Ebola and the Quarantine Quandary

Posted in: Reflections Articles

Stephen Prescott, M.D.  “Ebola and the Quarantine Quandary” 

Like Oklahoma’s weather, the news on Ebola changes quickly. Between the time I write this article and the time you are reading it, the story about this global health crisis will no doubt have moved in many new directions.

Still, I feel confident that at least one thing will have remained the same: the vigorous debate over the use of quarantine to stop the spread of this deadly virus.

The issue came into sharp focus when nurse Kaci Hickox defied Maine authorities and refused to remain confined in her home following her return from treating Ebola patients in Sierra Leone. Because she was not symptomatic and said that she was regularly monitoring her condition, Hickox reasoned that she didn’t pose any threat to people she might come in contact with.

“So many states have started enacting these [quarantine] policies that I think are just completely not evidence-based,” Hickox told the media. “They don’t do a good job of balancing the risks and benefits when thinking about taking away an individual’s rights.”

Not long after Hickox decided to go for a bike ride with her boyfriend, Maine took legal action in an attempt to enforce quarantine. That action failed, with the judge allowing Ms. Hickox to go about her daily business with only minor restrictions. The decision was greeted both with loud applause and howls of derision.

So what’s the right answer here?

Health authorities have repeatedly assured us that the virus doesn’t become contagious until a person starts to manifest symptoms, the most obvious of which are a fever. So long as a person shows no signs of illness and remains vigilant about monitoring her condition, does she really pose any risk to others?

The truth is, we can’t be completely sure. With most viral illnesses, an infected person begins to “shed” virus before he or she shows signs of illness. How long before varies from virus to virus. Although anecdotal evidence suggests that Ebola may be different, there’s no ethical way to test that hypothesis.

The only way to know for sure would be to infect people with Ebola, then expose them (and their bodily fluids) to others over the ensuing weeks. By observing who contracted the virus and who didn’t, you’d get a clearer picture of when Ebola becomes contagious.

Maybe we’d discover that Ebola becomes contagious six hours before the body temperature begins to rise. Or maybe it’s when the body temperature reaches 99 degrees. Or 99.5.

Obviously, we’ll never know for sure, because we’ll never do that experiment. How on earth would you find volunteers?

Instead, we’ll continue to gather anecdotal information and make our best guess about when, exactly, the virus begins to spread.

In the meantime, the surest way to curb the Ebola outbreak is to resolve all doubt in favor of keeping people who may be infected away from those who are not. That’s especially true because there are many different strains of the virus, and they are constantly mutating, causing changes that could make the illness more contagious.

Quarantining those who have been exposed would result in some temporary loss of freedom for those individuals. We’ll just have to decide if that’s a cost we’re willing to bear to ensure that the Ebola epidemic does not take hold in the U.S.

Prescott, a physician and medical researcher, is president of the Oklahoma Medical Research Foundation. He can be reached at omrf-president@omrf.org.

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