Doctor recommends extending the quarantine period for Ebola
Dr. Manoj Jain, MD, MPH, has written a thoughtful piece published at the Huffington Post that examines the one-size-fits-all 21-day quarantine period for individuals exposed to Ebola:
For me, a recent article in the New England Journal of Medicine detailing the first nine months of the 2014 epidemic in West Africa raises concern about the short, often-mentioned 21 post-exposure-day periods in the guidelines. In the journal's study of 4,507 probable and confirmed cases, "approximately 95 percent of the case patients had symptom onset within 21 days of exposure." If we do the math, this means that approximately 5 percent or 225 of the Ebola cases in West Africa had symptoms 21 days after exposure, as reported by the patient or caregiver. (snip)
… Getting a history of possible date of exposure in a potential Ebola patient in a developing country during an epidemic is difficult … patients often do not provide an accurate history because they may not recall the sequences of events or they may have wishful thinking, hoping they have long passed the time after exposure. (snip)
… I believe we need to individualize the duration of quarantine based on exposure and risk of acquiring Ebola infection ….
While data are not available for Ebola, with most other viral infections, the greater the exposure inoculums (vomitus or blood touching the mucus membrane of health worker or family member during peak of illness) the shorter the incubation period, hence those with minor or minimal exposure may be more likely to show a longer incubation time.
The piece is outstanding and worth reading in its entirety. Dr. Jain has raised excellent points that should be embraced by all of those with the power to do something about this pressing issue.
Meanwhile, in addition to reassessment of quarantine guidelines, we need to stop all flights from Ebola-stricken nations, temporarily suspend the 13,000+ visas from people in those countries, and by all means, not go out of our way to bring those who are already sick to our shores.
There is little wiggle room to get this wrong. Little leeway to make mistakes. Call your elected officials and demand common sense measures be put in place immediately.