Doctors Spar With Congress Over Ebola Worker Quarantine

As members of Congress call for a mandatory quarantine of Ebola health workers returning from West Africa, doctors are pushing back, warning that the added burden could deter many from volunteering to fight the outbreak at its source.

The conflict highlights a rift between an anxious public fearful of the virus that has now been diagnosed in four people in the U.S., and medical aid groups who say their workers can monitor themselves and know how not to spread the disease.

There are currently no legal restrictions on health workers’ movements when they return to the U.S. after caring for Ebola patients, though at least one U.S. aid organization voluntarily quarantines its workers upon their return. That doesn’t go far enough, said lawmakers at a hearing in Washington today, who questioned whether scientists know enough about how the virus is spread to be confident they can protect the American public.

Quarantining health workers “sets a strong perimeter of defense to protect public health here in the United States while allowing for infectious-disease experts to gain a better understanding of this virus,” Representative Tim Murphy, a Pennsylvania Republican, wrote in an editorial yesterday in the Pittsburgh Post-Gazette. “As we learn more, we can adjust these policies. But let’s start from the strongest line of defense and work our way down, not begin with the weakest line of public-health protections and scramble our way up.”

Infection Control

Many doctors and aid groups say they know how to contain the virus and despite the cases in the U.S. no one has been infected through casual contact within the community.

“This question about what should be done with returning health care workers is one that is actively being discussed,” New York City Health Commissioner Mary Bassett said today. “It’s going to be something that’s going to be decided at the federal level.”

Thomas Eric Duncan, the first Ebola patient diagnosed in the U.S. infected two health workers caring for him. Duncan’s fiancee and three others who had close contact with him while he was sick didn’t contract the virus and were released from quarantine this week. Craig Spencer, a volunteer with Doctors Without Borders who returned Oct. 17 to New York City from caring for patients in Guinea, was diagnosed yesterday. His fiancee and two friends who had close contact with him are being quarantined.

“Any change would be based on politics,” because all the evidence indicates that people are not contagious before they have obvious symptoms of Ebola, said Robert Glatter, an emergency physician at Lenox Hill Hospital in New York.

Viral Incubation

Doctors Without Borders says isolating all workers returning from West Africa would be “excessive.” Its volunteers take their temperature twice a day and contact the group if they get a fever or other symptoms.

For 21 days, the time it takes the virus to incubate, returning workers must check their temperature twice a day, stay within four hours of a hospital with isolation facilities and immediately contact the organization if symptoms such as fever develop, under the group’s rules. Spencer followed those protocols, the group said.

The risk of not isolating health workers may be too great though, Representative Jason Chaffetz, a Utah Republican, said at a hearing today in Washington. He called on doctors returning from treating Ebola patients in West Africa to be quarantined for at least three weeks.

Doctor Quarantine?

“Extremely strict procedures are in place for staff dispatched to Ebola affected countries before, during, and after their assignments,” said Sophie Delaunay, executive director of Doctors Without Borders in the U.S. “Despite the strict protocols, risk cannot be completely eliminated. However, close post-assignment monitoring allows for early detection of cases and for swift isolation and medical management.”

Spencer is the first of 700 expatriate staff with Doctors Without Borders, also known as Medecins Sans Frontieres, to develop symptoms after returning to their home country. Two MSF staff diagnosed in Africa were medically evacuated and treated in France and Norway.

In contrast to Doctors Without Borders, the aid group Samaritan’s Purse started quarantining all its volunteers upon their return from West Africa since Kent Brantly, a group-sponsored doctor, contracted Ebola in Liberia in August, said Franklin Graham, president of the North Carolina charitable group. About 30 volunteers have gone through quarantine since then at an undisclosed location within an hour of one of four U.S. hospitals specially trained to handle Ebola patients, he said.

Most Deadly Virus

Graham said the potential risk of one of its volunteers infecting someone in the community or their family outweighs the inconvenience of the quarantine.

“You are dealing with the world’s most deadly virus and you cannot take a chance with this,” Graham said today in an interview.

The Centers for Disease Control and Prevention said this week it will give travelers from Guinea, Liberia and Sierra Leone, where the virus has killed almost 4,900 people, a self-monitoring kit and they will be required to report their condition to health officials.

Spencer, the New York City doctor, began feeling tired on Oct. 21, and first noticed he had a fever sometime about 10 a.m. yesterday. He immediately alerted Doctors Without Borders, which contacted health authorities and Spencer was brought to Bellevue Hospital Center, a state-designated center for such cases, in a special ambulance, Bassett, the New York City health commissioner, said.

Doctor’s Contacts

While Spencer tried to avoid close contact with people, he did go for a 3-mile run one day and went to The Gutter, a bowling alley in the Williamsburg section of Brooklyn the night before he developed a fever, Bassett said yesterday. Spencer also traveled on the A, 1 and L subway lines since his return and went to a restaurant and a coffee shop, she said.

When asked about whether additional quarantine measures from travelers from West Africa should be taken, White House press secretary Josh Earnest said medical specialists are “looking closely” at how to proceed.

“We’re always reviewing and assessing the protocols that are in place,” he said. “These kinds of decisions are going to be driven by science.”

Safe Movement

Quarantining everyone isn’t necessary and would be difficult to enforce, said Mark Jarrett, chief quality officer for the North Shore-LIJ Health System, a chain of hospitals in Long Island and New York City. “If they feel perfectly well, they are not contagious, it is safe for them to go out,” he said.

Such restrictions for everyone who comes back from West Africa could make the situation worse by discouraging doctors and other health-care workers to volunteer and help contain the virus there.

“If you put people in quarantine, that is, home rest, after they come back from Liberia, you will get no volunteers going over there,” said William Schaffner, an infectious disease doctor at the Vanderbilt University School of Medicine in Nashville, Tennessee.

“We need to send not fewer resources over to Africa but more,” Schaffner said. “The longer it goes on the greater the risk” for the rest of the developed world.

Bodily Fluids

Ebola is spread through contact with blood or other bodily fluids such as vomit, feces, urine and saliva. While an infected person who sneezes or coughs directly in another person’s face could infect that person, the virus primarily enters the body through tiny cuts or abrasions, or through mucus membranes of the eyes, nose, ears and mouth.

Symptoms of Ebola include sudden onset of fever, intense weakness, muscle pain, headache and sore throat. This is followed by vomiting, diarrhea, rash, impaired kidney and liver function, and in some cases, internal and external bleeding. Infections can only be confirmed through laboratory testing.

There is no specific treatment to cure the disease. Severely ill patients require intensive supportive care. They are frequently dehydrated and need intravenous fluids or oral rehydration with solutions that contain electrolytes.

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