When doctors risk their lives and sacrifice
their livelihoods to go to West Africa and provide desperately needed
treatment to those suffering from Ebola, what should be their reward
upon coming home?
The governors of New York
and New Jersey instituted just such a policy Friday, announcing that
airport screening will be stepped up in their states and that any
arriving passengers who'd recently been in the West African nations hit
hardest by Ebola could be hospitalized or quarantined for up to 21 days
-- sick or not.
Measures such as these
would affect people who lived or traveled to countries such as Guinea,
Liberia and Sierra Leone, where all but a handful of the nearly 10,000 documented Ebola cases and almost 5,000 deaths
have occurred. And it would also impact those who brought their medical
expertise to West Africa, doing what they could to prevent more people
from dying or spreading the disease
So there's a tradeoff:
Should the focus of American policy be to do everything to prevent
anyone from the most ravaged regions from entering the United States,
even if it discourages health care workers from going there?
Some U.S. lawmakers, such
as Rep. Andy Harris, favor a strict three-week quarantine. (That time
duration is significant because it takes anywhere from 2 to 21 days from
the time a person contracts Ebola to when he shows symptoms of it; if
more time than that passes without symptoms, a person is considered
Ebola-free.)
"In return from being
allowed to come back into the country from a place where a deadly
disease is endemic, you'd have to enter a quarantine facility and be
supervised for 21 days," the Maryland Republican told CNN.
Some, though, think such a
policy would be counterproductive. It might prevent some cases of Ebola
in the United States over the short term, they say, but over the long
run it could backfire if highly trained American doctors have even more
incentive not to head to Africa to help corral the disease.
Dr. John Carlson, a pediatric immunologist at Tulane University, is one of them.
He has spent four weeks
working with Ebola patients at a hospital in Freetown, Sierra Leone, and
is scheduled to return to New Orleans on Saturday. Health care workers
already sacrifice a lot by volunteering their time to help those who
most need it; tacking on more time or not being able to venture out in
public or go to work might seem like a punishment, discouraging people
such as him from doing it again.
"If I lose three weeks
on my return and don't get to do the work I'm supposed to do," Carlson
said, referring to his job at Tulane, "means this wouldn't be workable
for me."
Centers for Disease and
Control and Prevention director Dr. Tom Frieden expressed a similar view
earlier this month, arguing that stringent travel restrictions may
create more problems than they solve.
"It makes it hard to get
health workers in, because they can't get out," he said. "If we make it
harder to respond to the outbreak in West Africa, it will spread not
only in those three countries (in West Africa hit hardest by Ebola) but
to other parts of Africa and ultimately increase the risk here" in the
United States.
Official: New guidelines coming 'shortly'
That said, change may be coming.
Some of it may come at the state level, as happened in New York and New Jersey.
That policy shift was
spurred by the hospitalization of Dr. Craig Spencer, a Doctors Without
Borders physician who'd treated Ebola patients in Guinea and arrived at
New York's John F. Kennedy International Airport on October 17; he
eventually was diagnosed with Ebola.
Since then, a female
health care worker who recently been in West Africa has -- hours after
showing no symptoms after touching down at northern New Jersey's Newark
Liberty Airport -- developed a fever, New Jersey health department
spokesman Donna Leusner said. That woman is now in isolation at Newark's
University Hospital. Quarantined woman tests negative for Ebola
This came the same day New York and New Jersey outlined their new policy.
The policy allows the
states to determine hospitalization or quarantine for up to 21 days for
travelers from the affected countries. A mandatory quarantine is called
for those who had "direct contact with an individual infected with the
Ebola virus," including medical workers who treated Ebola patients. In
addition, people with a travel history to the affected regions but with
no direct contact with Ebola patients will be "actively monitored...
and, if necessary, quarantined."
This is on top of the
federal policy requiring all travelers coming to the United States from
Ebola-affected areas to be actively monitored for 21 days, starting
Monday. Already, such travelers landing in New York's Kennedy,
Washington Dulles, New Jersey's Newark Liberty International, Chicago's
O'Hare International and Hartsfield-Jackson International in Atlanta
must go through enhanced screening.
Dr. Anthony Fauci,
director of the National Institute of Allergy and Infectious Diseases,
said Friday that the federal government's policies could change even
more.
"That is something that
is right now under very active discussion, and you'll be hearing shortly
about what the guidelines will be," Fauci said, answering a reporter's
question about quarantines.
Some experts say there
might be some middle ground between the two extremes of physically
confining people in one place for 21 days or just letting them do
whatever they want (beyond, as is now recommended, taking their
temperature daily and monitoring themselves for other symptoms).
One possibility is to have those travelers do more than temperature checks.
Dr. Irwin Redlener,
director of Columbia University's National Center for Disaster
Preparedness, thinks that checking daily for decreases in white blood
cell counts or platelets -- which could be, but aren't necessarily, a
sign of an Ebola infection -- could be one such measure.
And Mike Osterholm, an
infectious disease epidemiologist at the University of Minnesota, thinks
that there should be stricter controls on what a person who has come
from West Africa does in his or her first three weeks in the United
States. For instance, he thinks they shouldn't take public
transportation or go to crowded places like bowling alleys, both of
which Spencer did before officials say he was symptomatic.
Public health experts
say there's plenty of scientific evidence indicating that there's very
little chance that a random person will get Ebola, unless they are in
very close contact (close enough to share bodily fluids) with someone
who has it.
Still, there's also a
sense that authorities have to do something because of Americans' fears
-- rational or not -- and belief that the country is better off being
safe than sorry.
As Osterholm says, "You want to try to eliminate not just real risk, but perceived risk."
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