Last week, a doctor returned to New York from the Ebola hot zone and came down with the deadly disease. But he only went into quarantine after he felt symptoms — though that followed a jog through the city, a ride on the subway, and a now infamous trip to a bowling alley. The resulting public fear about potentially infectious health-care workers bringing Ebola back to the US prompted governors in a number of states, including, New York and New Jersey, to impose a 21-day quarantine on them.
The public-health and medical communities have unanimously said this measure will actually do more harm than good. "The governors' action is like driving a carpet tack with a sledgehammer," the authors of a new New England Journal of Medicine editorial wrote. "It gets the job done but overall is more destructive than beneficial." Their main concern this policy is not medically indicated and it may deter doctors and nurses from going over to help fight the disease in the place that needs them most right now. Ebola victims are only infectious after they are symptomatic, and health workers who have become symptomatic — like the New York doctor — have promptly quarantined themselves anyway.
Still, the pitchforks are out and the politicians are responding with draconian health policies. I spoke to Howard Markel, a University of Michigan physician and professor who has studied the history of quarantines, about why we're deviating from the science and what quarantine policy would actually make sense.
Julia Belluz: With the arrival of Ebola in the US, we are seeing health policies that seem to be fear-based and not science-based, most recently, with this mandatory quarantine of health workers returning from West Africa in some states. Why is this happening?
Howard Markel: We do this when people get frantic and fearful of things. Ebola is perfect for that: it's rare, it kills people in a spectacularly disgusting way, and we don't know everything about it. We always react out of proportion to those types of diseases instead of infections that actually kill us every day. When these diseases come along, we need public-health measures that allay the fear not feed into the fear. I think the mandatory quarantine fed into fear.
What we saw with the grandstanding of New Jersey Governor Chris Christie, he was beating his breast a little bit so we don't have another Dr. Spencer [the physician who returned to New York from West Africa and came down with Ebola].
This is a very committed doc, he wouldn't knowingly spread his Ebola — but the idea of a guy on the subway who the next day comes down with Ebola is guaranteed to cause fear and panic. It's like a bad movie. It causes fear, and panic, and distrust. That's what authorities were responding to.
JB: With your knowledge of infectious diseases and quarantines, what do you think would be the best way forward — the most reasonable, medically indicated approach — to dealing with returning health workers?
HM: We need a standard set of guidelines of what the health workers coming in from West Africa need to do, and that will be based on science. These are health-care workers who are so committed, they went to West Africa. I do know they would never knowingly harm anybody. They are helpers, healers. I think we should have a voluntary self-quarantine, where you ask these health professionals to stay in their homes for 21 days. Make them as comfortable as possible, ask them to self-monitor their symptoms, and this method would not only help contain the virus but would also meet the public's need for reassurance.
JB: So such a quarantine would be more about optics and politics than science?
HM: Let's remember, the phrase public health includes the word 'public.' The idea of a guy going on a subway who comes down with Ebola scares people. I think if you spoke with these health professionals and said, "This is what we need, not only for your safety and for the public part of public health, but also because we don't want to ramp up fear and ramp up distrust," they would understand.
JB: But then, as we have seen, we have a public that seems to want to lock up folks who might have been exposed to Ebola, so our political leaders are in a tough place.
HM: It's important if you're the boss, you're the leader, that you say to the public, "Let me explain to you in calm and measured tones why this isn't what we need to do. I will be speaking with the President and the Centers for Disease Control and Prevention, and we need to figure out what to do." That's what a great leader is. That's why we're a republic, not a true democracy. We're represented by people in the government who, hopefully, have our best interests at heart and take those into account when they make difficult decisions.
JB: What's the harm of fear-based policies like these?
HM: In this case, with Ebola, what it's done is potentially harmed the public's trust. We have to have steady leadership in this crisis that is well informed by the medical science of the day. There might be a time when you need the public to cooperate, whether it's Ebola or flu, and they say, "You were wrong about x, y, and z."
To learn more about Ebola, see our card-stack on the 13 things you need to know.