Ebola – Yes to isolation, quarantine, and travel restrictions (Part III)

By Adil E. Shamoo, Ph.D. (guest blogger)

The HIV experience can be used as a learning model to understand what processes may need to be used for this Ebola epidemic. While there are differences, there is much similarity, especially in the deadliness of the virus of both diseases in the early phase of the epidemic. Both are also transmitted through contact with body fluids, and can be transmitted through sexual contact. This aspect should not be overlooked; the sex drive is very strong and frequently sexual relationships defy logic and rationality.

Some people consider the way the public health system treated the HIV epidemic as a success and many have celebrated the policies that led to a more controlled disease. In the US, the number of HIV infections is way down. However, the first decade of treating HIV infection in the U.S. and worldwide was a colossal failure from all sides. The current numbers of HIV infections and other sequelae of the disease are the proof (see the table below). We failed to take strong measures to delay or stop the spread of the disease for political reasons and political correctness. Our political leadership and the public health system were an abysmal failure in controlling the spread of the disease.

The number of worldwide infections since HIV inception in 1981 is 75 million; 39 million died. Currently, there are 35 million infected and in 2013 alone 1.5 million died and 2.1 million new infections. In the U.S. alone, we have had 1.7 million infected since its inception with a death toll of 658,992. In 2013 we had 1.1 million living with HIV and 7,683 deaths. The number of infections in the U.S. in 2013 alone is 50,000 (these numbers were culled from WHO, 2014, CDC, 2014).

The public health system failed at the beginning of the epidemic in 1981. We knew from the beginning that sex was the main culprit in spreading the disease but we kept the bathhouses open, where sex with multiple partners was rampant, in New York City until 1985 and in San Francisco till 1987 . The 1987 bestselling book by the San Francisco Chronicle journalist, Randy Shilts, And The Band Played On chronicles the failure of the federal and local government’s public health system in controlling the spread of the disease. The failure of many other segments of society (including the gay community) to explain the importance of abstinence for affected individuals and using measures such as condoms to save lives seems inexplicable today. Yet it is understandable that the gay community reacted to further isolation since they were demonized and marginalized within their wider communities (including the public health community). Thus public trust was lost in the very agencies that could have helped. The dollars allotted for public health on HIV infection, research, drug and vaccine development were paltry. As we now face the widening spread of Ebola cases, now into tens of thousands, it will be difficult to eradicate the disease, just as in HIV infection.

The best evidence that isolation and quarantine dramatically reduces the spread of the disease comes from the Ebola experience in West Africa. The evidence indicates that the best way to slow the spread of the disease is the isolation and quarantine currently in use. No one would now suggest that we should eliminate isolation and quarantine in West Africa. In this article, the debate is whether we extend the isolation and quarantine to healthcare workers returning from West Africa and additional restrictions on travel.

In retrospect, the spread of HIV could have been slowed down, in the first decade, if isolation and quarantine was instituted in the first few years in the U.S. and if other countries were encouraged to do the same. Simply, if health and political leaders (with few exceptions) were interested in the health of patients devoid of social and political factors, we could have reduced the spread of the disease. The World Health Organization could have taken a stronger leadership in this direction.

The current resources provided to combat this disease are not commensurate with the magnitude of risk from the Ebola epidemic. Resources should be directed to West African nations to mitigate/eradicate the disease. For example, the presence of one or two dozen facilities in the entire United States to quarantine Ebola patients is not adequate. A few hundred or a thousand patients with Ebola in the U.S. would overwhelm the present system. The Reagan administration could have taken the leadership in such a national crises in providing resources. It was only when C. Everett Koop, then the Surgeon General, took the leadership on the HIV epidemic in defiance to the White House (See Shilts’ book). Dr. Koop announced public health measures to reduce the spread of HIV infection. Among the measures to reduce the spread of the HIV infection was to strongly recommend the use of condoms.

Let’s not repeat the mistakes we’ve made in the past. Recognizing that sexual contact is a factor must be addressed with formal recommendations; the use of quarantine and other isolating practices should be more seriously considered. Public health officials should be more open with our political leadership in combating the scourge of Ebola in order to protect the public.