Kaci Hickox is a hero. First for volunteering to help treat Ebola patients, as eradicating Ebola in West Africa is the only way to handle this disease. She became a hero again for standing up to unjust restrictions upon her civil liberties upon returning home and supporting the concept of making political decisions based upon science and reason as opposed to giving in to public hysteria.
It was Hickox’s protests which forced Governors Christie and Cuomo to back away from guidelines policies which were both unnecessary and counterproductive. Some state governments are still going beyond the extremely cautious CDC guidelines with policies such as home quarantine of individuals who show no sign of the disease for twenty-one days. We know that this is unnecessary based both upon our knowledge of how the Ebola virus is transmitted and based upon our experience to date. Ebola is not contagious early in the disease and is not transmitted by casual contact. While highly contagious when people are having symptoms such as projectile vomiting and uncontrolled diarrhea, those who do not have symptoms are not contagious. People with Ebola do not yet pose a danger of spreading the disease when they initially reach the CDC’s threshold of a fever of 101.4 degrees, and they certainly are not contagious before reaching this point.
We have seen one patient in Texas be released in error by an Emergency Room and return to the community. We have seen a nurse later revealed to be infected with Ebola fly with a low grade fever. We have had a doctor traveling around a city as densely populated as New York City just prior to meeting criteria for isolation. Not a single person has contracted Ebola due to contact with these individuals. That is the nature of the disease.
Kaci Hickox, well aware of the science, has stated she plans to fight the involuntary home quarantine being imposed:
“I will go to court to attain my freedom,” Hickox told “Good Morning America” today via Skype from her hometown of Fort Kent, Maine. “I have been completely asymptomatic since I’ve been here. I feel absolutely great.”
One of her attorney’s explained her legal position:
New York civil rights lawyer Norman Siegel, said she would contest any potential court order requiring her quarantine at home.
“The conditions that the state of Maine is now requiring Kaci to comply with are unconstitutional and illegal and there is no justification for the state of Maine to infringe on her liberty,” he said.
Hickox will abide by daily monitoring, as recommended the by updated guidelines released Monday by the federal Centers for Disease Control and Prevention, Hyman said. She has been in regular contact with state health officials, Siegel said.
U.S. CDC Director Tom Frieden called for isolation of people at the highest risk for Ebola infection but said most medical workers returning from the three African nations at the center of the epidemic — Sierra Leone, Liberia and Guinea — would require daily monitoring without isolation.
The new guidelines recommend considering isolation only for individuals exposed to Ebola who show symptoms. Those with no signs of illness should be monitored for 21 days after the last potential exposure, with symptom-free individuals at the highest risk subject to “restricted movement within the community” and no travel on public transportation, according to the guidelines…
“She understands the nature of the disease, she treated it,” Hyman said. “She understands the nature of the risk.”
The American Civil Liberties Union has posted an article on the over-reaction to Ebola coming from some politicians, in contrast to the more rational guidelines proposed by the Center for Disease Control and the Obama administration:
One over-reaction to the disease that has emerged is a proposal for a blanket travel ban from the affected countries in West Africa. Public health experts say that such bans are not necessary, would not be effective, and would be a poor use of resources. Worse still, experts say they would most likely make matters worse by further isolating the countries where the outbreak is taking place, worsening the situation in those countries and therefore the threat to the United States. Travel bans “hinder relief and response efforts risking further international spread,” as the World Health Organization warned. Experts say such bans would also inevitably drive travelers underground, making it difficult to retrace the path of a disease when a case does appear.
Proposals to close the border to all travelers from affected nations are not a scientifically and medically legitimate exercise of government power and therefore would be arbitrary and discriminatory whether applied to citizens or non-citizens.
Now, of course, we are also seeing the questionable use of quarantine powers in some states. Medical experts have opposed such steps given that Ebola is not transmissible until after a fever begins and is not a highly transmissible disease generally, and given that individuals have strong incentives to carefully monitor themselves. Doctors Without Borders, for example, has condemned these quarantines as a threat to its battle against the disease in Africa. It cites the effect the quarantines will have in deterring doctors and nurses from taking the already remarkably brave step of entering the fight against the disease—and in stigmatizing them when they do. In short such quarantines threaten to weaken the most effective weapon we have in stopping the disease at its source. (It’s also shameful to treat returning health care workers, who have put their own lives at risk to help others, as anything less than heroes.)
Where individuals cooperate with the authorities in allowing close monitoring of their health and other reasonable precautions, the imposition of quarantines on those without symptoms appears to be driven by politics rather than science, and therefore raises serious civil liberties concerns.
While some political leaders have acted out of fear, Obama Administration officials deserve praise for largely sticking to science and not caving in to some of the fear mongering that is swirling around them. The White House has prioritized medicine over politics. It has resisted calls for travel bans, tried to persuade the governors of New Jersey and New York to reconsider their quarantines, and has largely followed the advice of public health experts in the recommendations that they have made. The Administration has also taken helpful steps such as expediting emergency FDA authorization for the use of new machines for rapid detection of the Ebola virus—which could allow detection of the disease before symptoms appear.
In fact, the Obama Administration has a history of good policy on communicable diseases. As we described in a 2009 white paper on that year’s H1N1 flu scare, the Administration acted calmly and appropriately in response to that epidemic, and overall, President Obama has turned away from his predecessor’s military/law enforcement approach to fighting disease, which we criticized in detail in our 2008 report on pandemic preparedness.