“We want to strike the right balance of doing what is best to protect the public's health while not impeding whatsoever our ability to combat the epidemic in West Africa,” CDC spokesman Tom Skinner said. A quarantine, he said, is “one of the options on the table.”
While many medical experts say it's not necessary as long as the returning workers carefully monitor themselves for the virus, some experts say it would be a good idea—if only to alleviate public anxiety and the resulting cost of disinfecting all the places they've been and monitoring all the people they've come in contact with. The flip side is that a mandatory quarantine could discourage healthcare professionals from volunteering and could unduly frighten the public.
Art Caplan, director of medical ethics at New York University Langone Medical Center, told the New York Daily News that while a mandatory quarantine is probably unnecessary medically, it would offer “peace of mind” to the general public. He said the city should provide special, quarantined housing for doctors returning from West Africa.
Dr. Samuel Packer, a medical ethicist at North Shore-Long Island Jewish Medical Center, Great Neck, N.Y., called it a “gray zone” issue. “That's worth further discussion, but not decision at this point,” he told the Daily News.
Dr. Craig Spencer, the emergency physician who is being treated for Ebola in New York City, followed all internal protocols upon his return to the United States, said Doctors Without Borders, the medical aid organization he was working with in Guinea.
Spencer is the first Doctors Without Borders staff member who has developed confirmed Ebola symptoms after returning home, Doctors Without Borders said in a written statement. Since March, three international staff members and 21 local employees have contracted the virus while working in West Africa, and thirteen have died.
Doctors Without Borders workers returning to their home country are asked to stay within four hours of a hospital with isolation facilities during a 21-day active monitoring period, according to the group. If they don't live within four hours of an appropriate facility, Doctors Without Borders will provide the staff member with appropriate accommodations, a statement said.
Though many people have questioned why Spencer ate at a restaurant and visited a Brooklyn bowling alley with friends during his 21-day monitoring period, Doctors Without Borders said self-quarantine is not warranted nor recommended to staff members.
But, the group said, staff members are “discouraged” from returning to work during this period, as returning to work without rest could make individuals more susceptible to simple bacterial or viral infections with symptoms similar to Ebola. The organization continues to pay its staff during the 21-day monitoring period.
Doctors Without Borders spokesman Tim Shenk said that the organization is not aware of any obvious breaches of protection that could have led to Spencer's infection, such as a tear in his personal protective equipment. But he said an internal investigation is underway to determine how he may have become infected.
“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,” said Sophie Delaunay, the organization's executive director, in a written statement.
Doctors Without Borders requires that staff wear personal protective equipment, much of which meets or surpasses guidelines that have been put in place for providers in the U.S. by the CDC. The private group's protocols also restrict the number of people who can go into high-risk treatment areas.
Its staff members who are placed abroad are rotated every four to six weeks to ensure that they don't become too tired to safely treat patients, the organization said. In addition, the group's treatment protocols limit administering blood tests on patients, and patients are given oral therapy in lieu of injections whenever possible to limit the risk of needlestick injuries.
Working with the CDC, Doctors Without Borders pre-identifies hospitals that can treat staff members if they develop symptoms once they return to their home countries, the organization said. Staff members are instructed to take their own temperature two times a day, finish their ongoing preventive treatment for malaria and monitor themselves for symptoms.
Many in the U.S. medical community believe total self-quarantine is unnecessary if an individual does not present symptoms.
But a physician who heads safety and risk prevention at a prominent medical center, who did not want to be named, told Modern Healthcare that it's obvious healthcare workers returning from direct contact with Ebola patients in West Africa should quarantine themselves for 21 days as an expected part of their volunteer medical aid service.
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