Ebola+Quarantine

=Quarantining Ebola Health Care Workers=

Recently, Ebola fears have spiked in the United States with the death of the first patient in Texas and the diagnosis of Ebola infection in two of the nurses who treated him. Those nurses self monitored as they went about their lives- and reported for care when they became symptomatic. One traveled back to Tallmadge, Ohio to plan her wedding with her family before returning to Texas, and in response to her diagnosis most of those she had contact with were directed to stay home from work and self-monitor. Apparently the disease can take up to 21 days after infection to show symptoms, usually a fever (which could easily be a sign of the flu or another kind of infection), and one only becomes contagious after symptoms are manifest.

Both nurses have been declared Ebola free after their quarantine in Texas and Atlanta. But, a nurse who had returned home after working in West African is being quarantined against her will- and a Dr. who was working in West Africa and returned to New York City has become diagnosed with Ebola after showing symptoms and is now in quarantine. And now, claiming public health authority, a number of state governors have declared mandatory 21 day quarantines of all who return to their state from West Africa and / or have been involved with treating Ebola patients.

Is this justified? Or, is this a violation of civil rights? Can this be mandated, or should it only be voluntary?

What are the costs and benefits of quarantining health care workers who are risking their lives to save patients who have contracted Ebola- and by doing so to contain Ebola so that it doesn't become an epidemic?

NEW EXTENSION- NATIONAL ANNENBERG SPEAKOUT DISCUSSION.

You can join in a national discussion with other students here: Ebola Quarantine- Who Should Decide, and earn double extra credit points by posting your thoughts both to the Annenberg site and this discussion. In your post to our discussion, please note that you also posted to the SPEAKOUT. The National Discussion screens all of its posts before publishing them online... so there can be a delay of up to a day between your submitting a post and seeing it on their site.

Annenberg also offers lots of background to each discussion. Here is what they have for the Ebola Quarantine discussion:

Who should decide a quarantine policy?

Nov 5, 2014

By Jeremy Quattlebaum, Student Voices staff writer

As an increasing number of U.S. aid and medical workers return from Ebola-stricken West Africa, questions have arisen on whether they need to be quarantined. Depending on the state, returning workers may face anything from a 21-day isolation period in a hospital to a recommended, but not enforced, at-home quarantine. This may seem like a straightforward medical question, but states and the federal government disagree.

The Centers for Disease Control and Prevention (CDC), the national public health institute, recommends that only people who have come into direct contact with Ebola patients without protective gear submit to an at-home 21-day isolation period.

Ebola is spread when an infected person’s bodily fluid comes into contact with another person’s skin, which would rarely happen outside a medical setting. The disease is not easily transmitted. The 21-day period is based on the fact that this is the longest period of time a person with the disease can go without developing symptoms.

The federal government, following the advice of the CDC, recommends that returning health care workers quarantine themselves at home for 21 days, and avoid public places and travel on public transportation and other crowded areas. The governments of the West African nations that are experiencing the Ebola outbreak monitor individuals’ temperature as they board planes and have them fill out a questionnaire to determine if they have come into contact with the disease.

U.S. military personnel who have been sent to the infected areas for support are mandated to undergo a 21-day quarantine. According to Secretary of Defense Chuck Hagel, this is due more to the uncertainty of exposure the personnel may have had, in addition to the fact that the service members are volunteers. Hagel said, “This is also a policy that was discussed in great detail by the communities, by the families of our military men and women, and they very much wanted a safety valve on this.”

After three isolated cases in Texas and New York, a lot of people around the country have heightened fears about the disease, much of which the CDC says is unfounded.

The governments of Illinois, New Jersey and New York, fearing a potential outbreak in their states, require quarantines for all people returning from working with Ebola patients in West Africa, regardless of whether they show symptoms. Meanwhile, Maryland will monitor people who return from Ebola-affected countries for 21 days, taking their temperatures and looking for other symptoms. Illinois has established a 21-day at-home quarantine for anyone who may have come into contact with the disease, including health workers.

These mandatory quarantines have been criticized by the CDC, the federal government, and many in the medical community as unnecessary and potentially damaging to the international effort to combat the disease. Organizations like Doctors Without Borders, a nongovernmental international aid organization, argue that they could deter doctors from volunteering abroad because of the scrutiny they would experience when they return.

“I’m concerned of the disincentive for the health care workers” to travel to West Africa, said Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health.

“This is an overly extreme and non-evidence-based policy,” said Dr. Anthony Harris, an infectious-disease expert at the University of Maryland School of Medicine. “There’s no reason to have policies with that level of detail because there’s no risk.”

Some governors don’t see it as going overboard when it comes to protecting their states. Citing the case in Texas, where a Liberian man arrived in Dallas with the disease and infected two nurses who cared for him, Govs. Chris Christie of New Jersey and Pat Quinn of Illinois say hospitals are not prepared to deal with Ebola.

“This protective measure is too important to be voluntary,” Quinn said.

Criticized for quarantining a nurse who returned from West Africa and registered a low-grade fever after arriving at the Newark, N.J., airport, Christie argues that New Jersey’s quarantine is necessary to protect his state. The nurse later tested negative for the disease and was allowed to return to her home in Maine.

“The reason she was put in the hospital in the first place was because she was running a high fever and was symptomatic,” Christie said. “If you live in New Jersey, you’re quarantined in your home. That’s always been the policy. If you live outside the state, and you’re symptomatic, we’re not letting you go onto public transportation. It makes no common sense. The minute she was no longer symptomatic, she was released.”

This patchwork of health policies is the result of President James Madison’s ideas on federalism and the Tenth Amendment, which give a considerable amount of power to the state to regulate the well-being of their citizens.

Federalism, backed by an 1824 Supreme Court case, //Gibbons v. Ogden//, gives states significant power when dealing with issues that happen only within state boundaries.

The Public Health Service Act allows the federal government to override states on public health issues. The act empowers the U.S. secretary of health and human services, an executive branch position, to take measures to prevent a disease from coming into the country and crossing state borders.

**What do you think?**

Should states or the federal government decide how to handle returning health care workers from Ebola-affected countries? Do the states with strict quarantine policies go over the line, or are they necessary to prevent an outbreak? Should the medical community or the government have a greater say in a policy? Join the discussion and let us know what you think!