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HICprevent

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This award-winning blog supplements the articles in Hospital Infection Control & Prevention.

The Low Point in America’s Response to Ebola

March 26th, 2015

The misguided (read cynical) attempts to quarantine asymptomatic health care workers returning from fighting Ebola in West Africa last year were unethical and counterproductive, a federal bioethics group concluded in a recent report.

“Needlessly restricting the freedom of expert and caring health care workers is both morally wrong and counterproductive -- it will do more to lose than to save lives,” says Amy Gutmann, PhD, chair of the Presidential Commission for the Study of Bioethical Issues. “[Ebola] demonstrated the dire need to prepare before the next epidemic. A failure to prepare and a failure to follow good science — for example, by not developing vaccines and not supporting health care providers — will lead to needless deaths.”

Future epidemics and public health emergencies should be guided by the ethical principle of “least infringement,” which means the least restrictive measures possible should be taken to protect the public’s health and health care workers, the commission recommended.

“These measures should not present unnecessary barriers to movement of health care workers to and from affected areas so that they can contribute their skills to the management of the public health emergency and other health problems,” the report stated.

After the first U.S. case of Ebola onset in a patient last year and subsequent occupational transmission to two Dallas nurses, some states enacted or proposed 21-day quarantines for all health care workers returning from the epidemic frontlines in West Africa. The three-week duration was to cover the outer limits of the incubation of the virus, but the frank idiocy of such policies starts with the fact that Ebola is not transmissible in the absence of symptoms. The CDC recommended self-monitoring policies that, backed by court rulings, eventually held the day. Otherwise, health care workers would have likely refused to volunteer to fight the epidemic, if doing so meant a three-week lockup upon return even if they had no symptoms.

Nobody said it better than Kaci Hickox, RN, who was detained at Newark (NJ) Liberty Airport for three days in a tent with a portable toilet.

“I was quarantined against my will by overzealous politicians after I volunteered to go and treat people affected by Ebola in West Africa,” she wrote in an op-ed piece in the Guardian newspaper in London. “My liberty, my interests and consequently my civil rights were ignored because some ambitious governors saw an opportunity to use an age-old political tactic: fear. [NJ Gov. Chris] Christie and my governor in Maine, Paul LePage, decided to disregard medical science and the constitution in hopes of advancing their careers. They bet that, by multiplying the existing fear and misinformation about Ebola – a disease most Americans know little about – they could ultimately manipulate everyone and proclaim themselves the protectors of the people by “protecting” the public from a disease that hasn’t killed a single American.”

Though infected and now recovered nurse Nina Pham may certainly argue otherwise, this was the low point of America’s response to Ebola -- demonizing care givers who volunteered and risked their lives in the name of naked ambition. We must be watchful for such grandstanding when the next epidemic finds its way to our shores, for both disease and demagoguery will inevitably recur.