Divisions surface between healthcare workers, public over Ebola quarantines

As numerous states begin imposing quarantines on healthcare volunteers returning from fighting Ebola in West Africa, infectious-disease experts decry measures they say would undermine the most effective means of controlling the spread of the disease—containing it at its source.

So rather than bringing the country together to fight this deadly disease, divisions in the healthcare community and among the public are growing. Those favoring quarantines include politicians in hotly contested elections races as well as a majority of the American public. Meanwhile, health experts fear imposing such restrictions will only make recruiting personnel to fight Ebola more difficult.

For a fearful public with little time to understand the complexities of infectious-disease control, the bottom line was confusion and reduced trust in public-health officials working to prevent an epidemic. It also could reduce the number of U.S. healthcare workers willing to go to West Africa.

The conflicted U.S. response is reflected in the nonstop media coverage of two quarantined returned workers, Dr. Craig Spencer in New York, who has Ebola, and nurse Kaci Hickox in Maine, who remains symptom free.

The uproar stunned some foreign observers, including officials in Nigeria, which was recently declared Ebola free after limiting its exposure to 20 cases and eight deaths.

“One thing that was very striking to us compared to what we see going on here in the U.S. was the level of awareness that people had in Nigeria,” said Dr. Sola Olopade, a professor of family medicine and clinical director for the University of Chicago Medicine's Center of Global Health.

Government-sponsored television and radio ads and heavy use of social media promoted understanding of the disease and how it is spread. Restaurants and other public places provided patrons with thermometers and hand sanitizers.

“It wasn't out of fear,” Olopade said of the preventive measures. “It was out of understanding of what Ebola was, and what precautions they needed to take.”

That clearly wasn't the case in the U.S., where even healthcare workers remain sharply divided over how potentially exposed individuals should act. Hickox, who was symptom free after returning from Sierra Leone as a volunteer for Doctors Without Borders, defied a house quarantine declared by Maine Gov. Paul LePage after declaring her civil rights had been violated.

“I feel it's almost like there's a stigma that's attached to it,” said Brandon Berrett, director of international human resources and recruitment for Los Angeles-based humanitarian aide organization International Medical Corps. “These people are being treated differently for doing very commendable work out in the field and they're coming back and being penalized for it.”

Guidelines from the Centers for Disease Control and Prevention suggest voluntary quarantines for returnees or others exposed to Ebola patients. Those at “some risk” for exposure, which would include healthcare workers who treated patients and had no mishaps with their personal protective equipment, should voluntarily isolate themselves for 21 days after their last contact with an infected person, the CDC advised.

Few returning healthcare workers are following Hickox's lead in defying public authorities or the CDC's entreaties.

“For me, this is not a burden, this is manageable,” said Dr. Colin Bucks, clinical assistant professor of surgery at Stanford Medicine's Division of Emergency Medicine. California placed Bucks under house quarantine after he returned from a month in Liberia treating Ebola patients.

The American Medical Association, American Hospital Association and American Nurses Association issued a joint statement Oct. 28 in support of the CDC guidance, and stressed the importance of the continued work of healthcare volunteers.

But the number of states imposing stricter quarantine measures continues to grow. Connecticut, Georgia, Illinois, Maine, New Jersey and New York have all imposed mandatory house quarantines.

Maine forbade Hickox from using public transportation and asked her to remain at a distance of at least three feet from others after she defied her house quarantine and took a televised bicycle ride near her home.

The U.S. military went beyond the CDC guidelines. It is requiring troops returning from West Africa—as many as 3,000 have been deployed—to be isolated on bases for 21 days following their return.

While Hickox's actions grabbed the public spotlight, polls suggest most healthcare workers and the public support more stringent measures. “If that's what's necessary to say to my community and my neighbors, 'You are at zero risk,' then I'm happy to share that message,” Bucks of Stanford Medicine said.

Follow Steven Ross Johnson on Twitter: @MHsjohnson