With the recent lapses, intentional and non-intentional, in self-monitoring by Ebola exposed healthcare workers it has become apparent that certain questions must be answered.
Question 1: Is a 21-day self-monitoring quarantine adequate to determine Ebola exposure and infection?
Question 2: Can a negative blood test for Ebola be definitive before symptoms have developed?
Question 3: Can a mandatory quarantine be imposed upon an individual exposed to Ebola?
Fact: CDC Ebola interim guidance states:
“Ebola virus is detected in blood only after the onset of symptoms, usually fever. It may take up to 3 days after symptoms appear for the virus to reach detectable levels. Virus is generally detectable by real-time RT-PCR from 3-10 days after symptoms appear.” http://www.cdc.gov/vhf/ebola/pdf/ebola-lab-guidance.pdf
Fact: CDC states that the incubation period for Ebola is 2 to 21 days. http://www.cdc.gov/vhf/ebola/symptoms/index.html
Fact: Charles Haas, Drexel University, published an article, on Oct. 14, 2014, that showed that there is up to a 12 percent chance of developing Ebola symptoms after the “21-day incubation period.” The study considered the statistics involved in the current West Africa outbreak and the 1995 Congo outbreak. http://currents.plos.org/outbreaks/article/on-the-quarantine-period-for-ebola-virus/
Fact: The CDC quoted standard 21-day Ebola incubation period was based on incubation periods calculated for the Zaire (1976) and Uganda (2000) outbreaks.
Fact: The World Health Organization [WHO] states that:
- 95 % of Ebola cases have an incubation period of up to 21 days,
- 98 % have an incubation period that falls within a 42 day period, and
- the remaining 2 % have an incubation period greater that 42 days. http://www.who.int/mediacentre/news/ebola/14…
Fact: Jacobson v. Massachusetts, a 1905 U. S. Supreme Court decision will support the right to quarantine an individual when there is a public need for quarantine.
Fact: Treatment of a quarantined individual has to be reasonable and decent. It cannot be punitive.
Fact: An individual must be given the right to protest an imposed quarantine.
Fact: Ebola is an infectious agent that has a known high lethality.
Quarantine is a time-tested response to slowing the spread of infectious disease. Voluntary compliance with an imposed quarantine is an important part of infectious disease control. A self-monitoring quarantine may be appropriate for individuals that have discipline and empathy toward their community. But, if the individual does not consider the impact of noncompliance on the community then a mandatory state imposed quarantine is justified.
“The liberty secured by the Constitution of the United States to every person within its jurisdiction does not import an absolute right in each person to be, at all times and in all circumstances, wholly freed from restraint. There are manifold restraints to which every person is necessarily subject for the common good.” Jacobson v. Massachusetts, 197 U.S. 11, 11 (1905).
“It might be that an acknowledged power of a local community to protect itself against an epidemic threatening the safety of all, might be exercised in particular circumstances and in reference to particular persons in such an arbitrary, unreasonable manner, or might go so far beyond what was reasonably required for the safety of the public, as to authorize or compel the courts to interfere for the protection of such persons.” Jacobson v. Massachusetts at 27.
Healthcare workers should be cognizant of the impact their behavior has on the community and act in the best interest of the community. If they elect to self-monitor they should confine themselves for the duration of the quarantine. They should not potentially expose others to disease, even if they are not infectious, until the quarantine period is over. Currently, it seems that healthcare workers feel that they should not be subject to the rules of quarantine. This attitude does not reinforce confidence in the profession. It also creates a standard for the rest of the community to not be compliant if they are quarantined.
There are a certain percentage of individuals that will not show Ebola symptoms until after the standard 21-day incubation period. Both the CDC and the WHO understand this. Therefore, the incubation period and quarantine period will have to be increased in order to insure the safety of the community.
Ebola can be diagnosed by blood test only after the individual has developed symptoms. So, if an infected individual is tested before he or she develops symptoms, the blood test may come back as a false negative. Therefore, a negative blood test should not be used as a definitive test if there are no symptoms being demonstrated.
If you are an exposed healthcare worker feeling good, do not assume that you will not develop symptoms until at least 42 days out.
If you are a healthcare worker, recently exposed to Ebola, you have an obligation to adhere to any quarantine either imposed by the state or self imposed. You must consider the impact that noncompliance will have on others. Noncompliance will erode trust in the healthcare profession and may unnecessarily expose others to disease. That is morally and ethically wrong.
Any “fundamental” liberty interest you think you may have that justifies your noncompliance does not exist. Your liberty will be balanced against the state’s interest in protecting its citizens. The Court will usually side with the state.