Confined to home for twenty-one days, monitored by doctors twice a day with only family and friends allowed to visit after being screened. That is the quarantine required by the states of New Jersey and New York for any medical care worker returning after assisting with the Ebola epidemic. At first glance, the quarantine seems extreme and possibly unconstitutional. However, recent cases of Ebola in the United States support the upholding of quarantine for the safety of others and raise questions about the responsibility of those returning from West Africa.

Thomas-Duncan
Thomas Duncan

The first case of Ebola in the United States occurred in Dallas; the fourth case in New York City. Thomas Duncan of Dallas lied during a screening about contact with Ebola; if he hadn’t, he would have most likely been prohibited from departing Liberia. The nurses who cared for Duncan would not have been infected (cases two and three), and Dr. Craig Spencer would have been the first Ebola case in the United States instead. Dr. Craig Spencer returned from West Africa on October 17, 2014. As soon as he discovered he had a fever, Spencer called his employer and self-quarantined, thereby ensuring that he wouldn’t infect others. However, officials tracked Spencer’s movements prior to developing symptoms and learned that he took the subway, ate in restaurants, bowled and jogged.

Craig-Spencer
Dr. Craig Spencer

Even though Ebola patients are only infectious once they show symptoms, should Spencer have quarantined himself as soon as he arrived in New York City? What exactly is the responsibility of medical professionals and civilians returning from West Africa? To answer such a question, we must first examine the contagious and infectious nature of Ebola. Ebola is not that contagious, but is extremely infectious. Contagiousness of a disease refers to how easily a virus is transmitted. Ebola is similar to HIV, requiring direct contact (broken skin or mucous membranes) with bodily fluids that have the virus; it is not airborne. On the other hand, infectiousness (infectious dose) of a disease refers to how many viral particles are needed to infect a host.  Ebola’s infectiousness is 1 – 10 viral particles; in other words, only 1 virus is needed to cause symptoms. Compare that number with the infectious dose of Streptococcus (causes strep throat), 1000, or that of E. coli, which is in the billions. Still, these numbers are no cause for panic — since Ebola is not that contagious, the infectious dose only has bearing for those who come into direct contact with Ebola patients, namely, the caretakers of patients.

As the Ebola cases in the United States demonstrate, every precaution can be taken, but that still may not be enough; two of the nurses caring for Duncan became infected with Ebola. Duncan’s situation illustrates that everyone arriving from West Africa must be honest with his/her whereabouts and actions, even if this means risking denial of entry into the United States. There is more than one individual at risk; lying would put family members, friends, and others at risk, and these numbers could grow exponentially.

Spencer’s case is more complex.  Once symptoms start to appear, the individual should be quarantined; every medical professional and civilian should be aware of the symptoms. Spencer is commendable for the actions he took once symptoms appeared. However, what about beforehand? Spencer had been going about his daily routine days before symptoms started showing, going all over New York City. In hindsight, knowledge of his actions induces unnecessary fear for those not familiar with how Ebola is spread, especially in a city of eight million. Although it is highly unlikely for anyone to be infected without direct contact, the virus is already present in the individual’s body and still presents a potential risk.

Nancy-Snyderman
Dr. Nancy Snyderman

Medical professionals have a moral obligation to take the steps necessary to protect themselves and others from harm. Just as Spencer had done, they must self-quarantine once symptoms start to appear. Though it isn’t necessary for them to be quarantined before symptoms are observed, it is advisable for medical professionals and anyone returning from West Africa to restrict their movements. Unfortunately, the length of the incubation period of Ebola (21 days) renders such restrictions unfeasible; furthermore, over time, self-attention to safety precautions naturally wanes. Dr. Nancy Snyderman and her team, for example, were under voluntary quarantine after working with someone who had contracted Ebola; Snyderman violated the quarantine about a week and a half after it began. The quarantine was later changed to mandatory to ensure no other violations would be made.

Medical professionals have a moral obligation to take the steps necessary to protect themselves and others from harm.

Therefore, the mandatory quarantine enacted by New Jersey and New York appears to be an appropriate measure in the quest to stop the spread of the virus. Critics, particularly medical professionals, call the quarantine extreme and profess that it deters people from going to the forefront of the fight against Ebola in West Africa where health workers are needed the most. But as medical professionals, such volunteers should be well aware of the precautions they should take once they return, not to mention that helping in the Ebola epidemic already puts them at risk. Upon taking the Hippocratic Oath*, medical professionals have a higher obligation to lower the risk for others. As such, monitoring for symptoms and restricting movement are included in steps to be taken upon returning from West Africa. Sadly, such actions cannot be found in recent Ebola cases, suggesting that the safest and most reliable policy can only be a mandatory quarantine.

*The Hippocratic Oath is taken by medical professionals to uphold ethical standards and includes the line: ““I will prevent disease whenever I can, for prevention is preferable to cure.”

References

Culp-Ressler, Tara. “Top Medical Journal Calls Mandatory Ebola Quarantines ‘Unfair And Unwise’.” ThinkProgress. ThinkProgress, 28 Oct. 2014. Web. 30 Oct. 2014. <http://thinkprogress.org/health/2014/10/28/3585223/medical-journal-ebola-quarantines/>.

Diamond, Dan. “’60 Minutes’ Just Broke New Details On The Dallas Ebola Case. Here’s What They Revealed.” Forbes. Forbes Magazine, 26 Oct. 2014. Web. 30 Oct. 2014. <http://www.forbes.com/sites/dandiamond/2014/10/26/60-minutes-just-broke-new-details-on-the-dallas-ebola-case-heres-what-they-revealed/>.

“Ebolavirus.” Public Health Agency of Canada. Public Health Agency of Canada, 22 Aug. 2014. Web. 28 Oct. 2014. <http://www.phac-aspc.gc.ca/lab-bio/res/psds-ftss/ebola-eng.php>.

“Frequently Asked Questions on Ebola Virus Disease.” WHO. World Health Organization, 8 Aug. 2014. Web. 29 Oct. 2014. <http://www.who.int/csr/disease/ebola/faq-ebola/en/>.

Lasagna, Louis. “Bioethics.” Hippocratic Oath, Modern Version. Johns Hopkins Sheridan Libraries, 2010. Web. 30 Oct. 2014. <http://guides.library.jhu.edu/content.php?pid=23699&sid=190964>.

Mangan, Dan. “NYC Health Dept Disputes Report Ebola Doc Lied.” CNBC. CNBC, 30 Oct. 2014. Web. 30 Oct. 2014. <http://www.cnbc.com/id/102132467>.

Misra, Ria. “How Ebola Can Still Be Very Infectious (Without Being Very Contagious).” Io9. Io9, 3 Oct. 2014. Web. 30 Oct. 2014. <http://io9.com/how-ebola-can-still-be-very-infectious-without-being-v-1642322295>.

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