Cracking the Quarantine Conundrum

Recently, to the chagrin of the CDC, Governors Cuomo and Christie instituted mandatory quarantine procedures at John F Kennedy and Newark Liberty International Airports. Dr. Howard Zucker, Commissioner of health for New York State, explained that:

Any individual while in one of the three West African nations who had direct contact with  infected people or people who could have been infected with the Ebola virus and including any medical personnel having performed medical services to infected patients will be automatically quarantined.

The CDC is not happy about this decision because, according to a Federal official: “They're very worried we won't be able to get physicians or nurses to go (to countries affected by the Ebola outbreak)."

A problem with this argument is that medical personnel who go to these countries already know they risk contracting Ebola. If that doesn’t dissuade them, it is unlikely that a mandatory 3-week quarantine period will.

The CDC, in addition to being against mandatory quarantines, is against restricting travel to these countries for the same reason. CDC director Dr. Thomas Frieden said that a travel ban could hurt Americans in the long run, by limiting the ability of relief workers and supplies to get into West Africa's Ebola zone. At a news conference, Dr. Frieden said:

Until the disease is controlled in Africa, we can't get the disease to zero here.

One problem with this argument is that doctors can be sent to high-risk countries even with travel restrictions. 

Dr. Frieden also made the argument that:

Right now, we know who is coming into the United States. If we try to restrict air travel, people from West Africa may try to get into the United States by land. Our borders are porous, and if West Africans enter over land, we will not be able to monitor them for fever or to question them when they enter the country.

If our borders are porous, the solution is to seal the borders. In order to cross from Mexico into the United States, West Africans with Ebola would first have to get into Mexico. That is not easy -- in fact, Mexico recently refused to allow a Carnival cruise ship carrying a nurse who treated a patient with Ebola to land at Cozumel. 

Dr. Frieden’s argument that “we will not be able to monitor them for fever” is strange because he currently relies on people voluntarily monitoring themselves for fever. A person from a high-risk country who has seen the horrors of Ebola first hand is not likely to need government encouragement to get medical help if he gets a fever.

Dr. Frieden is right that getting the disease under control in Africa would reduce the risk of the disease spreading to the United States. The problem is that sending doctors there increases the risks of those doctors spreading infections when they return to the United States. Dr. Spencer, who treated Ebola patients in Guinea, is an example. His case was the impetus for the decision of Governor Cuomo and Governor Christie to institute mandatory quarantines. 

One factor that needs to be weighed in considering travel restrictions is how lethal Ebola is and how easily it is spread. There is no debate regarding its lethality, but there is debate on whether Ebola is airborne. Dr. Frieden says it isn’t. Canadian scientists have shown that infected pigs can pass the deadliest species of Ebola to monkeys without ever coming into contact with them. A U.S. military medical handbook says  “In several instances, secondary infections among contacts and medical personnel without direct body fluid exposure have been documented.” One glance at a photo of Dr. Spencer attired in full medical protective gear makes it clear that he was careful. Yet he was infected. Questioning of nurse Nina Pham, who became infected after treating Thomas Duncan, found no breach of protocol. Such evidence has done nothing to lead Dr. Frieden to question his assumptions. Perhaps Dr. Frieden is attempting to prevent panic? The best way to do that is to prevent Americans from getting sick, to tell the truth so that adequate precautions are taken, including steps to prevent airborne transmission to medical personnel, restricting travel to high-risk countries, and quarantining people who have been to those countries.