Health Workers, Fairness, and Ebola

In the NY metropolitan area, there has been a lot of press regarding Ebola. First, Dr. Craig Spencer returns from Guinea and starts having symptoms which led to his hospitalization and eventual confirmation as a case of ebola. Next, nurse Kaci Hickox returns from working in the hot zone and, apparently, has a fever of 101.

New York, New Jersey, and other states have imposed a mandatory 21 day quarantine on all persons that have been exposed to the ebola virus.  This, as you might imagine, includes all healthcare workers treating victims of the disease.  Given that the United States has not instituted a travel ban from the affected countries, a quarantine for those exposed to the virus seems to have the next best level of protection for U.S. citizens. In any case, Ms. Hickox was told that she is under quarantine (the first person affected by the quarantine order).

What happened next is, at least to me, hard to believe. Ms. Hickox apparently became so incensed with the news that she must be quarantined that she raised her own temperature to 101. This triggered even more intervention until tests were performed that came back negative for Ebola.

A negative test result is wonderful news, but Ms. Hickox’s lambasting of New Jersey for the mandatory quarantine has called into question the “fairness” of putting ebola caretakers under quarantine.  Ms. Hickox believes that this policy will make it less likely that medical personnel will volunteer to help those affected in the epidemic region.

These are two separate questions which should be examined. First, is it fair to quarantine all health workers that care for ebola patients? In my mind, the few people that are truly at high risk are, indeed, that exact group of people. They are involved with handling bodily fluids from the infected, such as feces, blood, and vomit. These fluids have the highest levels of viral “load”, and small bits of splatter could result in infection. As such, if anyone is a candidate for quarantine, health workers are.

The second question is “Will a quarantine order discourage health workers from volunteering for work in West Africa in the future?”  This is a distinct possibility, as it can’t be pleasant to spend three weeks in relative isolation.  It is certainly more pleasant, however, than spending time in a hazmat suit in hot weather dealing with bodily fluids from sick patients. Therefore, if you are willing to sign up for the latter, it seems that you would be willing to tolerate the former.

Soldiers, when they sign up, know that they may be sent to a war zone.  Ebola health workers know that they’re heading for the front in a different war. Both, in my opinion, are brave beyond measure, and we should show our appreciation for all they are doing to make the world a better place. We should give them all the resources they need to do their job, and they should be rewarded for their service. If there is financial loss involved, we can consider giving help where it is needed.

The hard reality is that our priority remains the safety of U.S. citizens. In the final analysis, it is what’s fair to them that must be most important. The battle between individual rights and the public good is an eternal one in the United States. Choices must be made, and we must live with the consequences of our decisions.

Joe Alton, M.D.

Our latest offering is our collaboration with Skyhorse publishing to produce “The Ebola Survival Handbook“. It’s a short guide to what’s going on with the Ebola epidemic and what you can do to prepare for an infectious disease outbreak in your area.