If you don't have Ebola and can't spread Ebola, you can be quarantined in the USA. Post scientific world - I fear for our future.
— @eliowa
great to see the ID/pub health community united on a Sunday, working get the Ebola response back on track @drmt @eliowa @TimLaheyMD @apc_md
— @philiplederer
Today in #Ebolanoia: Online abuse, threats being heaped on force-quarantined nurse - Below is one of many...
http://t.co/...
— @marynmck
Some interesting developments occurred over the weekend, some medical and some political.
The New Jersey Médecins Sans Frontières (MSF) nurse hastily confined to the unheated tent with the porta-potty (on a cold night!) isn't taking this quietly.
Kaci Hickox, a nurse whose return to the U.S. after treating Ebola patients in Sierra Leone was sidetracked when she was placed in a mandatory 21-day quarantine Friday, is criticizing the way New Jersey officials have handled her case.
Hickox says she doesn't have a fever; a preliminary blood test came back negative for Ebola. She reportedly hired a civil rights attorney Sunday to work for her release.
The mounting criticism has not shown any signs of abating either. In fact, the
White House is now involved.
Federal officials made it clear that they do not agree with the governors about the need or effectiveness of a total quarantine for health care workers, though they were careful not to directly criticize the governors themselves.
A senior administration official, who did not want to be identified in order to discuss private conversations with state officials on the issue, called the decision by the governors “uncoordinated, very hurried, an immediate reaction to the New York City case that doesn’t comport with science.”
Indeed, Mr. Christie said he did not consult with the White House about the decision. “I did not let them know,” he said in a brief interview in Boca Raton, Fla., where he was campaigning for the state’s Republican governor, Rick Scott.
The medical societies, infectious disease experts, public health people and epidemiologists were pretty clear what they thought. But more of that below the fold.
Let's start with the basic CDC page:
Ebola Outbreak: Advice for Humanitarian Aid Organizations
After Employees and Volunteers Return to the United States
If employees or volunteers have a known exposure to Ebola during their trip, advise them to call their doctors even if they do not have symptoms. Their doctors should evaluate their exposure level and consult with public health authorities to determine whether testing for Ebola, monitoring for symptoms, or travel restrictions are necessary. Have employees and volunteers pay attention to their health after they return, even if they were not exposed to Ebola during their trip.
They should monitor their health for 21 days if they were in an area with an Ebola outbreak.
• Take their temperature every morning and evening.
• Watch for other Ebola symptoms: severe headache, muscle pain, vomiting, diarrhea, stomach pain, or unexplained bleeding or bruising.
If their temperature is 100.4°F (38°C) or higher or they have any other Ebola symptoms, they should seek medical care immediately.
• Tell the doctor about their recent travel and symptoms before they go to the doctor’s office or hospital. Advance notice will help the doctor care for them and protect other people who may be in the doctor’s office or hospital.
• Limit contact with other people when they travel to the doctor; avoid public transportation.
• Do not travel anywhere except to the doctor’s office or hospital.
During the time they are monitoring their health, employees or volunteers can continue their normal activities, including work.
Interestingly,
MSF has a twist on that. They acknowledge fear while standing up for science.
As long as a returned staff member does not experience any symptoms, normal life can proceed. Family, friends, and neighbors can be assured that a returned staff person who does not present symptoms is not contagious and does not put them at risk. Self-quarantine is neither warranted nor recommended when a person is not displaying Ebola-like symptoms.
However, returned staff members are discouraged from returning to work during the 21-day period. Field assignments are extremely challenging and people need to regain energy. In addition, people who return to work too quickly could catch a simple bacterial or viral infection (common cold, bronchitis, flu etc.) that may have symptoms similar to Ebola. This can create needless stress and anxiety for the person involved and his/her colleagues. For this reason, MSF continues to provide salaries to returned staff for the 21-day period.
Both groups aren't keen on self-quarantine, let alone on mandatory forced quarantine on a person without symptoms who is not spreading disease. And
MSF is especially unhappy about how this nurse is being treated.
“There is a notable lack of clarity about the new guidelines announced yesterday by state authorities in New York and New Jersey,” said Sophie Delaunay, executive director of MSF. “We are attempting to clarify the details of the protocols with each state’s departments of health to gain a full understanding of their requirements and implications.”
Another organization, The Society for Healthcare Epidemiology of America (SHEA), one of the country's largest collection of infection control experts, issued a
position statement yesterday:
Based upon the strong evidence that Ebola is not transmitted by those who do not have symptoms of EVD, we do not support mandatory quarantine of individuals, including HCP, who have provided care for patients with EVD. Our concern is about both the ramifications for HCP returning from West Africa and the potential application of this quarantine to all HCP caring for patients with EVD. SHEA believes that mandatory quarantine will lead to fewer volunteers and increased difficulty in assembling care teams in West Africa and in other countries, including the United States, preparing to care for EVD patients.
SHEA and its membership of infection control and prevention experts support the active monitoring (twice daily, for fever and symptoms of EVD) of all HCP providing care for EVD patients, including returnees from Ebola outbreak areas in West Africa. Mandatory quarantine should only be implemented for those who do not adhere to such monitoring.
When the unnamed administration official says "doesn’t comport with science," that's what they are talking about.
So, to recap, the governors of NY and NJ (followed by up-for-re-election governors in Illinois and Florida) have instituted a hastily and poorly thought out mandatory quarantine policy with little consultation from experts that's resulted in an asymptomatic American nurse returning from Africa (no fever, and with an Ebola negative blood test) being held in a tent next to a NJ hospital for an undefined amount of time, and with an undefined end point.
The governors apparently didn't bother to consult with NYC Mayor de Blasio (who blasted them this evening) or any public health officials we know of (certainly not CDC or NYC DOH):
Mayor Bill de Blasio said on Sunday that the way Ms. Hickox had been treated was shameful and vowed that New York City would do all it could to honor the work of the health care workers here and those who go help fight the epidemic in West Africa.
“The problem here is, this hero, coming back from the front having done the right things was treated with disrespect,” Mr. de Blasio said.
It doesn't help that Gov. Cuomo
falsely accused the NY doctor of breaking protocol which he did not, and Gov. Christie claimed the nurse was
"obviously ill" when she isn't.
That raises some questions. Here are a few good ones:
#QuesrtionsForCuomo
1/n If healthcare workers treating Ebola patients are to be considered contacts/quarantined, why not Bellevue HCWs?
— @Farzad_MD
#QuesrtionsForCuomo
2/n Why shouldn't the quarantine be extended to other travelers to Ebola-affected areas, such as journalists, officials?
— @Farzad_MD
#QuesrtionsForCuomo
3/n Once the JFK quarantine policy is known, won't travelers just use other airports, connecting flights to get to NY?
— @Farzad_MD
#QuestionsForCuomo
4/n You said we can't trust "honor system"- what's to stop travelers from denying Ebola contact to escape quarantine?
— @Farzad_MD
#QuesrtionsForCuomo
5/n If travelers lie to avoid quarantine, would they face prosecution?
would that incr risk of delayed notification?
— @Farzad_MD
#QuesrtionsForCuomo
6/n Which public health experts in outbreak control and quarantine law did you consult with prior to the decision?
— @Farzad_MD
#QuesrtionsForCuomo
7/n Dr Cuomo, what is the prob that a quarantined individual is infectious given a neg PCR assay? she they be released?
— @Farzad_MD
#QuesrtionsForCuomo
8/n Dr, What's
p(JFK|returning MSF)
p(infection|returning MSF)
p(infectious|asymptomatic)
p(transmission|infectious)
— @Farzad_MD
#QuesrtionsForCuomo
9/n What are the rights of detained individuals under quarantine?
— @Farzad_MD
That doctor was not happy! But he sure does ask good questions.
In fact, there are a growing number of unhappy doctors (and nurses) who will be speaking out on this in the next few days. They will, unfortunately, be facing powerful governors who have no political interest in backing down.
This isn't a done deal, whatever the governors think. And the next few days are sure to turn even more interesting. Stay tuned.
[UPDATE] Under Pressure, Cuomo Loosens Policy for Ebola Quarantines in New York