Quarantine: Ethical & Legal Battle for Human Rights during Public Health Emergencies

As the Ebola Epidemic of 2014 continues, some officials are calling upon a centuries-old tactic to combat the disease: medical quarantine. In an effort that began on October 24th, New York and New Jersey state officials instituted a mandatory 21-day quarantine on all medical personnel returning from volunteer efforts to combat the disease in West Africa.

No Standard Protocols

While some states are embracing the idea and implementing quarantines of their own, other state and national officials are denouncing them. Medecins Sans Frontieres (MSF), the main humanitarian group coordinating volunteer efforts in Africa also denounced the quarantines:

There are other ways to adequately address both public anxiety and health imperatives, and the response to Ebola must not be guided primarily by panic in countries not overly affected by the epidemic,” said Sophie Delaunay, executive director of MSF-USA. “Any regulation not based on scientific medical grounds, which would isolate healthy aid workers, will very likely serve as a disincentive to others to combat the epidemic at its source, in West Africa.

International MSF staff members commit to burdensome four-to-six week assignments in the Ebola affected countries. The risk of being quarantined for 21 days upon completion of their work has already prompted some people to reduce their length of time in the field. Others will be less inclined to volunteer in the first place. This will present significant operational disruptions at the field level for MSF and other organizations, and lead to an overall shortage of desperately needed health workers, precisely when the Ebola outbreak is as out of control as ever.

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Baylor College of Medicine Team Provides Ebola Training in Nigeria

City of Lagos (courtesy of nigeriaembassyusa.org)

In mid-September, a six-member team from Baylor College of Medicine trained nearly 1,500 healthcare providers and non-medical personnel in the basic facts about Ebola and in the care of people with the disease during four days of training in two Nigerian cities – Lagos, Africa’s most populous city, and Eket, an industrial city in the south. The effort was sponsored by ExxonMobil, which has offices and petroleum operations in the African nation.

Nigeria has had a limited number of cases of the disease in the current outbreak, and the disease has been designated as contained as of early October.

The Baylor training consisted of a presentation for the non-medical public about the disease itself and how best to protect against it. A second, more sophisticated presentation was designed for healthcare providers, describing the best methods to prevent transmission, caring for patients, and protecting against acquiring the infection during care. A third presentation dealt with the appropriate personal protective equipment and how best to put it on and take it off safely.

Dr. Bobby Kapur, physician leader and associate professor of medicine – emergency medicine at Baylor, said it was interesting that Nigeria’s situation was similar to that in the United States. One person traveled from Liberia to Nigeria and then had some contact within the community.

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Enterovirus D68: Sweeping across the US

The respiratory virus known as Enterovirus D68 (EVD68) has been sweeping the country this summer, primarily infecting children. So far 691 people in 46 states have been infected. Luckily, enterovirus is typically a summer virus, and it’s season shall soon come to an end.

EV68-map-lg

 Children with Asthma may have Worse Outcomes with EVD68

While the signs and symptoms of EVD68 generally mirror that of other  respiratory viruses and can include fever, runny nose, sneezing, cough, and body and muscle aches. In some children wheezing and difficulty breathing can develop.  The most deadly form of the virus seems to be more widespread in the Midwest. At the peak of the Kansas City-area outbreak their 354-bed hospital was filled, and Children’s Mercy had 100 patients in their pediatric intensive care unit (PICU), three times more than normal for this time of year. Patients usually end up in the PICU due to severe bronchospasms, and often many children affected by the virus suffer from asthma or have had episodes of wheezing in the past. This video describes EVD68 in more depth.

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Ebola: Hot Zone arrives in the Lone Star State

The 1st ever documented case of Ebola in the United States was announced on September 30, 2014 by the Centers for Disease Control & Prevention (CDC) and the Texas Department of State Health Services.  

Ebola virus (Image courtesy dailytech.com)

Dallas, We have an Infection

Thomas Eric Duncan, a 42 year old Liberian national, who was traveling to the US for the 1st time to visit family in Dallas arrived in Texas on September 20, 2014.  He had traveled to Dallas via flights from Brussels to Washington, DC then to Dallas.  Mr. Duncan, initially showed signs of a low-grade fever and abdominal pain beginning on September 24th and was seen at Texas Health Presbyterian Hospital Dallas on September 26th. Although his family had informed the healthcare workers of his recent arrival from Liberia, the hospital personnel decided he did not meet the criteria for Ebola suspicion since he did not have a temperature greater than 101.5 degrees Fahrenheit. He was discharged home. On September 28th, Mr. Duncan’s symptoms worsened, and he was transported by Dallas County EMS back to Presbyterian Hospital and was placed into isolation.  On September 30th, lab tests from the State of Texas and the CDC confirmed the patient has Ebola. He is currently in critical condition in the ICU. The C.D.C. has sent a team to Dallas to identify others who may have contracted the illness.

Texas Health  Presbyterian Hospital. Image courtesy of NPR

Texas Health Presbyterian Hospital. (courtesy of NPR.com)

It is important to remember that Ebola does not have respiratory transmission. The disease is only spread through exchange of bodily fluids and is only contagious when symptoms appear. Thus, only those who interacted with Mr. Duncan on or after September 24th are at risk.  The Director of the CDC, Dr. Thomas Frieden has stated there is “zero risk of transmission” to fellow passengers on his flights because he was not showing signs of symptoms while traveling.

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Antibiotic Resistance: Rapidly Growing Threat

Presidential Response

On Thursday, September 18, President Barrack Obama issued an Executive Order which created a Task Force with the Mission to Combat Antibiotic-Resistant Bacteria in response to this report published by the President’s Advisory Council (PAC) on Science and Technology. The CDC estimates that there are have been over 2 million illnesses and 23,000 deaths from antibiotic-resistant bacteria in the United States.

National_Summary_Data

Culprit Bacteria

The PAC report outlines a 5-step plan to combat these specific pathogens:

  • Carbapenem-Resistant Enterobacteriacea
  • Methicillin-Resistant Staphylococcus aureus
  • Ceftriaxone-Resistant Neisseria gonorrhea
  • Clostridium difficle

The CDC also includes Extended-Spectrum Beta Lactamase producing Enterobacteriacea, Multi-Drug Resistant Salmonella, and Pseudomonas on its list of pathogens to target.

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Severe Respiratory Virus Targets Hundreds of Children in the US

source: gbtimes.com/world/

“Tip of the Iceberg”

Public health officials and physicians are scrambling to keep up with hospital admissions and Emergency Department (ED) visits in 10 states across the country as an epidemic of children presenting with severe respiratory symptoms spreads across the US. Mark Pallansch, the director of CDC’s Division of Viral Diseases has said that these increased hospitalizations could represent, “just the tip of the iceberg in terms of severe cases” and have prompted health officials in Colorado, North Carolina, Georgia, Ohio, Iowa, Illinois, Missouri, Kansas, Oklahoma, and Kentucky to reach out to the CDC for further assistance.

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Flood Preparedness: Staying Afloat

Did you know that September is National Preparedness Month? My reports this month are going to focus on various natural disasters and how to be ready to weather the storms. This week – monsoons!

Monsoon Crisis

Five days of heavy and unrelenting monsoon rains in the Kashmir regions of northern India and Pakistan have killed over 120 in India and 160 in Pakistan in landslides and flash floods. In India, 450 villages are submerged and 2,000 others have been affected, while in Pakistan the floods have hit at least 286 villages and collapsed over 4,000 homes. Rescuers in both countries are attempting to reach thousands of stranded citizens, though their efforts are being hampered by fast-moving floodwaters. For example, even though the rains had stopped on Sunday, the overflow from the Jhulem River was moving too quickly to allow boats to reach those in need. In Srinagar, a major city in Indian-controlled Kashmir, the floodwaters were 12 feet deep, with entire houses completely under water. Even the state’s maternity hospital was flooding, forcing patients and staff to flee to higher floors of the building. The Indian Prime Minister has described the situation as a “national level disaster.”

Image courtesy of weather.com

Image courtesy of weather.com

Image courtesy of weather.com

Image courtesy of weather.com

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Volcano Preparedness: Getting Ready to Blow!

Did you know that September is National Preparedness Month? My posts this month are going to focus on various natural disasters and how to be ready to weather the storms. Up first – volcanoes!

Volcanic Geography

There are over 160 volcanos within the United States alone with most centered around the western coast in Alaska, Washington, Oregon, California, Wyoming, Hawaii and the western islands – find the full list here. You can find a list of all the active volcanoes around the world here.

Last week the world learned how to pronounce Bárðarbunga as word spread that another Icelandic volcano was ready to blow. We all remember when Eyjafjallajökull erupted in 2010 spreading ash miles into the air and causing airlines to shut down flights in Europe for 6 days out of fear that the ash would ruin the jet engines.

Baroarbunga on map

Bárðarbunga is part of a system of volcanos in the center of Iceland which lay beneath a massive glacier. Seismologists detected over 3,000 earthquakes in the region, a forewarning of a future eruption. Indeed on Monday the 8/28 Bárðarbunga erupted, and had a second eruption a few days later on 8/31. While these eruptions were nothing that those experienced in 2010, Iceland still banned flights within 6,000 feet of the peak on the 31st for a few hours until it was determined that no ash had been released and air travel remained safe. You can read more about the Bárðarbunga volcano via Vox’s excellent coverage here and here. And even catch a livecam of the volcano.

image courtesy of the BBC

image courtesy of the BBC

Iceland wasn’t the only hot zone this last week, however. Mount Tavurvur’s Rabaul volcano in Papua New Guinea also erupted on August 29, 2014, spreading a plume of smoke and ash 18km into the air.  4,000 people in the town of Rabaul were evacuated in anticipation of the storm, and the rest were warned to stay indoors. This eruption is causing changes in flight patterns, with Qantas airlines rerouting planes to avoid the smoke and ash. Others are concerned for the fate of agriculture nearby as ash blankets the land, similar to a previous Rabaul eruption in 1994 devastated the area.

taurvur volcano

Tavurvur imageImages via @hhnamani

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Napa Earthquake: Wine Country Shaken but not Stirred

The strongest earthquake to hit Northern California in 25 years occurred Sunday August 24th at 3:20am.  The magnitude 6.0 earthquake was located near American Canyon, CA, approximately 6 miles south of the city of Napa.

Building at corner of Second and Brown Streets damaged from Napa earthquake. Courtesy of chicagotribune.com.

 Early Morning Devastation

The pre-dawn trembler woke many area residents from their sleep, and individuals all across the Bay Area felt the impact with nearly nine million people experiencing the tremors.  Initially, 70,000 customers lost electricity, but by Monday morning only 2,200 were left without power reported the electric company Pacific Gas & Electric.  In addition, multiple water lines were ruptured during the event, and it may take a week to have them all repaired said Napa Public Works Director Jack Rochelle. However, “Running water is safe to drink,” stated Rochelle. Napa Division Fire Chief John Callanan told reporters that the earthquake spurred six major fires that destroyed multiple mobile homes in the area.  Some of these fires were caused by broken gas lines.  There were 20 gas distribution “outages,” and utility team are responding to several hundred “gas odor” calls. Amtrak suspended its train service through the Bay Area so tracks could be inspected. Governor Jerry Brown has declared a State of Emergency.

Firefighters spray foam on a fire at a mobile home. Courtesy of latimes.com.

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Ebola in Nigeria: Africa’s Most Populous Country at Risk

Health official uses thermometer at arrivals hall of Murtala Muhammed International Airport in Lagos, Nigeria. Courtesy of theguardian.com.

This report is the 3rd in a continuing series on the Ebola epidemic affecting West Africa.  Previous reports can be found here: Report #1 and Report #2.

Large Number of People in the Crosshairs

With a population of more than 177 million people, Nigeria has a larger population than the next two most populous African countries combined (Ethiopia & Egypt).  Although the current Ebola crisis has focused on the more than 2,100 cases and 1,100 deaths in Liberia, Sierra Leone, and Guinea, the epidemic has now spread to Nigeria.

Confirmed Ebola deaths by country. Courtesy of bbc.com.

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