Ebola: If Not Quarantine, Then What?

I’ve (uncharacteristically) made several comments on websites I follow to address the Ebola situation.  Usually I prefer to lurk, since I typically lack the base of knowledge to contribute meaningfully to discussions.

That said, it is probably time to discuss what I think should be done to help keep Ebola from entering the U.S. (again) or other countries.  Two points before I begin:  1) These are my own thoughts and in no way shape or form represent the opinions or policies of my employer and 2) yes, I do have a personal stake in the matter, since I am in West Africa and would like to go home at some point.

First, stopping flights from Guinea, Liberia, and Sierra Leone.  Sorry, there are no direct flights, nor have there been for a while.  The closest was a Delta flight that stopped in Accra, Ghana.  They ended that service in late August.  So, you can’t just say “no commercial flights from the three countries.”  There are none.  To stop travelers from the three countries, you’d have to stop flights from Brussels and Casablanca.  Oh, and then you’d have to stop all the connecting flights, too.  Heathrow is a pretty common one, as is Madrid.  So is Frankfurt.  Not going to happen.

OK, how about canceling all visas for citizens of these countries?  Fine, but that would miss non-citizens who are here (including U.S. citizens, like me) or citizens who live in other countries.  You’d catch too many people who have had absolutely no exposure to the region, and too many who have been in the region.  As a colleague is fond of saying, “Ebola isn’t tied to your citizenship.”

Alright, then let’s quarantine everyone who comes from Guinea, Liberia, and Sierra Leone.  Two questions:  Where, and on whose dime?  Seriously, do we set aside the National Institutes of Health (or another facility) to send everyone who enters the U.S. within 21 days of being in the region?  Would the taxpayers agree?  That could get very expensive very quickly.  What about people who don’t have sick leave or vacation time?  Would they lose their jobs?  I am not entirely opposed to this option, but think it may be too much, and those who espouse it haven’t thought it through.

An additional problem with all of the above is it would make it more difficult to get qualified health professionals to the region to help keep Ebola from spreading even more.  If you were a doctor or nurse thinking about volunteering with MSF or another organization, would you do so if you knew you either wouldn’t be let back in to the U.S. or would face a mandatory 21-day quarantine at your own expense?

Here’s what I suggest (again, this is me, not anything official):  1) expand the additional health screening to all U.S. airports and 2) establish a hotline to the CDC for travelers from Guinea, Liberia, and Sierra Leone to call the instant they develop any of the symptoms.  In my opinion, the first measure won’t actually to a lot beyond ensure that everyone who comes from the region gets the information on what to look out for (as if we don’t know) and the contact card.  Frankly, it will also make the U.S. public feel better.  The real key is the hotline.  Could local 911 operators handle an Ebola-related call?  Probably.  Would it be better if those calls when straight to the CDC?  In my opinion, yes.  The CDC could then direct the patient to call 911, if warranted, and/or ensure that the health care workers who respond to the call are appropriately prepared.

Senegal was able to stop Ebola at one case.  A student crossed from Guinea to go back to his studies (or to get better health care, maybe).  Guinean health officials noticed that they “lost” one of the people they were tracking as a contact, and alerted Senegal.  Senegal responded appropriately, finding the patient and immediately isolating him.  He survived, and no one else got the virus.  It can be done, but it requires common sense and vigilance, not knee-jerk reactions that will hurt in the long run.

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