ebola cases. Someone was placed on leave by an employer for visiting Dallas (in whose city limits there were two Ebola cases). A Haitian woman who vomited on a Boston subway platform was presumed to be Liberian, and the station was shut down. Press coverage of Ebola in the U.S. has fed the public's panic.
How we deal with risk is a pretty personal thing. It has a lot to do with what outcomes we feel it most important to avoid (even if the probability of those outcomes is very low) and which outcomes we think we could handle. This means our thinking about risk will be connected to our individual preferences, our experiences, and what we think we know.
Sharing a world with other people, though, requires finding some common ground on what level of risk is acceptable.
Our choices about how much risk we're willing to take on frequently have an effect on the level of risk to which those around us are subject. This comes up in discussions of vaccination, of texting-while-driving, of policy making in response to climate change. Finding the common ground -- even noticing that our risk-taking decisions impact anyone but us -- can be really difficult.
However, it's bound to be even more difficult if we're guessing at risks without taking account of what we know. Without some agreement about the facts, we're likely to get into irresolvable conflicts. (If you want to bone up on what scientists know about Ebola, by the way, you really ought to be reading what Tara C. Smith has been writing about it.)
Our scientific information is not perfect, and it is the case that very unlikely events sometimes happen. However, striving to reduce our risk to zero might not leave us as safe as we imagine it would. If we fear any contact with anyone who has come into contact with an Ebola patient, what would this require? Permanently barring their re-entry to the U.S. from areas of outbreak? Killing possibly-infected health care workers already in the U.S. and burning their remains?
Personally, I'd prefer less dystopia in my world, not more.
And even given the actual reactions to people like Kaci Hickox from states like New Jersey and Maine, the "abundance of caution" approach has foreseeable effects that will not help protect people in the U.S. from Ebola. Mandatory quarantines that take no account of symptoms of those quarantined (nor of the conditions under which someone is infectious) are a disincentive for people to be honest about their exposure, or to come forward when symptoms present. Moreover, they provide a disincentive for health care workers to help people in areas of Ebola outbreak -- where helping patients and containing the spread of the virus is, arguably, a reasonable strategy to protect other countries (like the U.S.) that do not have Ebola epidemics.
Indeed, the "abundance of caution" approach might make us less safe by ramping up our stress beyond what is warranted or healthy.
If this were a spooky story, Ebola might be the virus that got in only to reveal to us, by the story's conclusion, that it was really our own terrified reaction to the threat that would end up harming us the most. That's not a story we need to play out in real life.