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.
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.
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.
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.
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.
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.
Continuing coverage of the Ebola Epidemic affecting West Africa with the potential to spread to a wider region. The 1st article in the series can be found here.
The Fight Ramps Up
The 2014 Ebola outbreak “is moving faster than our efforts to control it..this is an unprecedented outbreak accompanied by unprecedented challenges. And these challenges are extraordinary,” said Margaret Chan, director-general of the World Health Organization (WHO) in response to the continued devastation in Africa where the outbreak has claimed at least 932 lives, including that of Sierra Leone’s leading Ebola expert Dr. Sheikh Umar Khan, and over 1700 cases. The WHO announced on August 6th that it will convene a special panel to deliberate the use of experimental drugs in an attempt to control the outbreak with innovative measures.
The US Centers for Disease Control (CDC) has raised its Emergency Operations Center Response to the Ebola epidemic to a Level One, its highest level of response. Level One has occurred only 2 other times in the CDC’s history: Hurricane Katrina in 2005 and the H1N1 Outbreak in 2009. The CDC has 240 staff members working on the Ebola response and 30 members in the affected regions with more en route.
Many organizations such as US Peace Corps have already evacuated hundreds of volunteers from the most severely affected areas in West Africa. The situation has garnered international concern and the World Health Organization recently announced allocation of $100 million in funds to provide much needed supplies and officials to reverse the disease’s overwhelming tide and plans to send another 50 specialists to West Africa to help control the outbreak. But as efforts are escalated to treat those infected, containment protocols have also been expanded:
– The CDC has issued a Level 3 travel warning (highest level) for US citizens that severely discouraged from all nonessential travel to those countries hardest hit by the virus: Guinea, Sierra Leone and Liberia
– In Sierra Leone the government has announced plans to quarantine the hardest hit regions and to deploy security personnel to assist healthcare workers in their efforts to combat the disease
– Liberia has declared that all non-essential government personnel will be placed on a thirty-day long complusory leave and is making plans to close all schools temporarily
– Meanwhile from Nigeria to New York, vigilance has been increased at airports for passengers arriving from endemic regions with symptoms consistent with the Ebola virus. Dr. Jay Varma, deputy commissioner for disease control at the New York health department has reassured the public that any such affected individual would be briefly quarantined at the airport before being transported to an area hospital for further evaluation.
Severe Pandemic in West Africa
A deadly pandemic has been brewing in western Africa since December 2013. This latest outbreak of the deadly Ebola Virus Disease (EVD) began in the Republic of Guinea and then spread to Sierra Leone and Liberia. To date, 344 suspected and confirmed cases of EVD have been reported in Guinea, 112 in Sierra Leone, and 13 in Libera. Since emerging in 1976 in Sudan and Congo, EVD outbreaks have occurred 33 times.