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10/28/2014

If no travel restrictions, then….quarantine?

As the Ebola epidemic rages on, the debate about travel limitations has moved inevitably to the next stage: whether there ought to be a quarantine imposed on healthcare providers and others returning from service in endemic areas. We have been reading two opposing views, one emphasizing, as did Governor Christie of New Jersey, that “the obligation of elected officials is to protect the public health of all the people,” and the other warning of the “disincentive” and “stigma” that would affect those healthcare professionals who might volunteer in West Africa.

The fear of stigma remains a curious phenomenon. It is plainly obvious by now that healthcare workers caring for Ebola patients are the most likely Americans to catch the disease. I propose that their free and unquarantined movement through society would not make them suddenly immune to stigma. If science and its facts are to guide our decisions, we must not shirk from finding all facts that are relevant to the decision at hand. For example, key to such a decision would be to find out how likely it would be that healthcare workers would change their mind about serving in the Ebola epidemic if they knew that they’d face a 21-day quarantine afterwards. I won’t claim to know the answer, but nobody else knows it either. If “science” is to be our guide, then we ought to do the research and not speculate. One could easily posit that healthcare workers would be encouraged by having the confidence that they would return to accommodations that would ensure that the risk that they would transmit a deadly disease to loved ones was zero. As one Army physician told me, if he were exposed to a patient with suspected Ebola, he would not go home to his wife and children until the risk was nullified.

The Army’s self-imposed quarantine is enlightening. The Army knows full well how disruptive such a risk could be to a community, undermining its ability to function, both in how it supports itself and how it moves toward its goals (for the Army, of course, its mission). It knows the importance of establishing confidence and trust within its community, and with its neighbors. The Army also has vast experience in safety and risk assessments, and as anyone who has gone through the Army’s mandatory safety training knows, risk is determined by both the likelihood of occurrence and the severity of consequences. Admonitions from the director of the CDC that Ebola is not contagious like cold or flu viruses are willingly silent on the obvious fact that if a person catches Ebola, he or she is likely to die. My opinion is that Major General Darryl Williams is more circumspect about the totality of consequences than is Dr. Frieden.

Similarly, if our society is going to move forward on the admirable mission of assisting nations in West Africa, we need to have the confidence and trust in each other, and throughout our entire complex and interactive society, that can only be achieved by the discipline and assurances exemplified by the Army’s latest actions. I am sure there is a science for that.

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