To Whom It May Concern:
I am writing in response to a letter from Gerry Scharfenberger recently published in the Atlanticville, the East Brunswick Sentinel, the Hub, the Independent, the North and South Brunswick Sentinel, and the Suburban ("Governor’s stance on quarantine lauded") as well as the Atlantic Highlands Herald ("Gov. Christie Shows Leadership on Ebola Quarantine"). I am responding specifically to his reliance on the statements of Bruce Beutler, M.D., who won the Nobel Prize for Medicine and Physiology in 2011 for his work on cellular immunity and is currently the Director of the Center for the Genetics of Host Defense at the University of Texas Southwestern Medical Center in Dallas.
Dr. Beutler has been cited as saying not only that he supports mandatory quarantine for all health care workers who may have been exposed to Ebola (since "it is unclear whether individuals who do not exhibit symptoms of Ebola can still transmit the virus"), but that isolation should ideally take place in a specialized hospital ward. In contrast, the current guidelines of the federal Centers for Disease Control and Prevention (CDC) for those who may have been exposed to Ebola are that such individuals should undergo “direct active monitoring,” with a public health official observing these individuals for a 21-day period, taking their temperature once a day and checking on the temperature by phone a second time daily. (People being monitored must also report any symptoms. Additionally, they should avoid travel by airplane, ship, or long-distance train or bus, and discuss local public transit with health officials.)
I would respond to Dr. Scharfenberger's letter in part by pointing out that the intersection of government and medicine is public health, not government or medicine, and that Dr. Beutler's recommendations have not been consistent with those of prominent public health experts. For example, Georges C. Benjamin, M.D., executive director of the American Public Health Association, has asserted that the use of quarantine powers in this situation is likely to complicate the job of U.S. public health officials by creating more uncertainty and fear than is necessary, and George Annas, J.D., M.P.H., chairman of the Department of Health Law, Bioethics & Human Rights at Boston University’s School of Public Health, has argued that extreme requirements such as quarantines can even drive sick people into hiding, which is “the worst thing that can happen".
With respect to the policy of quarantining health workers in particular, the Infectious Diseases Society of America recently issued the following statement against the practice:
"Because the transmission of [Ebola Virus disease] requires bodily fluid or blood contact, mandatory quarantine of asymptomatic healthcare workers who are expected to comply with active health monitoring by public health authorities provides no substantiated benefit and little, if any, theoretical benefit. Mandatory quarantine may also adversely impact the ability of US healthcare workers to participate in the care of suspected and confirmed Ebola patients."
An editorial published in the November 20, 2014 issue of the prestigious New England Journal of Medicine also makes the case against quarantining health care workers even more strongly:
"Médecins sans Frontières, the World Health Organization, the U.S. Agency for International Development (USAID), and many other organizations say we need tens of thousands of additional volunteers to control the epidemic... If we add barriers making it harder for volunteers to return to their community, we are hurting ourselves."
(From a purely short-term economic point of view, it may also be worth noting that the use of a wrist-sensing device to perform "direct active monitoring" such as that currently recommended by CDC has been estimated to cost about $100 per person, in contrast to the cost of quarantine, which could amount to $1,000 per person per day or more.)
Kenneth J. O'Dowd
North Brunswick, NJ
Ebola: Quarantines May Complicate Job of U.S. Public Health Officials
- Written by Kenneth J. O'Dowd
- Category: Letters to the Editor
To Whom It May Concern: