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To Quarantine or Not to Quarantine?: Doctors Weigh In on 'Sledgehammer' Tactic

Doctors lined up Monday to slam the controversial new quarantine measures announced by governors of states such as New York and New Jersey.
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Doctors lined up Monday to slam the controversial new quarantine measures announced by governors of states including New York and New Jersey as well as the U.S. military, saying they’re not only unjustified but could in the end endanger Americans.

“The governors’ action is like driving a carpet tack with a sledgehammer: it gets the job done but overall is more destructive than beneficial,” the editors of the influential New England Journal of Medicine wrote in a commentary.

“This approach, however, is not scientifically based, is unfair and unwise, and will impede essential efforts to stop these awful outbreaks of Ebola diseases at their source, which is the only satisfactory goal,” they wrote.

From the Infectious Diseases Society of America to the director of the National Institutes of Allergy and Infectious Diseases, there was an unusual degree of solidarity against the idea of keeping people at home for three weeks if they aren’t sick.

New Jersey Governor Chris Christie has pushed back hard. “You can’t take chances on this stuff and allow people who may in fact be contagious to travel,” he said. Christie has been under fire for his state’s decision to forcibly quarantine 33-year-old nurse Kaci Hickox, who railed very publicly from an isolation tent inside a New Jersey hospital complex, where she was held after her return Friday from volunteering with Doctors Without Borders in Sierra Leone.

There are four main arguments against simply making all recent travelers stay home for 21 days.

The fever gives you a chance to act

“We now know that fever precedes the contagious stage,” Dr. Jeffrey Drazen and fellow editors of the New England Journal of Medicine wrote in their editorial. The fever gives a traveler a chance to seek isolation and help, they argued.

“What happens as someone begins to become ill with Ebola, they develop an increase in symptoms,” Centers for Disease Control and Prevention director Dr. Thomas Frieden agreed. “Early on, tests such as a blood test may be negative because there is such a tiny quantity of virus in their body.” So even as Dr. Craig Spencer traveled around New York City, there was almost no chance of his spreading virus. The real risk comes as people get very ill. “It is not as if someone is going to be completely healthy one moment and the next moment emanating huge quantities of virus,” Frieden said.

No symptoms equals no risk

“When there are no symptoms, there is no risk,” said Dr. Daniel Diekema, an infectious disease specialist at the University of Iowa and president of the Society for Healthcare Epidemiology of America, a medical association for experts in infection control and prevention.

“The science is very clear that catching Ebola requires direct contact with someone who is ill. We have not seen any spread that is from contact with someone who is not ill,” Frieden said.

“This point is supported by the fact that of the nurses caring for Eric Duncan, the man who died from Ebola virus disease in Texas in October, only those who cared for him at the end of his life, when the number of virions (particles of virus) he was shedding was likely to be very high, became infected,” Drazen and colleagues added.

In years of studying Ebola in Africa, it’s been shown time and time again that the people who became infected were directly caring for very sick people or handling their bodies – including their corpses. Even people sharing homes and meals with patients often did not become ill.

Draconian measures don’t control spread

“The reasons to do it have largely been political and to control the fear and perception of risk,” Diekema said. An international team of researchers including Alessandro Vespignani of Boston’s Northeastern University made a computer model showing that trying to block travelers form Ebola-affected countries would be futile. “Traffic reductions are shown to delay by only a few weeks the risk that the outbreak extends to new countries,” they wrote in the journal Eurosurveillance.

New CDC guidelines recognize this, allowing for state health officials to exercise best judgment about giving people some freedom while keeping an eye out for symptoms.

The damage outweighs any benefits

“The downsides are real and include the reluctance of health care workers to provide care for Ebola victims, not just primarily in the outbreak zone, which needs help, but also to volunteer in our hospitals to be part of the team to care for domestic patients,” Diekema argued.

“If we add barriers making it harder for volunteers to return to their community, we are hurting ourselves,” Drazen’s team wrote.

And it means people won’t be able or willing to go fight Ebola at its source – in turn, putting the world at even more risk as the virus spreads. “The risk of being quarantined for 21 days upon completion of their work has already prompted some people to reduce their length of time in the field. Others will be less inclined to volunteer in the first place,” said Sophie Delaunay, executive director of Medecins Sans Frontieres (Doctors without Borders) USA. “This will present significant operational disruptions at the field level for MSF and other organizations, and lead to an overall shortage of desperately needed health workers, precisely when the Ebola outbreak is as out of control as ever.”