It's sort of hard to read so much about ebola without making a post about it.
Right now, Ebola is pretty low down on the list of things I am worried about. Hell, the flu kills more people every year than ebola has ever killed ever. It doesn't seem incredibly contagious and it doesn't seem like any Americans have died from it yet, making its mortality rate in Americans somewhat less than 70%.
That said, when I heard about how Dr. Spencer, the physician who treated ebola patients in Africa, went around the city doing his thing for over a week before he was diagnosed with Ebola, it did make me angry. If you have a clear exposure to sick patients, why wouldn't you want to be quarantined? It's clear that the doctor who went to Africa to help these people is a hero and cares about people a lot, so why wouldn't he automatically take this precaution?
Yes, I do understand that a three-week quarantine is probably difficult. But at least he could've avoided going on the subway or going bowling. He could've just gone out for completely necessary things.
And yes, I know that ebola is supposedly not contagious until the patient starts to show symptoms. But what if he is contagious an hour or two before the fever is noticed? How many people could be exposed in that period of time if he is going on the subway and not taking any precautions?
It seems like we go from being completely hysterical and overcautious to completely throwing caution to the wind. That medical correspondent Nancy Snyderman was given shit and put on mandatory quarantine after running out to grab a bite to eat when she hadn't even been caring for any sick patients, yet they allowed a nurse who cared for an ebola patient to fly on a plane when she was running a fever.
Aid groups are arguing that a mandatory quarantine would cut medical personnel volunteering in Africa by three quarters. Is that really true? Dr. Spencer was in Africa for two years. Would he really not have gone if he knew he was going to have to be in quarantine for three weeks afterwards? People going to treat Ebola in Africa are risking their lives. Are these people fine with risking their lives, but wouldn't be able to handle a three-week quarantine to prevent risking more lives?
So yes, I am in favor of a mandatory quarantine if there is clear contact with someone sick. But feel free to convince me otherwise.
I agree Dr. Fizzy. A mandatory quarantine period is justified. We need to err on the side of caution until we get a better handle of this situation. As for Dr. Spencer and other physicians who are risking their lives every day, a heartfelt thank you.
ReplyDelete2 reasons why quarantines are so "controversial."
ReplyDeleteOne: The reason why everyone is against the quarantine is because they are all a bunch of spoiled, 1st world brats. Because of that, it would be a huge deal for those being quarantined, even though in reality, it is no big deal.
I live in New England and a few years ago, we had a freakish ice storm the week before Halloween. Some people were without electricity for 2 to 3 weeks. Yeah, it sucked, but you would have thought it was Armageddon the way people behaved. Boo hoo, I had to shower at the gym because I don't have hot water. Boo hoo, my whole family had to sleep in sleeping bags for 10 days. Boo hoo, I lost $100 of food in my freezer (mind you, I get that this would be a big deal if you were living at or below the poverty line, but these are not the people who were complaining). Boo hoo, I had to buy cheap underwear at the local CVS because I couldn't do laundry. Boo hoo, my kid's school was closed and I had to work from home and he drove me crazy all week. And on, and on, and on. I had to remind people that the folks in Haiti who lost everything in an earthquake the year before were STILL SLEEPING ON DIRT and many would probably never have 4 walls solid walls and a leak-free roof over their head for years, if ever.
2: And then there are the crazy conservatives who, on the one hand, run some of the news outlets fanning ebola hysteria, and making it all Obama's fault, but on the other hand, don't want no gov'mint interference in their lives. Because they have rights written into the Constitution against illegal seizure of their person, goddammit, and they'll stand their ground and shoot (with one of their 28 AK47s) any government official who dares tell them what to do, public health and safety be damned. Especially because if we let the gov'mint illegally incarcerate us for three weeks, that's when they will go into our homes and take all our guns. Or some bullshit theory like that.
I agree with mandatory quarantine too. Anyways, if I had been in an underresourced country for two years and just got back home, I think a three week quarantine would be heavenly. Three weeks of not being forced to answer questions, three weeks to debrief, three weeks to catch up on series and movies and eat all the food I had missed. And sleep and sleep and sleep until my body clock corrects itself. Yeah, it really doesn't sound too bad. People just don't like the idea because anything with the word "mandatory" awakens the teenager within them.
ReplyDeleteI agree with barefootmeds. I don't know for how long health care professionals have been helping with Ebola patients and then coming home without incident, no doubt many years. However, after several recent problems - how does it not make sense to voluntarily minimize your risk of spreading what you've seen first hand to be a very nasty problem when not contained? Seems to me that's part of the responsibility you've assumed when you agree to go help in the first place.
ReplyDeleteAbsolutely no disrespect intended towards those who take time from their lives to help where help is so desperately needed.
the current ebola crisis is a new event. previous outbreaks were locally contained and controlled. the problem is that proper isolation technique is not easy or intuitive. even operating room personnel require extra training. and the virus can spread via sweat, not usually considered a bodily fluid.
DeleteI am super pregnant and a completely exhausted resident right now. If someone offered me 21 days of forced quarantine, I'd do nothing but sleep and watch TV instead of get up at 4:30 am for work and be exhausted in my very active specialty. It sounds completely heavenly. Probably the wrong reaction, but I have zero sympathy for those angry about it. I'll gladly take their place and take a 21-day nap.
ReplyDeleteGlad I'm not the only one. Though I am not pregnant.
DeleteI couldn't agree more. I keep seeing patients coming into my Emergency Dept convinced they have Ebola, when I feel that I am in much more danger in my car driving to work. It has been blown out of proportion. Now if you are truly in contact with an infected person, you absolutely should be quarantined for the 21 day incubation period. No question about that. That is simply the best way we have to prevent the spread of the virus.
ReplyDeleteI'm going to go against the grain here, and discuss the reasons for not having a mandatory quarantine. Basically, there would be absolutely no scientific basis for it. Ebola is not transmitted through casual contact, but through exchange of bodily fluids or exposure of bodily fluids to exposed skin or mucous membrane. So you can't get it from riding the subway with someone. It's not airborne. The cases of Ebola in the West were from contact of health care providers with patients, so fairly prolonged exposure involving patient care. Also, there is absolutely no scientific evidence that Ebola can be transmitted when the patient is not symptomatic. Dr. Spencer was checking his temperature regularly upon arrival, and sought medical care appropriately when he became febrile.
ReplyDeleteThe main reason - for me- for not having mandatory quarantine is that - in this environment of hightened hysteria, it is really incumbent on our leaders not to make policy based on - or to appease- mass hysteria. If we start ignoring the science, then where do we stop? do we start quarantining everyone from Africa? Do we start quarantining them for a month? two months? (because, really, if you don't trust the science, how can you be sure that 21 days is enough?) We are basically talking about limiting someone's freedom based on no scientific evidence - when public health decides to quarantine someone forcibly, they do it when there is evidence of harm to the public. It is not something to be taken lightly.
I think the problem is with *voluntary* self-reporting of symptoms. People who do become ill after coming home so far have appeared to be going to straight to the ER, but you have to trust that people will continue to do that. Health care professionals? Will probably follow the rules. Laypersons who were there, got exposed, and then come back? Ticking time bombs and perhaps not all of them will know enough to seek help right away and in the meantime, they could be exposing others. What if it's a father who comes home from a trip to one of the countries where there is Ebola, and then he starts feeling unwell but takes his kids to school the next morning before it dawns on him that he's got a fever and should think about going to the ER, and in the meantime, he stopped for gas and pays the cashier in cash, shook the hand of the 1st grade teacher, etc.
DeleteWell, so much for trusting health care professionals to do the right thing.
Deletehttp://nypost.com/2014/10/29/ebola-doctor-lied-about-his-nyc-travels-police/
I was going to answer saying all that the Anonymous from 12:44 PM said, but he beat me to it. :)
ReplyDeleteI think that we, as doctors and (I expect) sciente people, should base our opinions on solid evidence and do not adhere to the current hysteria, even if it would somehow appease our minds.
Disclaimer: I am a resident from a specialty other than Tropical Medicine/Infectious diseases, in a country with no known ebola cases as of today, but with a steady influx/efflux of people from African countries (ex-colonies).
I am torn about the idea of a three-week quarantine for those exposed to sick people (health care workers or perhaps travelers). I am surprised to see so much agreement here. In the case of a volatile subject I think it makes a lot of sense to look to experts and trust their opinion because if we follow our emotion too far we may cause more harm than good (limit the flow of aid personnel, for example). This doctor did what he was told and it worked. He caught his fever immediately and reported it, etc. But if there is a chance he could have spread the disease, then arguing for a quarantine makes sense. I am not an expert so I don't know if that chance is significant. What I object to is the way this particular quarantine in New Jersey was carried out. From what I read this nurse was confined to a tent within a hospital room and given a porta-potty! She is an international aid worker. She has zero symptoms. We treat prisoners better than that. We treat animals better than that…. If you're going to quarantine, have a plan and make it humane.
ReplyDeleteI believe NY and NJ have instituted mandatory quarantine for anyone who has taken care of Ebola victims. They had a nurse come from Liberia I think, they made up her temperature or because she was flushed and upset the forehead scanner misread her temp and she was forcefully put into a hazmat suit and taken to a hospital with a huge police escort...where she was found to not have a fever at all. Then she was forced to quarantine.
ReplyDeleteUpdate: Nurse quarantined for Ebola to go home. This issue is a tough one, folks.
ReplyDeleteI believe we're going to have to deal with this on a case by case basis.
...they allowed a nurse who cared for an ebola patient to fly on a plane when she was running a fever.
ReplyDeleteSaid nurse had a temp of 37.5. That's not a fever, though in the ICU we might call that a "low grade temp". However, with no fever and no other symptoms, she was not infectious. And that's the issue here - asymptomatic individuals are not infectious and there is no rationale to quarantine anyone even if there is a high risk exposure history. Keep track of them, yes, perhaps with home visits or (at most) enforcing a home quarantine. But it's not clear that it's necessary. And mandatory quarantine is not at all evidence based and may be harmful.
My argument is that you don't know the exact moment the patient becomes infectious. This guy went out to Brooklyn to a bowling alley. What if he started running a fever just before that and didn't notice it and was infectious entire time he was at the bowling alley and riding the train home. What if he developed a nosebleed during the train ride like that little girl in Africa? Maybe he didn't need to lock himself in his apartment and never leave, but I think it was irresponsible to start riding around on public transportation in using public facilities. And he knew it, which was why he lied about it initially. So obviously we can't trust even heroic doctors to do the right thing.
DeleteI am sooooo pissed that he lied. What an a**hole.
DeleteAfter hearing NONE of Thomas Du ncan's household got ebola, even though he was feverish for 2 days at home, I felt more assured that no quarantine is necessary prior to the onset of symptoms. I doubt Nurse Amanda infected anyone on her trip to Cleveland. If I'm wrong, I might change my mind again.
ReplyDelete