Ebola: An Enemy of The People

Sure, it’s a little affected to title an article referencing an Ibsen play; but the similarities are too great. In that play, a doctor was darling of a community until he did not do what the community wanted. This is similar to what is happening to healthcare workers who treat Ebola patients.

The facts here are changing by the minute. The more I write, the more the news changes. The quarantining in New Jersey of the nurse who returned from western Africa has raised many issues. She is currently threatening to sue the State of New Jersey because she feels her civil rights have been violated. As of now three states, New York, New Jersey and Illinois have executive orders stating that they will quarantine anyone who has had direct contact with an Ebola patient, including American healthcare workers returning from Africa. (What about someone sitting next to them on a subway? Is that direct contact? )

What bothers me is how she was apparently being treated. According to her she is being kept in an unheated tent outside of Newark Airport and being given nothing to wear but hospital scrubs. Where are we, in Liberia? Obviously the fear and “cootie syndrome” created by one doctor who tested positive for Ebola and roamed the streets of New York while possibly contagious, has caused politicians to act rashly if not illegally. Without knowledge of Ebola and the science that surrounds it, they have caved in to public frenzy and have jumped the shark. They had no plan of action as how to quarantine anyone exposed to Ebola, except to isolate them. They have no definition of what “exposure” is. Does someone sitting next to someone on the subway who turns out to have Ebola count as an exposed person? Will they then be quarantined? Where does it end? They don’t know. They are playing it by ear. That is a scariest thing.

I do know one thing, in the long run this type of quarantining may be increasing EVERYONE’s chances of getting Ebola. Soon few doctors and nurses will go to western Africa to treat patient’s with Ebola if this is what awaits them upon their return. You cannot expect good Samaritans to risk their lives to save us all and then accept being treated like lepers upon their arrival home.

But don’t we quarantine people with dangerous communicable diseases all the time? The answer is yes. The HUGE difference is that we do that once we KNOW they have a communicable disease, not when we just suspect they do. You may think that the stakes are higher here because Ebola is so dangerous. But as of now no one has died from contracting Ebola in the US. Which causes me to have a huge moral dilemma. I believe in quarantining health care workers on the honor principle as a way of stopping spread… but I do not agree with the way it is being done now. However, there may be a solution. The solution once again is science.

There is a test that is used both to detect and follow the progression of HIV. It is called the PCR (polymerase chain reaction) test. It is also used to test for progression of the Ebola virus in someone’s body. If you do not have Ebola in your blood this test will be negative. It is not like the antibody test that can take days or weeks or months to be positive. If you do not have the Ebola genetic material in your blood this test will be negative. What I have not been found in the medical literature is how soon after you are infected with Ebola will this test be positive. If this test is positive within a day or two after infection then problem solved.

When a health care worker returns to America from an endemic area he or she should be given an Ebola PCR blood test and then be placed under home observation, in his or her own home. They must report to health authorities twice a day after that. They must have a PCR test every two to three days. If they have successively negative PCR and do not develop symptoms after a set period of time that “science” has determined to be safe, they can then be released from observation. That is of course if we know that my theory is correct.

Regardless, I hope that the government is taking Ebola PCRs form all health care works returning from western Africa so that we can learn more about the natural progression of this disease. If not, they should create a voluntary research protocol that does this.

If it looks like I have reversed my position on mandatory quarantine, I have! After seeing the reaction of the public and the government, I am now much more concerned about the frightened town’s people storming Frankenstein’s castle, than I am of the virus.

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EBOLA: Quarantine or Internment?

Last Friday night I was asked again by CNN to be a medical expert regarding the Ebola epidemic. Unbeknownst to me, in the interim between CNN’s ask and my actual on air segment, the governor’s of New York and New Jersey had decided to imposed mandatory quarantine on anyone, including healthcare workers, who landed in their state from the most Ebola ridden countries of western Africa. I heard a little bit about this on my earphone before my segment. While one air was then asked what I thought about mandatory quarantine.

I said, that I believed in quarantine. I had thought long and hard about this in the prior days; but obviously not long and hard enough. I gave what I thought was a thoughtful and educated answer. My friend, who was waiting in the greenroom, was uncharacteristically silent when I returned. When he finally gave me his opinion about my segment, all hell broke lose. I feel our discussion was representative of many discussions occurring throughout the U.S. Science vs. Fear. Practicality vs. Rights.

My friend was a bit in shock about my on air response. He felt that my opinion was more in step with the very conservative FOX network than with CNN. (By the way the good people of CNN and FOX have both used my services) He wondered how I could be in agreement with mandatory quarantine, in a hospital or hotel, of ANYONE returning from western Africa; whether they were symptomatic or not. Apparently, the woman who was quarantined at Newark International had a horrible experience; almost to the point of being treated like a prisoner. Much like Japanese-Americans were treated during World War II. The more I read about the episode the more I understood my friend’s anger toward me. The more I read about the incident, the more it became evident that I had to clarify my stance, because we, and I mean America, were at the intersection where fear, science and action meet. We need to be clearheaded here, because it can get ugly quickly if we don’t.

Firstly, let me make my opinion very clear. I believe that anyone who comes from an area where Ebola is endemic must go through a 21-day quarantine period before they can resume their normal day-to-day activity. I also do not believe that this should be at a hospital or make shift quarantine facility being managed by people who are poorly educated on medical facts and techniques. Did we not learn anything from Dallas? People who come from these unfortunate areas, should be sent to their homes for 21 days. They need to report to local or national health authorities twice a day. If they elicit any symptoms they must then report to a designated “Ebola-knowledgeable” hospital to be evaluated.

From what I understand, Doctor’s Without Borders, makes their health care workers follow rules similar to this once they return home. However, find their recommendations not stringent enough. The New York case tends to prove this. The physician in New York City who recently tested positive for Ebola, upon his return from Africa was advised not to go to work and to check in twice a day with his temperature reading. However, he was not prohibited from going out to public places. This walking among the masses when one is possibly infectious is what is fueling the fear that is making many people, including politicians, have knee jerk reactions.

I know that Ebola is not transmissible until someone has symptoms. But what I don’t know is what those symptoms really are. The physician in New York said he felt sluggish two days before he spiked a fever. Is that when he was contagious? Should he have reported it then? Should he have gone to a hospital at that time? I say yes.

The danger that we are facing, which is as menacing as, if not more than, Ebola is that fear may lead to behavior that strips good law abiding American citizens of their rights. We are risking that doctors and nurses not go to western Africa to help contain this epidemic because of what they may face upon their return. This cannot happen. EVERY expert will tell you that the best way of keeping Ebola from coming here is by stopping it there.

I am supporting a middle ground. I am suggesting that anyone coming from an area where Ebola is endemic, who has had direct contact with someone infected with Ebola, be placed under house quarantine under his or her own supervision. They must not go out in public and must report to the appropriate HEALTH authorities under penalty of law. Hopefully this will not deter the good people going to Africa to fight OUR fight from doing so.

We are all a bit scared; but fear cannot prevail. I saw inhumanity win too many times during the beginning of the AIDS epidemic. Let us not repeat those mistakes. We must walk a fine line between humanity and civil responsibility. There is no other choice. We must walk carefully; if not we run the risk of becoming more horrific than Ebola.

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