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Do quarantines work?

October 27, 2014

Ask Nigeria. On October 20, that nation was declared Ebola-free after just 20 cases and eight deaths were traced to their “index patient”. Their containment and control methods are detailed in an article published October 18 on Scientific American.com.

The article quotes the World Health Organization (WHO) as declaring the response and outcome “a piece of world-class epidemiological detective work.” It also quotes a Vanderbilt University chair as saying that the methods employed were simply standard, albeit vigorous, public health practices. Those practices include quarantine.

When the current Ebola outbreak in Africa began receiving media coverage, long before anyone was concerned about it reaching American shores, two main obstacles to controlling it were cited,  even when good healthcare was available.

Those were publicized as failure of infected or exposed persons to maintain standard public health quarantine disciplines and the practice of washing the deceased without any protection being used by the people preparing the body for burial.

Fast forward to the present. Two governors, one Republican and one Democrat, and a Democratic mayor instituted the protocols the Centers for Disease Control (CDC) and WHO have established as the minimum requirements to contain potentially infected, i.e. possibly symptomatic returnees from South Africa.

It’s tough to be the first anything, and nurse Kaci Hickox drew the short straw to be the first returning health care worker to be quarantined, after reportedly registering a fever upon entry into the U.S.

Given that government workers aren’t the most tactful in the world at any time, and especially not in that circumstance, one can readily imagine that Ms. Hickox wasn’t dealt with too tactfully, and she’s none too happy about it.

Her anger is understandable, even forgivable. Unfortunately, she is paying the price for the confusion and ineptitude evidenced by the CDC and the National Institutes of Health(NIH) and the lackadaisical attitude of some of her fellow health care workers.

Those healthcare workers don’t seem to have grasped the importance of following the same public health care protocols that WHO lauds as the reason Nigeria is now Ebola-free.

One can rationalize that government agencies are ham-fisted and ineffective at best, and that their best has certainly not been in evidence since our index patient Mr. Duncan arrived and died here.

What’s harder to understand is why healthcare workers returning from Africa would be angry about trying to contain a disease that they know results in over 50% fatalities, and that has reportedly killed hundreds of their fellow healthcare workers.

Given that the CDC guidelines for self-monitoring seem to be being made up as we go along, it still is an immutable fact that every single one of the folks that were supposed to be self-quarantining themselves haven’t done so unless forced to by the authorities.

The latest doctor to be hospitalized reportedly had  unusual fatigue, which is listed as one of the early indicators, but still interacted freely in his city, which just happened to be the largest city in the U.S.

The excuse for that is given that he “knew” he wasn’t contagious until he had active symptoms.

Whether that’s due to the “It isn’t going to happen to me” mindset, or a lack of understanding or recognition of the actual symptoms of the disease doesn’t matter.

What these people, that the rest of us rely on to protect our health in normal circumstances, are doing when they know they are at risk borders on reckless endangerment.

The public is understandably confused about how these supposedly well-trained and well-protected healthcare workers are getting the disease in the first place.

It may well be due to a breakdown in protocol or ineffective standards, but the fact remains that they are getting the disease. Some of them are dying from it, and apparently in many cases they at least report that they followed all the required protocols.

Dr. Fauci of the NIH is concerned that strict quarantine procedures will deter healthcare workers from going to Africa.

Maybe it will. But one could hope that it might also result in a more serious attitude among those healthcare workers about getting infected in the first place, i.e. not being careless about infection control while in Africa. If it doesn’t, or if that level of protection simply isn’t available, maybe they shouldn’t be going.

If they choose to go anyway, then accepting the consequences when they return home has to be a part of their decision.

It is highly likely that we can come up with a better quarantine system than a tent in a hospital parking lot without a shower. That was inept at best, but it was the best solution at hand at the time. If we are supposed to cut the CDC and WHO some slack, we could apply the same forgiveness to the state of New Jersey.

The inadequacies of that housing aside, quarantine apparently works to contain infectious diseases.

With any luck, Ms. Hickox will not contract Ebola. No one wishes that on her. But before she gets too much more outraged, perhaps she and her colleagues might remember the basic tenet of medicine.

First, do no harm.

From → op-ed

4 Comments
  1. There’s a difference between indexing and tracing possible exposure to a disease, and sticking a trained provider with no symptoms in a tent out of blind panic. She had no fever. Under-qualified workers kept her detained long enough to get angry, then misinterpreted a forehead “flush” reading of 101 without getting an oral confirmation from a disposable thermometer. Once she got to the hospital, they confirmed she had no fever. But they still kept her.

    Ignorance and fear spread disease too. People avoid vaccinations out of ignorance, and now we have resurgences of diseases we could have wiped off the Earth.

    The reason workers get the disease in Africa is because they treat hundreds under the worst conditions imaginable, having to disinfect and re-use gloves and gowns, no running water, in abominably hot weather. It’s easier to make mistakes.

    The reason workers get the disease here is because they haven’t been trained, or in cases like Texas Presbyterian, are making up protocols “on the job”. Even then, few get infected. We have hot water, laundry facilities, and plenty of gear.

    • You raise valid points. However when you say she was detained by under-qualified workers, then who exactly would you suggest we get to make a 100% accurate diagnosis on the spot? The protocol is the one the CDC says should be in place, i.e. if the person shows a fever, then they are referred for more thorough testing. Since we don’t yet have an on-the-spot test, that means people are at least going to be detained until currently available testing methods exclude them. I grant you all the “extenuating conditions” you cite for why people are getting infected. But they ARE getting infected, and each confirmed case generates a radiating circle of contact, and every single one of those people has to be identified, tracked and monitored. Not only is that incredibly disrupting to THEIR lives, it’s damned expensive as well. Could we come up with a better testing method or less lengthy period of time to hold the returnees? Undoubtedly. Should one person’s hurt feelings mean that we should stop all testing and quarantine protocols? I don’t think so.

      • According to the nurse herself, it would have been easy to confirm a correct temperature reading using a disposable oral thermometer, but those who examined her refused to provide one. She had no fever. They misread a forehead “flush” after getting her angry from three hours of senseless questioning. When she got to the hospital, they agreed she had no fever, therefore no symptoms, therefore she was being detained illegally. We have to expect these kinds of hiccups when there’s no nationally consistent protocol for quarantine or treatment, like there is in other countries.

        You can’t get Ebola from casual contact, and if a person has no symptoms they aren’t infectious. Staying at home, with mandated twice-daily check ins to the health care system is enough. There’s no advantage to using “plague tents”, as if this was the Crimean War.

  2. OK. Whatever you say. The authorities said she tested high with one of those handheld units as soon as she got off the plane, she says that isn’t true. I wasn’t there and I doubt you were either, so I guess neither one of us will know. You’re entitled to your opinion, and I’m entitled to mine, and while I may agree that the initial case of quarantine was poorly handled, so was the first case of Ebola to arrive in the U.S. Of the two missteps, I’ll take the quarantine problem over the Ebola problem. The first can’t kill you, the second one can.

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