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Dr. Piero Olliaro was supposed to do a lot of talking in New Orleans this week.
The tropical disease expert for Britain’s Oxford University and the World Health Organization was scheduled to present findings on treating malaria and worm infections, and to co-chair two sessions at the American Society for Tropical Medicine and Hygiene (ASTMH) meeting.
But Olliaro stayed home, because the state of Louisiana told him he’d be confined to his hotel room if he came because of recent travel to West Africa. “I had to find somebody to fill in,” Olliaro said in a telephone interview from Oxford, where public health authorities have not restricted him in any way.
He says it’s just one example of how fear of Ebola may discourage people from going over to fight it at its source. And that, in turn, could hurt efforts to end the epidemic.
"People are taking action now in the United States based on fear."
Olliaro was in Guinea earlier this month, scoping out places where doctors can test experimental Ebola treatments. He’s not sick and he didn’t even treat Ebola patients, but fear of Ebola means any traveler may be restricted.
“We came back full of admiration for the people working there,” he said. Then, many find they are not welcome to come back home. “Some countries are making it more difficult than others,” Olliaro said.
But these are experts who can help guide what has so far been a disorganized and far from effective international response to the epidemic.
“They should be heard,” Olliaro said. “You need to hear it from the horse’s mouth.”
The tropical medicine meeting in New Orleans has scheduled a panel on Ebola for Wednesday, but no one who’s recently been in one of the affected countries will be there.
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“That’s the issue here — it’s fear. People are taking action now in the United States based on fear,” said Dr. Alan Magill, president of the ASTMH and director of malaria programs at the Bill & Melinda Gates Foundation. “The way to get rid of the fear is to get rid of the epidemic. We want to end the epidemic in West Africa.”
Experts agree many, many more healthcare workers are needed to do that. Liberia, Sierra Leone and Guinea don't have nearly enough. But many of the volunteers who go from other countries must take leave, often without pay to do so, and they may not able able to afford another 21 days away from work and family.
Louisiana says it recognizes that people who don’t have symptoms cannot transmit Ebola, but it says it’s committed to preventing “any unnecessary exposure.”
“As part of that commitment, we have requested that any individuals that will be traveling to Louisiana following a trip to the West African countries of Guinea, Liberia, and Sierra Leone or have had contact with an Ebola virus disease-infected individual remain in a self-quarantine for the 21 days following their relevant travel history,” it said in a letter to conference attendees. “In Louisiana, we love to welcome visitors, but we must balance that hospitality with the protection of Louisiana residents and other visitors.”
Such restrictions vary from state to state. If the meeting was just across the border in Texas, the 4,000 experts on malaria, dengue fever, Lassa fever, worms and other ills would likely be hearing from colleagues who have recently been in West Africa.
The disparities hit the headlines hardest when New Jersey governor Chris Christie supported his state’s decision to forcibly quarantine returning nurse Kaci Hickox, setting off a very public standoff. Hickox is now being monitored in Maine.
Texas released its guidelines Tuesday and they closely mirror what the Centers for Disease Control and Prevention recommends.
“The task force does not support mandatory government-imposed strict quarantine for cooperative asymptomatic health care workers unless they meet the ‘high risk’ category (one of the four exposure categories),” the state department of health said in a statement. “High risk” health care workers would include someone who treated a patient without wearing protective gear, and someone who got what’s known as a needle-stick injury while treating a patient.
Guidelines are important, but so are common-sense judgments by health experts, the Texas authorities say.
At least 13,000 people across Guinea, Liberia and Sierra Leone have been infected by Ebola in just the space of a few months. WHO says 70 percent are dying.
Aid is slow to get there and clinics are overflowing. Ebola patients are being turned away to go home and die, but so are women in labor, children with malaria, people suffering from Lassa fever and other infectious diseases. Vaccinations have come to a virtual standstill and aid groups say people are breaking quarantine just to find food.
Magill doesn’t agree with Louisiana’s decision, and he says it’s definitely affected the conference, which attracts around 4,000 delegates. But he also understands the fear.
“Right now, we don’t actually have a fire department and we don’t want to pay the taxes to have one."
“Our role is to offer useful information and to counter misinformation,” he said. “We all know sometimes that it takes repetition multiple times of the same message on multiple occasions to get through.”
Right now, the United States has a single Ebola patient — Dr. Craig Spencer, being treated at Bellevue Hospital in New York. Spencer is one of seven people to bring Ebola to the United States from West Africa and only one, Thomas Eric Duncan, infected anyone else. The two nurses infected while treating him are fully recovered.
Magill hopes Americans will now turn their fears into stronger actions.
“We are going to have other emerging infections,” he said. Pandemic influenza is a constant threat, for instance. So is chikungunya.
“The real lessons here are maybe we need to have a better global response on this,” he said. That means funding CDC and the WHO, both of which have suffered budget cuts in recent years.
Magill likens it to paying to have a fire department, whether there are fires or not.
“Right now, we don’t actually have a fire department and we don’t want to pay the taxes to have one,” he said. “Maybe this Ebola crisis will convince people that we need to have one.”