Ebola’s ‘Science’: Why it’s so Hard to Manage
by BETSY MCCAUGHEY, PHD
October 30, 2014
On Monday, Centers for Disease Control and Prevention head Thomas Frieden unveiled a new policy for health-care workers returning from Ebola-plagued West Africa.
Yesterday, President Obama defended that policy, claiming it is based on science, not fear. Sorry. The administration's halfway approach is based on political correctness. It ignores the science.
According to Frieden, every day about five health-care workers fly back from West Africa to the United States. For months, the CDC did almost nothing to prevent returning doctors and nurses from inadvertently spreading the disease here.
On Thursday, Dr. Craig Spencer, who had returned from a stint with Doctors Without Borders in Guinea on Oct. 17, was rushed into isolation at Bellevue Hospital with Ebola.
Before his diagnosis, Spencer took subways, went bowling and dined out. Authorities scrambled to identify his contacts.
Gov. Chris Christie of New Jersey, a Republican, and Gov. Cuomo of New York, a Democrat, jointly announced on Sunday that health-care workers landing at area airports after treating Ebola patients would have to undergo 21 days of isolation.
Governors of Florida and Illinois announced they would be devising policies, as well.
By Monday, Frieden had to respond to the spectacle of governors concocting isolation policies on the run to prevent the possibility, however small, of Ebola being spread. Alas, Frieden stopped short of endorsing isolation.
Instead he announced that local officials would monitor doctors and nurses coming from West Africa for fever or other symptoms but not necessarily isolate them.
Frieden said isolating the brave doctors and nurses would be a "stigma" and make them "pariahs." That's a shockingly unscientific attitude toward quarantine from a trained epidemiologist.
Here's the science:
- About one in seven people infected with Ebola doesn't have a fever before diagnosis. Airport screening relies largely on temperature-taking. Data from over 4,000 Ebola cases (the most complete analysis ever) published Oct. 16 in the New England Journal of Medicine show that 13 percent of patients don't develop fever early on.
- Doctors and nurses can't be depended on to spot Ebola in themselves faster than other people. Relying on them to monitor themselves assumes they will catch any sign of illness quickly and avoid spreading it. But the New England Journal research found doctors and nurses with Ebola don't get to the hospital sooner.
- Health-care workers who treat Ebola patients are at risk of getting it, despite wearing protective gear. As of Oct. 25, the World Health Organization reports that 450 health-care workers contracted Ebola this year, and 244 have died. One staffer at Doctors Without Borders in Guinea who worked with Spencer called him a "rigorous man" who carefully followed procedures in removing his protective gear and decontaminating it, adding "we understand that we are also at risk despite the measures."
- The most important fact about Ebola is how little we know. There's no cure for the infected, no vaccine and no knowledge of how the virus might behave in colder temperatures. Doctors, nurses and missionaries who nobly volunteer in Africa could inadvertently be bringing Ebola home to every continent, giving the virus wings.
To be safe, Samaritan's Purse, a relief organization, imposed a 21-day isolation period on workers returning from West Africa after one of its own, Dr. Kent Brantly, became infected. The hospital where Spencer practices requires a 21-day wait to return to work.
On Monday, the Joint Chiefs of Staff recommended all US troops returning from West Africa undergo a 21-day quarantine. Their biggest worry isn't stigma.
There is no stigma to being quarantined. Our nation's heroic astronauts who landed on the moon were quarantined on their return to ensure possible "moon germs" didn't endanger the public.
Obama is creating a false choice by saying we can applaud health-care workers or quarantine them. We should do both.
The White House hasn't said much about soldiers, but it's busy arm-twisting governors to back off isolating health-care workers. On Monday, Cuomo backed down from mandatory isolation, despite overwhelming popular support for it.
One positive note: Frieden changed his tune Monday, saying "managing Ebola is not easy." He and President Obama need to replace hubris with humility and take fewer gambles with this deadly disease.