Dr. Sacra: Quarantine has negative consequences

Last Friday, the governors of New York, New Jersey and Illinois announced that U.S. health care workers returning from West Africa who had direct contact with Ebola patients will be placed under quarantine for 21 days upon arrival at airports in their states.

Even though New Jersey Gov. Chris Christie and New York Gov. Andrew Cuomo have softened their stance in recent days, some continue to call for a strict 21-day quarantine of all those returning from Guinea, Liberia and Sierra Leone. Such a policy would likely lead to unintended negative consequences.

As a physician with 15 years' experience in West Africa, and a recent Ebola survivor myself, I have both professional and personal insights into the likely consequences of such quarantine orders. Difficulties range from the order's impact on the global fight against Ebola, to a series of inconsistencies and logical loose ends in the rationale presented to justify it.

It is important that we avoid an isolationist approach to the Ebola epidemic in West Africa. On Oct. 21, Mali reported their first case of Ebola in a child who had crossed the border from Guinea. The borders in West Africa are porous and unregulated, as local people walk across the border to sell their wares or to seek medical attention. Other nations in West Africa also have vulnerable health systems which could be overwhelmed if enough Ebola cases occurred. In addition, there are thousands of travelers a day from Sub-Saharan Africa to countries in Asia like China, India and Pakistan. If the Ebola virus were to emerge in a major Asian population center, one can only imagine the impact.

Either one of these scenarios — widespread Ebola transmission across Africa or into a major population center in Asia — would lead to a tremendous increase in risk for cases in the United States, as well as overwhelming the world's resources to contain such an epidemic. The only way to reduce the risk of continued spread of Ebola is to bring it under control in those three countries where it has already taken root.

Feds get involved

Federal officials, including President Obama and Tom Frieden, the director of the Centers for Disease Control and Prevention, have pledged a leadership role for the U.S. in fighting the Ebola epidemic. One critical component in that response is sending doctors, nurses and lab technicians to West Africa.

Having worked in Liberia for years, I know firsthand how stressed that country's health system is. Estimates of the number of physicians caring for the entire nation of 4 million people range from as little as 50 to 170. Imposing a three-week mandatory quarantine on returning health care workers would reduce the number willing to volunteer, and will hamper our ability to take on the leadership role promised at the national level.

During his recent news conference, N.Y. Gov. Cuomo stated "It's too serious a situation to leave it to thehonor systemof compliance." The governor now says these health care workers can be quarantined at home, but he is still requiring that they be monitored twice daily by medical professionals.

Even with the change in New York, health care workers entering at the airport will be asked what activities they engaged in while in West Africa, and Cuomo is trusting them to tell the truth. One unintended consequence of burdensome quarantine policies is that returning individuals may falsely report their activities or re-enter the jurisdiction by another route. Health care workers flying under the radar would indeed pose a risk to the public. A system of monitoring that encourages transparency and frequent contact between returnees and their local health departments would be the safest approach for all of us.

There are many inconsistencies and loose ends to be worked out. What about the health care workers now caring for Dr. Craig Spencer at Bellevue Hospital? They are in direct contact with an Ebola patient. Are they to be placed in quarantine, now and for 21 days after his discharge? The experience of two nurses in Dallas demonstrates that U.S. health workers are not exempt from the threat of Ebola. I do not think Bellevue's health care workers should be quarantined, but monitored by the hospital's leadership.

What's 'direct contact' mean?

News media quotes suggest that those with "direct contact" with Ebola patients are the ones to be quarantined. That guideline could have missed at least two of the cases among Americans who have returned from West Africa for Ebola treatment — myself, and freelance photographer Ashoka Mukpo. I was not caring for Ebola patients, but pregnant women. Apparently one had undetected Ebola infection. Mukpo was a photographer and was not medically involved in caring for Ebola patients, though he was often close to critically ill cases as he documented the crisis.

It is difficult to predict which individuals may contract this infection out of the thousands traveling from West Africa. Once again, it would be better to watch closely for symptoms and encourage a cooperative relationship with local health authorities, allowing an orderly entry into care for those who do develop symptoms (as was the case with Dr. Spencer), rather than placing dozens or hundreds of individuals into quarantine to catch one or two cases of Ebola while possibly missing others.

We have no scientific evidence to suggest that a quarantine policy will reduce Ebola cases in the U.S. What we do know from scientific data is that individuals without fever or other symptoms cannot spread the virus.

Anthony Fauci of the National Institutes of Health is asking policymakers to "Go with the science." I understand that many Americans are afraid of Ebola, this new and dangerous threat. We have faced similar fears before, in the days of polio, and the first years of the AIDS epidemic. But as Americans we have risen above those fears and brought these diseases under control through rigorous scientific inquiry and dedicated efforts based on evidence. We can do it again with Ebola.

Dr. Rick Sacra, a medical missionary for SIM, was the third U.S. Ebola patient and was treated at theNebraska Medical Center in Omaha.

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