Quarantine Nurses & Doctors Returning From Treating Ebola in Africa?

There is no new thing under the sun, least of all panic at the approach of an epidemic of a deadly disease. In 1720, the preface to Loimologia, Nathaniel Hodges’ account of the Great Plague of London in 1665, first published in Latin in 1672, referred to the outbreak of plague in Marseilles:

The Alarm we have of late been justly under from a most terrible Destroyer in a neighbouring Kingdom, very naturally calls for all possible Precautions against its Invasion and Progress here…

In fact, though no one was to know it, no epidemic of plague was ever to occur in Western Europe again; and it is doubtful whether the precautions referred to made much difference.

The death rate from the Ebola virus is probably greater than that from bubonic plague, though of course the plague spread much faster and killed far more people in total than Ebola ever has: and at least we, unlike our plague-ridden ancestors, know the causative organism of the Ebola disease, even if we are not certain how the virus first came to infect Mankind.

That should help us to formulate a rational approach to the Ebola epidemic, but somehow it does not. However, children in Connecticut, I am reliably informed by a mother there, have definitely not panicked: in her child’s school playground, children playing tag call “Ebola!” when one of them is tagged, and must then fall down dead to the ground.

A recent editorial in the New England Journal of Medicine considers the imposition by the governors of a number of states of a compulsory quarantine of 21 days on all health workers returning from West Africa where they have volunteered to care for patients suffering from Ebola. The authors of the editorial consider the imposition not only irrational and unnecessary (though effective), but in some way dishonoring of the volunteers. “We should,” they write, “be honoring, not quarantining health care workers who put their lives at risk not only to save people suffering from Ebola virus disease in West Africa but also help to achieve source control…” This rather implies that there is a negative moral judgment implicit in quarantine, but honor and quarantine do not seem to me to be, at least in logic, opposites.

What of the argument, though?

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A patient infected with Ebola virus does not become infectious to others until he begins to suffer from symptoms. Fever precedes the infectious stage, so that if any returning health care worker were properly monitored, or monitored himself, for fever, there would be plenty of time to isolate him appropriately. Moreover, the fact that a patient’s fever precedes his infectiousness to others is not just a fallible clinical observation, of the kind that doctors have been making, more or less accurately, since the time of Hippocrates, it is borne out by virological studies, which show that the virus multiples dramatically after, not before, the onset of fever.

The authors say that if, by imposing quarantine on return, we reduce the number of volunteers, we are harming ourselves inasmuch as the volunteers help to prevent the spread of the disease at the source, and thus the likelihood of importation into the United States or Europe.

The authors recognize the need to reassure the public which “does need assurances that returning workers will have their temperatures and health status monitored according to a set, documented protocol.” But are “set, documented protocols” fool-proof? The problem is that the public is always much more concerned by unfamiliar but infinitesimal risks than by much larger but familiar ones. Political leaders – or is it followers? – know this only too well and behave accordingly.

As for the screening of passengers at airports, it is useless: but we feel much better doing something useless than doing nothing.

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