Nervous government officials who seem more interested in appearing tough rather than letting science actually defeat Ebola in the United States are misusing quarantine.
Prominent governmental officials such as Defense Secretary Chuck Hagel and potential presidential candidate Governor Chris Christie of New Jersey have succumbed to pandering in the face of Ebola. In fact, the Governor has now doubled down on his unscientific and ill-thought through policy of quarantining those exposed to someone with Ebola. He practically begged to be sued for summarily quarantining a heroic nurse, Kaci Hickox, upon her return from West Africa, even after she tested negative for Ebola. “Whatever. Get in line…I’ve been sued lots of times before. Get in line. I’m happy to take it [the decision to quarantine] on.”
The line is already forming. Hickox, a nurse who wil not be bullied, is at the head of it. The Governor will lose. And he should. State-mandated quarantines make little sense as a weapon against Ebola in the United States.
Christie tried to imprison Hickox without any explanation or even a hint of legal due process in a tent with no running water or TV at a Newark, New Jersey, hospital after she came back from a harrowing volunteer visit to fight Ebola in West Africa. She was tossed into the tent despite the fact that she exhibited no symptoms and was not infectious. She protested her confinement, scared New Jersey officials into letting her go and headed back in a limo to her husband and hometown in Maine.
Governor Paul R. LePage now says that Maine requires health care workers such as Hickox, who return to the state from West Africa, remain under a 21-day forced home quarantine. Hickox says no way.
“Going forward, she does not intend to abide by the quarantine imposed by Maine officials because she is not a risk to others,” her attorney, Steven Hyman, told reporters. “She is asymptomatic and under all the protocols cannot be deemed a medical risk of being contagious to anyone.” Hickox will, however, do what is right and appropriate. She plans to abide by all the self-monitoring requirements suggested by the Centers for Disease Control.
Self-monitoring is the accepted, scientifically validated way to handle non-symptomatic people exposed to those with Ebola. Craig Spencer, the doctor who is now the only Ebola patient in America in a hospital, self-monitored while moving around New York City. When he got symptoms, he went to the hospital. Number of people he infected while self-monitoring? Zero.
Not only is quarantine not needed for responsible people like Hickox and Spencer, if enforced it will do far more harm than good.
Amber Vinson was the second nurse from Texas Health Presbyterian Hospital Dallas to get the virus while caring for Thomas Eric Duncan, a Liberian man who began showing Ebola symptoms after arriving in Texas and died under her care when he was finally admitted to that hospital. When she was discharged from the isolation unit at Emory University Medical Center in Atlanta, there were at least 30 doctors and nurses gathered around her as she joyfully thanked them for saving her life. I saw a room of heroes.
But if you are the Governor of New Jersey or New York or Maine, you must have seen something very different—30 people who ought to be immediately quarantined as a result of exposure to a person with Ebola. The same holds true for everyone who had any interaction with Hickox in her short stay in the isolation tent in Newark. This will include everyone in the courtroom in Maine if she shows up there, as is her right to fight mandatory quarantine.
Quarantine is a very intrusive tool in fighting disease. Our legal system permits it, but only when there are no other less restrictive ways to control an outbreak. There are less restrictive ways to contain Ebola, for example, self-monitoring and voluntary isolation at home. Those things work. The only people in America who got Ebola are health care workers who cared for Ebola patients. And to date, all but one who have been treated in America have survived. Ebola is not the lethal disease in the U.S. that it is in Sierra Leone, Guinea and Liberia, making quarantine even harder to justify.
The way to manage Ebola is with strict monitoring for symptoms. The way to manage fear and ignorance is with quarantine. The way to defeat Ebola in West Africa is to treat volunteers as responsible, moral heroes. The way to allow the epidemic to spread is to lock-up those who offer the only chance for treatment and eradication.
Arthur Caplan, PhD, is the Director of the Division of Medical Ethics at NYU Langone Medical Center.