The Ethics, Science, and Politics of Ebola Quarantines

Patric Cao

What’s New, Ebola?

Ebola is a nuanced disease. Many comics and media outlets have spun the morbid, grave virus into “fearbola” rather than the public health crisis that it is. Yet, it’s serious enough that, in October, a flight passenger’s Ebola joke prompted a HAZMAT crew to remove him from the US Airways plane.1 The fact is: it’s a sensitive subject. And rightfully so:

  • EVD’s (Ebola Virus Disease) fatality rate hovers around 50%, varying from 25% to 90% in that past outbreaks.
  • Often mistaken for malaria, typhoid, and meningitis, Ebola is hard to diagnose because it requires a contagious blood test.
  • There are no official vaccines or cures, and all treatments are palliative.
  • Finally, as the nail in the coffin, globalization amplifies the risk of protocol failures with Ebola’s ability to hop on a airplane across the world. (Information cited from “Key Facts” by WHO.2)

Ultimately, Ebola’s virulence drives policy makers to increase public awareness, issue travel notices for risk areas, increase research funding, track the disease spread, and support Western Africa’s health infrastructure. But recently, four U.S. Ebola cases pushed policy makers to quarantine individuals to minimize disease contact.3 But while quarantine is warranted, some policies overstep the ethical line while producing little results, hurting the patient, and exacerbating national paranoia. To make an effective quarantine period, legislators must motivate the quarantine solely to increase safety via empirical, scientific data, while also considering the patient’s health and the public.

Why the 21-day quarantine time?

At the moment, reports by the WHO and CDC indicate that the virus’s incubation period is from 2 – 21 days, meaning that after 21 days, if no symptoms appear, the individual is not likely contagious. Thus, U.S. policy suggests a 21-day quarantine for suspected carriers. But from where does that number come?

To arrive at that number, Professor Charles Haas at Drexel University examined the mean time between exposure and disease for past outbreaks noting that in the 1976, the Zaire outbreak had a mean 6.3 days, spreading from 1 – 21 days. For the 1995, Congo outbreak and 2000 Uganda outbreak, results indicated a mean of 5.3 and 3.35. But other analysis approaches resulted to a 10.11-day – 12.7-day mean. So while reports from the WHO, that draws data from the past 9 months of outbreak in Western Africa, indicate a mean of 11.4 days with an upper limit of 21 with 95% confidence are “reasonable”, Haas raises slight concerns with the 21 day number and estimates that there is a risk between .2 – 12% of developing the Ebola contagion after 21 days.4 But interestingly, Haas states that the goal of the paper was to emphasize that a quarantine period needs to consider the costs and benefits of quarantine. He adds that with more contagious and potentially deadly diseases, the risk of making a mistake is enormously high. But, he intends only to suggest and explore the topic and not provide a flat quarantine period.5

But, why can’t the CDC just make the quarantine time larger to eliminate risk?

The CDC is particularly wary of changing quarantine times because of 3 key elements: public safety, ethics, and quarantine. Statistically speaking, to make the confidence interval much larger quarantine times are needed to reduce risk to 0. But also, a shift in CDC policy will exacerbate paranoia, hurting public safety more than the slight boost.

Tom Frieden, the head of the CDC, encapsulates this in an interview early October when addressing unnecessary travel restrictions. He stated, “We don’t want to isolate parts of the world, or people who aren’t sick, because that’s going to drive patients with Ebola underground, making it infinitely more difficult to address the outbreak.”6 In other words, expanding policies, like making a travel notice into a blatant travel restriction or unnecessarily increasing quarantine times, will frighten the ill into secrecy. Steven Petrow, a Washington Post Health/Science Columnist, further echoes this sentiment, stating that the prevalence of the ebola in the news and comedy late night shows are driving people to think that Ebola is transmitted via benign contact other than through bodily fluids.7 Overall, blindly increasing the severity of ebola quarantine periods can dismantle public health more than it helps.

Finally, there could be a political aspect to the policy. Eleanor Clift, a journalist for the Daily Beast, suggests that the midterm elections were an impetus for fear mongering. She argues, “With Election Day approaching, Republicans are rushing to spin the Ebola outbreak as the result of the president’s poor leadership.” Interesting, the CDC could be wary of changing policies in the midst of a politically volatile because its actions could be misinterpreted, inciting disorder. For example, Senator Elizabeth Warren (D-M.A.) admonished Governor Chris Christie (R-N.J.) for his controversial decision to place all health care workers returning from Liberia, Guinea, or Sierra Leone under a mandatory quarantine, even if they are asymptomatic. Many have accused Gov. Christie of playing politics at the expense of basic human rights, while Gov. Christie remains steadfast that he is looking after public safety. Even more so on the political underpinnings of ebola, UN Secretary Geenral Ban Ki Moon released a statement alluding to those actions as “restrictions that are not based on science”.8

Conclusion

In the end, the Ebola public health crisis imbues safety, ethical, and political shades, and quarantine times need to be meticulous calculated to balance a variety of risks and benefits. So as Ebola outbreaks (and perhaps future diseases’) progress, government and societies should be particularly wary of how it’s policies limit disease factors and public-reaction related factors, particularly fear and misinformation. By elucidating all components, hopefully a more comprehensive and scientifically and morally apt can be arise to readily equip the nation against disease.

References

  1. Brumfield, Ben. “Ebola Comment Gets Passenger Hazmat Escort from Plane.” CNN. Cable News Network, 01 Jan. 1970. Web. 16 Nov. 2014.

  2. “Ebola Virus Disease.” WHO. World Health Organization, Sept. 2014. Web. 14 Nov. 2014.

  3. “Cases of Ebola Diagnosed in the United States.” Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 12 Nov. 2014. Web. 14 Nov. 2014.

  4. Haas CN. On the Quarantine Period for Ebola Virus. PLOS Currents Outbreaks. 2014 Oct 14. Edition 1. doi: 10.1371/currents.outbreaks.2ab4b76ba7263ff0f084766e43abbd89.

  5. Faulstick, Britt. “Drexel Study Questions 21-Day Quarantine Period For Ebola.” Drexel Now. Drexel University, 15 Oct. 2014. Web. 16 Nov. 2014.

  6. Frieden, M.D. Tom. “CDC Chief: Why I Don’t Support a Travel Ban to Combat Ebola Outbreak.” Fox News. FOX News Network, 09 Oct. 2014. Web. 14 Nov. 2014.

  7. Petrow, Steven. “Why ‘Fearbola’ Reminds Me of the Early AIDS Panic.” Washington Post. The Washington Post, 15 Oct. 2014. Web. 16 Nov. 2014.

  8. Oh, Inae. “Elizabeth Warren Challenges Chris Christie for the Science behind His Ebola Quarantine.” Mother Jones. Mother Jones, 28 Oct. 2014. Web. 16 Nov. 2014.