Bioethicist Arthur Caplan gives “7 Reasons Ebola Quarantine Is a Bad, Bad Idea”. I’m interested to know what readers think (I claim no expertise in this area.) My occasional comments are in maroon.
“Bioethicist: 7 Reasons Ebola Quarantine Is a Bad, Bad Idea”
In the fight against Ebola some government officials in the U.S. are now managing fear, not the virus. Quarantines have been declared in New York, New Jersey and Illinois. In Connecticut, nine people are in quarantine: two students at Yale; a worker from AmeriCARES; and a West African family.
Many others are or soon will be.
Quarantining those who do not have symptoms is not the way to combat Ebola. In fact it will only make matters worse. Far worse. Why?
- Quarantining people without symptoms makes no scientific sense.
They are not infectious. The only way to get Ebola is to have someone vomit on you, bleed on you, share spit with you, have sex with you or get fecal matter on you when they have a high viral load.
How do we know this?
Because there is data going back to 1975 from outbreaks in the Congo, Uganda, Sudan, Gabon, Ivory Coast, South Africa, not to mention current experience in the United States, Spain and other nations.
The list of “the only way to get Ebola” does not suggest it is so extraordinarily difficult to transmit as to imply the policy “makes no scientific sense”. That there is “data going back to 1975” doesn’t tell us how it was analyzed. They may not be infectious today, but…
Quarantine is next to impossible to enforce.
If you don’t want to stay in your home or wherever you are supposed to stay for three weeks, then what? Do we shoot you, Taser you, drag you back into your house in a protective suit, or what?
And who is responsible for watching you 24-7? Quarantine relies on the honor system. That essentially is what we count on when we tell people with symptoms to call 911 or the health department.
It does appear that this hasn’t been well thought through yet. NY Governor Cuomo said that “Doctors Without Borders”, the group that sponsors many of the volunteers, already requires volunteers to “decompress” for three weeks upon return from Africa, and they compensate their doctors during this time (see the above link). The state of NY would fill in for those sponsoring groups that do not offer compensation (at least in NY). Is the existing 3 week decompression period already a clue that they want people cleared before they return to work?
Quarantine is likely to be challenged in court.
And those challenging it are likely to win. Science does not support it.
Maybe so. I’m fairly sure that future volunteers will have to agree in advance. For those who haven’t agreed, I have no clue about legal precedence.
- Large-scale quarantine has not been thought through, in terms of making it bearable for those confined.
If government does not make it tolerable — and they show no signs of doing so, other than succeeding in stigmatizing people who are not dangerous — then people will not honor quarantine.
It isn’t clear it couldn’t be made tolerable. I think maybe people should be compensated if they are required to be quarantined.
- Health care workers who take care of those who really do have Ebola at big hospitals, such as Bellevue or Emory, are at the greatest risk.
If you quarantine them you are taking your best professionals offline for three weeks — and there are not a lot of replacements.
- Who will volunteer to go to West Africa to stamp out the epidemic, if they know they face three weeks of confinement upon their return?
Those who go are heroes who face hell on earth. Can’t they be trusted to do the right thing and self-monitor when they get back?
A serious worry is, indeed, that the new policy will kill off volunteers.
7. When officials respond to panic with quarantine they basically say they can’t trust public health officials, science and the ethics of doctors and nurses.
There is no substitute for that trust. None. If state and city officials undermine trust out of panic or politics, then they destroy the best weapon we have to control Ebola — good science implemented by heroes.
I don”t see why elected officials imposing a quarantine means they can’t trust public health officials, although obviously it would be best if health officials are behind it.
It may be too late to reverse the leap to quarantine for those politicians deem at risk. But it is a leap into an unknown that we are likely to come to regret.
First published October 26th 2014, 6:11 pm
Arthur L. Caplan, Ph.D., is the Drs. William F. and Virginia Connolly Mitty Professor and founding head.
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