National View: Governors’ quarantine policies short-sighted

On Oct. 23, Dr. Craig Spencer, an obviously compassionate and responsible young man, recognized the onset of fever during the incubation phase since his last exposure to patients with Ebola in Guinea. He acted quickly to minimize his contact with others, reporting his illness to his sponsoring organization, Doctors without Borders. His subsequent management by New York City authorities was swift and effective. Similarly, two nurses in Dallas closely tracked their temperatures and symptoms following Thomas Eric Duncan’s death from Ebola on Oct. 8. When the fever came, they too quickly reported the onset of illness and were hospitalized and isolated. Contrast this with the visceral and politically charged reaction of the governors of four states, including Gov. Christie’s shameful authorization to quarantine nurse Kaci Hickox on Friday after her return from West Africa, where she was treating Ebola patients. Rather than calming fears of contagion, the actions of the governors show a reckless disregard for medical evidence and public health and inflame the discourse on the handling of Ebola. Hickox, who is not ill, was nonetheless held in quarantine in a tent at a New Jersey hospital after her return to the United States. This week she was released and allowed to travel to Maine, where she is expected to self-quarantine. Accurate temperature measurements since Friday have shown that she has no fever, and laboratory tests have demonstrated that Hickox currently has no evidence of Ebola in her system. But her release came only after speaking out publicly against her quarantine. An unapologetic Christie stands by his decision to quarantine Hickox, which means it could easily happen to others. To order quarantines without a plan or scientific rationale leaves little question about the motivation for these actions, and they have had their desired effect. This needless quarantine did not make New Jersey a safer place. It merely thrust governors into the forefront of a public-health issue about which they appear to know little. Should Christie’s shortsighted approach become the norm, it is likely that American support for the global effort to contain Ebola will be impeded. That, in turn, will slow containment and worsen the epidemic. At a time of such public concern, America is in little need of aspiring politicians who set public-health policy on the fly in defiance of science and civil rights. Public-health law permits the incarceration of individuals who pose a threat to society through their negligent actions. Those who harbor illnesses transmissible to others may be legally quarantined when their refusal to receive treatment places others at risk. If an Ebola patient was well enough to refuse isolation and elude treatment, he or she should be treated in a similar fashion. Ebola, sadly, is so profound that patients are often left prostrate and fully dependent on others for sustenance and care. But, prior to the onset of symptoms, they are not contagious. In contrast, what we have seen in the example first of Christie and Gov. Andrew Cuomo of New York, and later Govs. Rick Scott of Florida and Pat Quinn of Illinois, is the willful disregard of medical evidence and a violation of civil rights. Happily, reasonable voices seemed to have tempered Cuomo’s position. But not so Christie’s. In every example to date of a health-care worker presenting with Ebola in the United States, the affected person has promptly self-reported his or her illness. Furthermore, there has been no evidence of significant exposures to the general public. Health care workers should not be subject to the degrading conditions Hickox received in New Jersey. Health-care workers responsible enough to travel overseas to apply their skills, or wade into hot zones in this country, deserve better than the spectacle of incarceration at the whim of ill-informed politicians. The capricious policy of quarantine implemented in four states should not be repeated in other jurisdictions and should be reversed where it is in effect before further harm is done to the effort to combat this illness. Dr. Patrick J. Brennan is an infectious diseases physician at Penn and a former director of tuberculosis control for the Philadelphia Department of Public Health.
On Oct. 23, Dr. Craig Spencer, an obviously compassionate and responsible young man, recognized the onset of fever during the incubation phase since his last exposure to patients with Ebola in Guinea. He acted quickly to minimize his contact with others, reporting his illness to his sponsoring organization, Doctors without Borders. His subsequent management by New York City authorities was swift and effective.Similarly, two nurses in Dallas closely tracked their temperatures and symptoms following Thomas Eric Duncan’s death from Ebola on Oct. 8. When the fever came, they too quickly reported the onset of illness and were hospitalized and isolated.Contrast this with the visceral and politically charged reaction of the governors of four states, including Gov. Christie’s shameful authorization to quarantine nurse Kaci Hickox on Friday after her return from West Africa, where she was treating Ebola patients. Rather than calming fears of contagion, the actions of the governors show a reckless disregard for medical evidence and public health and inflame the discourse on the handling of Ebola.Hickox, who is not ill, was nonetheless held in quarantine in a tent at a New Jersey hospital after her return to the United States. This week she was released and allowed to travel to Maine, where she is expected to self-quarantine. Accurate temperature measurements since Friday have shown that she has no fever, and laboratory tests have demonstrated that Hickox currently has no evidence of Ebola in her system. But her release came only after speaking out publicly against her quarantine. An unapologetic Christie stands by his decision to quarantine Hickox, which means it could easily happen to others.To order quarantines without a plan or scientific rationale leaves little question about the motivation for these actions, and they have had their desired effect. This needless quarantine did not make New Jersey a safer place. It merely thrust governors into the forefront of a public-health issue about which they appear to know little.Should Christie’s shortsighted approach become the norm, it is likely that American support for the global effort to contain Ebola will be impeded. That, in turn, will slow containment and worsen the epidemic. At a time of such public concern, America is in little need of aspiring politicians who set public-health policy on the fly in defiance of science and civil rights.Public-health law permits the incarceration of individuals who pose a threat to society through their negligent actions. Those who harbor illnesses transmissible to others may be legally quarantined when their refusal to receive treatment places others at risk.If an Ebola patient was well enough to refuse isolation and elude treatment, he or she should be treated in a similar fashion. Ebola, sadly, is so profound that patients are often left prostrate and fully dependent on others for sustenance and care. But, prior to the onset of symptoms, they are not contagious.In contrast, what we have seen in the example first of Christie and Gov. Andrew Cuomo of New York, and later Govs. Rick Scott of Florida and Pat Quinn of Illinois, is the willful disregard of medical evidence and a violation of civil rights. Happily, reasonable voices seemed to have tempered Cuomo’s position. But not so Christie’s.In every example to date of a health-care worker presenting with Ebola in the United States, the affected person has promptly self-reported his or her illness. Furthermore, there has been no evidence of significant exposures to the general public.Health care workers should not be subject to the degrading conditions Hickox received in New Jersey. Health-care workers responsible enough to travel overseas to apply their skills, or wade into hot zones in this country, deserve better than the spectacle of incarceration at the whim of ill-informed politicians.The capricious policy of quarantine implemented in four states should not be repeated in other jurisdictions and should be reversed where it is in effect before further harm is done to the effort to combat this illness.Dr. Patrick J. Brennan is an infectious diseases physician at Penn and a former director of tuberculosis control for the Philadelphia Department of Public Health.