There appears to be a race by politicians to show who is more serious about Ebola by imposing greater and greater restrictions on anyone suspected of being a carrier. It now appears that we may have our first court challenge to these limitations and there are viable claims to be made. The American Civil Liberties Union is acting on behalf of a nurse, Kaci Hickox, who has been under quarantine after she arrived at Newark International Airport. I will be discussing the case on CNN this afternoon with Wolf Blitzer.
The ACLU is moving to a possible lawsuit that challenges the basis for Gov. Chris Christie’s mandatory quarantine of healthcare workers as unconstitutional. Hickox remains in New Jersey state custody over her objections. Her international aid organization, Doctors Without Borders, has also objected to the confinement following her work in Sierra Leone.
She was quarantined on Friday, shortly after another Doctors Without Borders volunteer working in Guinea, Columbia Presbyterian Hospital employee Dr. Craig Spencer, tested positive for Ebola. Spencer tested positive six days after returning to the U.S. That case led Christie and New York Gov. Andrew Cuomo to hold a press conference saying that they were going to reject the standards of the Centers for Disease Control standards and imposed their own restrictions to impose far stricter conditions. The new protocols would require travelers from West Africa to go into 21 days of quarantine even though they show no symptoms.
New Jersey state law contains a highly generalized provision giving the Department of Health the power to “maintain and enforce proper and sufficient quarantine wherever deemed necessary.” The question is what the basis for the action must be to satisfy constitutional standards. Obviously, if someone has a disease, the state has much greater authority. The laws states that the Department “has the power to remove any person infected with a communicable disease to a suitable place, if in its judgment removal is necessary and can be accomplished without any undue risk to the person infected.” However, Hickox has no symptoms.
Federal law also has such a provision authorizing the Surgeon General and other federal officials to impose quarantines to prevent the spread of communicable diseases. Federal regulations state that
Quarantinable communicable disease means any of the communicable diseases listed in an Executive Order, as provided under section 361 of the Public Health Service Act. Executive Order 13295, of April 4, 2003, as amended by Executive Order 13375 of April 1, 2005, contains the current revised list of quarantinable communicable diseases, and may be obtained at http://www.cdc.gov and http://www.archives.gov/federal_register. If this Order is amended, HHS will enforce that amended order immediately and update that Web site.
Recently President Obama signed an executive order as a “quarantinable communicable disease.”
Experts have criticized the United States for policies based on hysteria as opposed to science. A person is not contagious until someone is experiencing symptoms. Hickox was scathing in her condemnation of Christie and her description of the conditions of quarantine as “inhumane.” She also disputed Christie’s assertion a day earlier that she was “obviously ill.” She stated that “If [Christie] knew anything about Ebola he would know that asymptomatic people are not infectious.”
The White House joined that criticism and seems to have convinced Cuomo to reconsider his position. He said that medical workers who had contact with Ebola patients in West Africa but did not show symptoms of the disease would be allowed to remain at home and would also receive compensation for lost income.
After Cuomo back down a bit, Christie also issued a statement saying that New Jersey residents not displaying symptoms would also be allowed to serve the quarantine in their homes.
Unfortunately, this issue falls within a dangerously ambiguous area of the law. While large-scale quarantines have occurred in our history for such emergencies as Spanish Flu, the authority to order such confinement has remained highly questionable for people who are not clearly contagious.
Such public health authority is largely a modern construction. Indeed, federal authority to quarantine has been linked to the Commerce Clause and interstate movement. Until recently, federal isolation and quarantine has been authorized for these diseases (note the last one):
Cholera
Diphtheria
Infectious tuberculosis
Plague
Smallpox
Yellow fever
Viral hemorrhagic fevers
Severe acute respiratory syndromes
Flu that can cause a pandemic
Actions are generally taken under section 361 of the Public Health Service Act (42 U.S. Code § 264) by the U.S. Secretary of Health and Human Services.
The issue of disease curtailment has historically been a state not a federal issue — even though the authority is again implied. While Article I, Section 10 mentions state authority over “inspection laws,” the Constitution is otherwise silent. However, the Supreme Court has long recognized the power of states to impose quarantines as a basic element of their authority as a matter of the 10th Amendment. That power was discussed in 1824 in Gibbons v. Ogden by Chief Justice John Marshall. The Court recognized that quarantine laws (and inspection laws generally) “form a portion of that immense mass of legislation which embraces everything within the territory of a State not surrendered to the General Government.”
The current federal regulations however suggest an almost entirely discretionary agency decision:
§ 70.6Apprehension and detention of persons with specific diseases.
Regulations prescribed in this part authorize the detention, isolation, quarantine, or conditional release of individuals, for the purpose of preventing the introduction, transmission, and spread of the communicable diseases listed in an Executive Order setting out a list of quarantinable communicable diseases, as provided under section 361(b) of the Public Health Service Act. Executive Order 13295, of April 4, 2003, as amended by Executive Order 13375 of April 1, 2005, contains the current revised list of quarantinable communicable diseases, and may be obtained at http://www.cdc.gov/quarantine and http://www.archives.gov/federal_register. If this Order is amended, HHS will enforce that amended order immediately and update its Web site.
[77 FR 75884, Dec. 26, 2012]
That is a disconnect with the areas of law governing civil detention and quarantines.
Once again, such actions are historically focused on people with proven communicable diseases. Moreover this confinement satisfies the definition of being in custody or prison under the Constitution since it is generally involuntary. When that occurs before trial, there is still an arraignment and showing of probable cause of not jus the underlying crime but the danger of flight or violence. To be sure, the standard for civil confinement is more relaxed and, according to Addington v. Texas (1979), can be based on a “clear and convincing evidence” standard, as discussed by people like Michael Dorf. However, it is unclear how such a standard would apply in situation like Ebola. What is clear and convincing evidence of the disease of an asymptomatic person is hard to define. Indeed, these new measures appear driven more by politicians than medical experts.
The problem is the lack of a limiting principle. If the risk of contamination is enough for clear and convincing evidence, the government could use such a rationale to confinement huge numbers of people for this and other diseases. The problem is that courts have spent decades removing key protections from areas like civil detention and increasing the authority of agency in the use of discretionary powers. If that body of law governs the issue of quarantine, it would allow for effective mass incarceration with little recourse in court. The federal regulations reflect this wide-open discretionary standard.
This is a case where an early lawsuit might not be a bad idea to allow courts to better articulate the standard before we have a true domestic crisis.
The New Jersey Department of Health just released the following statement:
Since testing negative for Ebola on early Saturday morning, the patient being monitored in isolation at University Hospital in Newark has thankfully been symptom free for the last 24 hours. As a result, and after being evaluated in coordination with the CDC and the treating clinicians at University Hospital, the patient is being discharged. Since the patient had direct exposure to individuals suffering from the Ebola Virus in one of the three West African nations, she is subject to a mandatory New Jersey quarantine order. After consulting with her, she has requested transport to Maine, and that transport will be arranged via a private carrier not via mass transit or commercial aircraft. She will remain subject to New Jersey’s mandatory quarantine order while in New Jersey. Health officials in Maine have been notified of her arrangements and will make a determination under their own laws on her treatment when she arrives.
Physicians at University Hospital have continuously monitored the patient’s situation since admittance on Friday, following her arrival at Newark Airport from West Africa where she had been treating symptomatic Ebola patients. The patient was initially found to have no symptoms, but later developed a fever. Because she had symptoms, she was subsequently transferred to University Hospital where she was placed in isolation under a quarantine order for review and testing. She was cared for in a monitored area of the hospital with an advanced tenting system that was recently toured and evaluated by the CDC. While in isolation, every effort was made to insure that she remained comfortable with access to a computer, cell phone, reading material and nourishment of choice.
@gmab
Nobody answered your question…
as it happens…. YOR question was ONE of the MOST important ones on this whole page.
From the onset of symptoms, it takes ROUGHLY 3 days
before the Ebola Virus has built up enough in the body
to detect via blood test.
Being that the virus has not built up enough to detect via blood tests.
this means it is not transmitted during this stage.
This is why the doctors and scientists who actually work with Ebola, are confident that it is safe to allow Health Care workers self monitoring, and and have them report when they are feeling the onset symptoms and fever.
During this time, it is NOT found in saliva.
It is first detected in the blood… and being that at the onset of symptoms
there is not enough of the virus to test positive, then it is certainly not going to be found in the saliva of somebody who has just spiked a fever, or has felt
totally unwell, and vomiting, etc… etc..
It is patients who are in ACUTE Stages of Ebola, who are most contagious as once detected in the blood, the viral loads keep climbing, patient is then at most toxic stage when near death.
After death they remain at the most toxic, and in Liberia, many of the transmissions are through handing dead bodies of Ebola patients.
Information regarding this from The CDC Website.
http://www.cdc.gov/vhf/ebola/hcp/interim-guidance-specimen-collection-submission-patients-suspected-infection-ebola.html
This info can also be found via The New England Journal of Medicine.
and The World Health Organization.
October 30 2014, 5.49am EDT
Why you should worry less about Ebola and more about measles
News that a doctor in New York City tested positive for Ebola sparked mandatory quarantine orders for heath workers returning from West Africa in New York and New Jersey last week. The outbreak has killed…
Author
William Moss
Professor, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health; Head of Epidemiology, International Vaccine Access Center at Johns Hopkins University
.
Disclosure Statement
William Moss receives funding from the National Institutes of Health and the Bill & Melinda Gates Foundation. He is affiliated with the World Health Organization as a member of the Strategic Advisory Group of Experts Working Group on Measles and Rubella.
The Conversation is funded by Howard Hughes Medical Institute, Robert Wood Johnson Foundation, Alfred P Sloan Foundation and William and Flora Hewlett Foundation. Our global publishing platform is funded by Commonwealth Bank of Australia.
In the US the risk of getting measles or dying from influenza is greater than the risk of getting Ebola. Jaime R Carrero/Reuters
.
News that a doctor in New York City tested positive for Ebola sparked mandatory quarantine orders for heath workers returning from West Africa in New York and New Jersey last week. The outbreak has killed nearly 5,000 people in West Africa, but only a handful of cases have been reported in the United States. Still, the virus has sparked widespread fear in the US. Views that Ebola is an exotic disease spreading out of control within Africa, with horrific symptoms, inevitable death, and limited means to prevent transmission are contributing to this fear. However, these fears are fueled by a misunderstanding of risk.
The outbreak is a tragic, public health emergency in urgent need of a massive and coordinated global health response. Fear of contagion is justified in communities where incidence is increasing and where protective measures are limited and health care is stretched beyond capacity.
However, this is not the case in the United States. The perceived risk to Americans is exaggerated. The risk of contracting Ebola in the US or the virus reaching epidemic proportions is very, very low.
The fact is, in the United States the risk of infection with measles virus or death from influenza virus is far greater.
Measles is more infectious than Ebola
Although the outbreak in West Africa is increasing exponentially, Ebola is not as contagious as many other infectious diseases. Transmission requires direct contact with infected body fluids. Measles, influenza and pertussis (whooping cough) on the other hand, are spread by respiratory secretions. They are much more explosive because transmission does not require direct contact with an infected person.
The speed with which an outbreak grows depends on how many additional people are infected by each infectious case and the time interval between infections. To put the current Ebola numbers in context, one person with Ebola will on average infect only 1.5 to 2.2 additional people. The relatively low number of people infected by a single case should make it easier to interrupt transmission. Further facilitating control is the fact that a person with Ebola is most infectious after the onset of signs and symptoms.
By contrast, a person with measles is infectious for several days before they become sick. And a person with measles will on average infect 12 to 18 additional people. This year 594 measles cases have been reported in the United States through September 29th, the most in two decades. These cases represent 18 measles outbreaks in 22 states.
An estimated 122,000 people – mostly children – worldwide died of measles in 2012, about 330 measles deaths every day. In the US the increasing number of measles cases is mostly due to people visiting countries with measles outbreaks and carrying the virus back home and into communities in which large numbers of people are not vaccinated.
Measles is also becoming a public health problem in countries affected by Ebola. Immunization services have ceased in many affected areas as health care workers are redeployed to fight Ebola and the public loses confidence in the health care system. Cases of measles have been reported in Liberia and may spread to neighboring countries and beyond.
Instead of worrying about Ebola, make sure your vaccinations are up to date. Brian Snyder/Reuters
.
Vaccines and risk perception
As panic over Ebola grows, it’s worth asking why Americans are becoming more complacent to the threat of vaccine-preventable diseases.
Some Americans distrust vaccines and misunderstand the risks and benefits. Most Americans with measles this year were unvaccinated and declined vaccination because of religious, philosophical or personal objections. The largest measles outbreak this year spread within communities in Ohio with low vaccination coverage, with smaller outbreaks in California and New York City.
As with Ebola, early diagnosis, isolation and notification are critical to preventing further spread. Unlike Ebola, we have a highly effective and safe vaccine that can prevent measles. The unvaccinated individuals who developed measles in the United States misjudged the risk to themselves and their communities.
Measles isn’t the only risk. As many as 50,000 people die in the US of influenza virus infection in a single season. Influenza vaccine coverage in the United States during the 2013-2014 season was only 59% among children and 42% among adults, putting those most likely to develop severe disease – young infants and the elderly – at risk.
Again, unvaccinated individuals misjudge the risk and consequences of influenza. The Centers for Disease Control and Prevention tracks deaths due to influenza in children. During the 2012-2013 influenza season, 171 children died of influenza in the United States and 109 children died during 2013-2014 season. Although the influenza season has just started, one child death has already been reported in other words the same number of deaths currently due to Ebola in the United States.
Some may fear of exposing themselves or their children to risk from vaccines, even though these fears have been disproved time and again. They may do so without calculating the real risk of actually contracting the infection that these vaccines prevent. The risk might be masked thanks to herd immunity, but outbreaks of measles and whooping cough show the risk is growing. From January 1 to August 16, 17,325 cases of whooping cough were reported in the United States, a 30% increase over the same period in 2013. In California alone, which is experiencing a particularly large outbreak, 312 people have been hospitalized, most of whom were young infants.
Ebola vaccines are currently in development and testing. Most experts agree an Ebola vaccine would be a welcome tool, even if supplies limit use to health care workers. But this begs another question – how many Americans would be willing to receive an Ebola vaccine?
http://theconversation.com/why-you-should-worry-less-about-ebola-and-more-about-measles-3298
http://www.dailymail.co.uk/news/article-2815903/New-CDC-confusion-Ebola-deletes-warning-virus-spread-coughs-sneezes-website.html
bigfatmike: “I think for many of us, the key questions are how reliably can symptoms be determined and how reliable are symptoms as an indicator of viral shedding which is apparently the contagious phase of the disease.”
Agreed. However, the false premise advanced by Hickox and others that ought to be clarified for the public is the notion that symptom is a determining element of quarantine.
In fact, neither symptom nor infectiousness is the standard for quarantine. Exposure to certain categories of diseases, which include Ebola, is the standard for quarantine. Quarantine, by definition, is precautionary, not reactive.
Most immigrants weren’t delayed at Ellis Island because they were sick, ie, symptomatic. They were delayed because someone else on the boat was sick and we waited until we were assured they weren’t – and wouldn’t become – sick before they contacted the population.
Bruce: “It seems to be a matter of medical dogma that Ebola is not transmittable unless it has reached the point of being symptomatic.”
Political dogma, more like.
As you, shelly, and others have pointed out, the line between safe and ‘symptomatic’ infectiousness for Ebola is not as clear as opponents of the state-level Ebola quarantine are characterizing it. What is known about Ebola ‘symptomatic’ infectiousness paints a thin line with little room for error.
I doubt Hickox’s lawsuit would advance far. There’s a reason that Ebola was designated as a quarantinable disease by the CDC before the current, historically worst, outbreak of Ebola.
State-level Ebola quarantine seems like normal, prudent, proven, precautionary practice with long precedent in the medical field. It does not stigmatize medical volunteers except for the insistence by Obama and others that it does. The Obama administration’s opposition to state-level Ebola quarantine is just strange.
“I doubt Hickox’s lawsuit would advance far. There’s a reason that Ebola was designated as a quarantinable disease by the CDC before the current, historically worst, outbreak of Ebola.”
Well, maybe. but the NYT and other sources just announced a Maine judge lifted the quarantine on Hickox.
Apparently she still has to submit to daily monitoring and cooperate with state authorities regarding travel and report any symptoms immediately. But still that is a far cry from quarantine.
I think for many of us, the key questions are how reliably can symptoms be determined and how reliable are symptoms as an indicator of viral shedding which is apparently the contagious phase of the disease.
One aspect which has garnered little attention is the inconveniently loosy-goosy nature of the medical “rules” which government Ebola. It seems to be a matter of medical dogma that Ebola is not transmittable unless it has reached the point of being symptomatic.
But there’s a problem here. That problem is that the presence of a fever has become the sine qua non of Ebola symptomatology. The reason it is a problem is that the World Health Organization (WHO) has published a large study finding somewhere in the neighborhood of 1 out of every 8 people – 13% – who develop Ebola DO NOT spike a fever when they come down with the disease.
In other words, of those people who are screened for Ebola using a thermometer of some sort, 1 out every 8 people who is in the early stages of Ebola will be presumed to be Ebola-free and permitted to go their merry way.
I find it astonishing that this fact has not reached any other news source apart from the LA Times but here it is: http://www.latimes.com/nation/la-na-1012-ebola-fever-20141012-story.html#page=1
Add:
It’s worth noting that the CDC’s answer to “What is the difference between isolation and quarantine?” states, “Quarantine refers to the separation and restriction of movement of persons who, while not yet ill, have been exposed to an infectious agent and therefore may become infectious.”
In other words, the standard for quarantine is exposure, not symptom nor infectiousness. Again, along with Professor Turley’s construction, President Obama and Kaci Hickox are applying the textbook standard for isolation to argue against the state-level Ebola quarantine, not the standard for quarantine.
While “both isolation and quarantine are public health strategies that have proven effective in stopping the spread of infectious diseases” (CDC), isolation and quarantine are different with different standards.
I said: “The fact that the Fed is not leading the way on Ebola quarantine is ab[n]ormal.”
After taking a longer look at the information on Ebola and quarantine at the CDC website, I was wrong to say that the Fed not leading the way on Ebola quarantine is abnormal. In fact, State leading the way on Ebola quarantine is normal. The Fed normally defers to state and local authorities on quarantine. While a federal quarantine has been rare since the Ellis Island era, the Obama administration – especially any CDC official – opposing state-level Ebola quarantine is abnormal.
From cdc.gov/quarantine/qa-executive-order-pandemic-list-quarantinable-diseases.html :
As a legal matter, Kaci Hickox is correct that there is a higher (different) bar for a quarantine-based involuntary detention than an isolation-based involuntary detention. However, it appears State passes the bar on Ebola quarantine because Ebola was already designated by the CDC and Executive Order as a “quarantinable (communicable) disease” before the current outbreak.
From cdc.gov/quarantine/historyquarantine.html :
Again, President Obama’s opposition to state-level Ebola quarantine is just strange. Obama’s position basically misrepresents symptom (as opposed to exposure) as the determining element of quarantine and contradicts the CDC view of Ebola risk, particularly the CDC designation of Ebola as a “quarantinable (communicable) disease” by Executive Order before the current outbreak, the CDC view on the effectiveness of quarantine, and normal deference to state and local authorities on quarantine.
From cdc.gov/quarantine/qa-executive-order-pandemic-list-quarantinable-diseases.html :
Moreover, the CDC categorizes healthcare providers of Ebola patients as one of the highest risk groups for contracting Ebola.
From cdc.gov/vhf/ebola/exposure/index.html :
With Hickox’s Maine-Ebola-quarantine-defying jogging on what appears to be a nature trail, note the risk assigned to infected wildlife.
As shelly notes, there was already a thin margin for error with Ebola. The margin for error seems even more opaque with the current outbreak which has included a higher incidence of healthcare providers becoming infected.
As such, in a balance of interests, a 21-day Ebola quarantine upon re-entry for healthcare providers with “highest risk for getting sick” (CDC) appears to be a reasonable and sensible precaution with ample precedent in the healthcare field. As CDC states, “isolation and quarantine are public health strategies that have proven effective in stopping the spread of infectious diseases.”
Again, the vigorous opposition by Obama, Hickox, and others against state-level Ebola quarantine seems jarringly out of proportion. The notion that a quarantine for a CDC-designated “quarantinable (communicable) disease” stigmatizes the “God’s work” of medical volunteers appears to be a strawman construction. Like our troops who aided logistics but not direct treatment, the medical volunteers who treated Ebola patients can and should be lauded, appreciated, encouraged, and undergo a 21-day precautionary quarantine upon re-entry.
From a reasonable person perspective, a 21-day Ebola quarantine does not seem onerous. Moreover, quarantine is an established measure in the healthcare field, so it seems odd that medical professionals would be surprised, discouraged by, or unable to adjust to a quarantine for a designated “quarantinable (communicable) disease”.
If there is an individual practical burden of adding 21 days to the weeks, months, or longer that a particular medical volunteer has set aside for volunteer work in Africa, it seems reasonable that the government, the individual’s medical employer, and the volunteer medical program can work out a patch to cover the additional 21 days. Quarantine is not unconventional.
Again, according to the information on Ebola and quarantine on the CDC website, state-level Ebola quarantine shouldn’t be a controversy in the first place.
That the Obama administration contradicts the standing CDC designation of Ebola as a “quarantinable (communicable) disease” and the normal CDC attitude on quarantine (effective and state-led), and employs a misdirected definition of quarantine (symptom versus exposure) and a strawman (quarantine stigmatizes medical volunteers) to make the issue into a controversy points to, as Dredd implies it to be, a political gambit.
Showdown over Ebola: Will Quarantines of Healthcare Workers Harm the Fight Against Epidemic?
http://youtu.be/52CyVtcp0AU
Scientist & Ebola discoverer Peter Piot warns ‘…every 30 days, there is a doubling of new infections.’
http://www.scmp.com/news/hong-kong/article/1625753/screening-airport-arrivals-ebola-not-effective-says-co-discoverer
http://www.washingtonpost.com/sf/national/2014/10/04/how-ebola-sped-out-of-control/
This article gives a great timeline of the whirlwind of events:
July 23rd, Dr. Kent Brantly gets sick at missionary hospital ELWA in Monrovia.
Late July, MSF’s head, Liu, begs the WHO’s head, Chan, to declare an international health emergency.
August 8th, Chan finally declares a global emergency.
August 12th, the UN appoints David Nabarro as senior UN system coordinator.
Early September, there is still no agreement on how to respond.
September 2nd, MSF’s Lui implores countries to deploy their military assets.
September 3rd, World Bank president Jim Young Kim (MD) beyond frustration, calls a meeting—with government and private sector stake holders
Kim warns ‘The future of the [African] continent is on the line.’
1st week in September, all realize that only the US military has the capacity for the scale/speed needed. Civilian response won’t be fast enough to get ahead of the epidemic.
September 7th, Obama tells “Meet the Press” he will use military to send equipment, logistics. By now, there are thousands of confirmed cases and no place to treat the sick and dying. Liberian President Sirleaf sends Obama an urgent plea: ‘[…] the virus will overwhelm us.”
September 8th, a group of high level administrative officials meet at the WH to discuss military options.
September 16th, recovering Dr. Kent Brantly meets with Obama in Oval Office.
Dr. Brantly tells lawmakers “It [Ebola] is a fire straight from the gates of hell.”
Obama flies to the CDC’s Atlanta headquarters to announce 3000 troops, $750 million dollars
September 23rd, CDC estimates 1.4 million cases in Liberia, Sierra Leone by Jan 20th (Guinea numbers left out as too sketchy)
September 26th, the Global Health Security Agenda Summit is held at WH.
October 4th, this article gets published in Washington Post.
The Washington Post has been having a terrific series of articles on the topic that I am catching up on:
http://www.washingtonpost.com/national/health-science/how-the-microscopic-ebola-virus-kills-thousands/2014/10/18/6e21bdec-561b-11e4-809b-8cc0a295c773_story.html
This article is the best explanation I have come across so far. (Note also the “View Graphic” box with subtitle “Ebola’s catastrophic effects on the body.”) Noteworthy are also the quotes from Peter Piot, one of main researchers who discovered the Ebola virus in 1976”: ‘He suspects the depth and breadth of the current epidemic are attributable not to changes in the virus but rather the lack of a timely international response and the way societies have become more urban and interconnected in recent decades. “A perfect storm,” he said.’
Another good description comes from a CDC epidemiologist named Kinzer: ‘“Ebola is a disease that is basically leaky pipes,” Kinzer said. “Your vessels are leaking, you’re losing water, electrolytes, protein, nutrients. You’re losing the things you need to fight off the viral infection. You feel terrible. You don’t feel like taking care of yourself. If you can counteract that, you can vastly increase your chances of survival.’ He says the reason they are dying in the poor African countries is because they can’t stay hydrated and nourished.
shelly,
Good info. Thanks.
Dredd,
I agree the politics are odd.
There shouldn’t be a controversy in the first place. Ebola quarantine is conventional. What’s abnormal is the Fed’s opposition to Ebola quarantine. The fact that the Fed is not leading the way on Ebola quarantine is abormal. The President’s opposition to Ebola quarantine is even stranger.
First, the President appointed Ron Klain as “Ebola response coordinator” despite that Klain has no medical and emergency-response background. His background is political which supports your theory of a purposeful political character to the controversy.
Second, critics of the state-level quarantine mislead immediately with their basic misrepresentation of quarantine as based on symptom despite that by definition, quarantine is based on exposure, not symptom. Professor Turley employs this basic misrepresentation as a main element of the original post.
Third, and most telling for me, the CDC explicitly designates Ebola as a “quarantinable (communicable) disease”. Before the current Ebola outbreak, the issue was settled. Yet the Obama administration seems to dismiss or not realize that Ebola is already designated by Executive Order and CDC policy for quarantine. In other words, the states are acting more consistently with the CDC view on Ebola risk than the CDC.
Fourth, a quarantine that’s set on a known Ebola incubation period (21 days) – not an indefinite detention – is reasonable, sensible, and a normal health measure with a long history. The reaction against Ebola quarantine by the President and others like Kaci Hickox seems jarringly out of proportion as though it is, as you believe it to be, a political gambit.
Fifth, the characterization of the current Ebola outbreak as an urgent crisis in Africa yet one that, at the same time, does not rise to quarantine in order to reduce the risk for the US is dissonant, especially as, again, the CDC had designated Ebola as a quarantinable disease before the current outbreak.
Sixth, also dissonant is the military under Presidential order is instituting a 21-day quarantine despite significantly lower-risk activity by soldiers in the Ebola zone than the medical professionals who have contacted Ebola patients in an outbreak that has been distinguished by medical professionals, including leading elite doctors, catching Ebola. There’s no rational justification for the President not only not instituting at least the same level of precautionary Ebola quarantine for returning medical professionals who’ve contacted Ebola patients as he’s instituted for the military, but actually opposing states instituting Ebola quarantine in the Fed’s stead. The President, when pressed on the issue, has not provided a rational explanation.
So, I agree the politics are odd.
So I changed my mind and agree with most of you here regarding early containment/isolation. Those people at risk or with recent travel or symptoms should be isolated for 21 days as is happening now with U.S. troops. First, the viral load is already enormously high from the get-go:
Ebola patient after +5 days of illness, 1/5 teaspoon of blood = 10 BILLION viral Ebola particles (NYTimes)
HIV: 1/5 teaspoon of blood = 50,000 to 100,000 HIV particles
Untreated Hepatitis C patient: 1/5 teaspoon of blood = 5-20 million Hep C particles
http://www.businessinsider.com/what-makes-ebola-virus-so-deadly-2014-10
Second, there’s that fuzzy, invisible line since initial Ebola signs & symptoms can appear anywhere from Day 2-21 after exposure. The grey area is when is the patient actually capable of shedding the virus in their blood/fluids? Each clinician (MD, DO, ARNP) has to make that determination based on looking at the patient and their test results. The Ebola viral load and infectiveness of bodily fluids increases as patient becomes sicker. The virus is truly the “living dead” and the kiss of death for loved one kissing the remains.
There is a very good PowerPoint at the CDC website which explains a lot. It is
called “Ebola 101”. http://www.cdc.gov/vhf/ebola/hcp/index.html
Finally, the Ebola test results with PCR assay take a while to come back. The turn-around time seems to be 12 hours I am told (while the actually running of the test is probably 4 hrs or less)…12 hrs is what patients could expect before hearing back on that result. fda.gov/downloads/MedicalDevices/Safety/EmergencySituations/UCM418815.
Eric
Dredd,
I believe we’re using the medical definition, eg, the CDC definition of “Quarantine separates and restricts the movement of people who were exposed to a contagious disease to see if they become sick.”
==============================
No problem on the “fix.”
I want to know if you are naive enough to think that the medical thingy controls when a political issue arises?
Like, are you saying that medical knowledge, counsel, and wisdom is driving this dog and pony show (“Attack of the Ebola Aliens!!!”) a week before the election?
Then after agreeing or disagreeing on that, we can decide if we would like to discussing fixing that … or going to get a beer and shoot some pool.
Oops. Wrong pronoun. Fix: … because
theyhe thought that Japanese, German, etc, phenotype was a contagious disease.Dredd,
I believe we’re using the medical definition, eg, the CDC definition of “Quarantine separates and restricts the movement of people who were exposed to a contagious disease to see if they become sick.”
I don’t recall that President Roosevelt interned Americans and other residents with lineage traced to an Axis power during WW2 because they thought that Japanese, German, etc, phenotype was a contagious disease.
The Fed’s stance on the issue is odd more so since Ebola is explicitly named on the CDC’s quarantinable disease list.
Excerpt from
http://www.cdc.gov/quarantine/historyquarantine.html :
Excerpt from
http://www.gpo.gov/fdsys/pkg/FR-2003-04-09/pdf/03-8832.pdf :
Now, the executive order does state in section 2 that “The Secretary [Secretary of Health and Human Services], in the Secretary’s discretion, shall determine whether a particular condition constitutes a communicable disease of the type specified in section 1 of this order.” However, given that Ebola is explicitly named as a communicable disease in section 1 of the order, I don’t see how a different determination can be reached.
quar·an·tine (kwôrn-tn, kwr-)
n.
…
3. A condition of enforced isolation.
4. A period of 40 days.
tr.v. quar·an·tined, quar·an·tin·ing, quar·an·tines
1. To isolate in or as if in quarantine.
2. To isolate politically or economically.