Why the Cuomo/Christie Ebola Quarantine is Stupid

Over the weekend, New York and New Jersey Governors Andrew Cuomo (D) and Chris Christie (R) imposed a quarantine on health care workers who treated Ebola patients in West Africa that would confine them to a government-regulated facility. This requirement is not science-based and is counterproductive. New York University bioethicist Arthur Caplan offers a nice summary of seven reasons why this policy is stupid. Here are his main points:

1. Quarantining people without symptoms makes no scientific sense.

They are not infectious. The only way to get Ebola is to have someone vomit on you, bleed on you, share spit with you, have sex with you or get fecal matter on you when they have a high viral load. …

2. Quarantine is next to impossible to enforce.

If you don't want to stay in your home or wherever you are supposed to stay for three weeks, then what? Do we shoot you, Taser you, drag you back into your house in a protective suit, or what?

And who is responsible for watching you 24-7? Quarantine relies on the honor system. That essentially is what we count on when we tell people with symptoms to call 911 or the health department. …

5. Health care workers who take care of those who really do have Ebola at big hospitals, such as Bellevue or Emory, are at the greatest risk.

If you quarantine them you are taking your best professionals offline for three weeks — and there are not a lot of replacements.

6. Who will volunteer to go to West Africa to stamp out the epidemic, if they know they face three weeks of confinement upon their return?

Those who go are heroes who face hell on earth. Can't they be trusted to do the right thing and self-monitor when they get back?

On Fox News Sunday, Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases, said:

"The best way to protect us is to stop the epidemic in Africa, and we need those health-care workers, so we do not want to put them in a position where it makes it very, very uncomfortable for them to even volunteer to go."

On Monday, the two governors have had a rethink and are walking back panicked policies. Returning health workers will now merely be confined to their homes. This is still too much.

Consider that the 76 health care workers who had contact with Ebola patient Thomas Eric Duncan are not being quarantined. Instead they report in daily on their health and are asked to avoid crowded public venues. It's been 19 days since Duncan died, and so far only two nurses who took care of him when he was at his most infectious became ill. Recall also that four people lived with Duncan for at least four days as his Ebola infection worsened and none of them were infected. This suggests that it is highly unlikely that people who bowled with Dr. Craig Spencer are are at risk.

The CDC and Obama administration officials have certainly not covered themselves in glory in their responses to the Ebola situation, but grandstanding by governors is not a sensible way to develop public health policy.

Comments

[Marktaylor]

Who writes this shit. What is a "bio-ethicist."

[UnCivilServant]

"Bioethicists" are categorically the most evil people on the planet.

[Heroic Mulatto]

Pete Singer, Leon Kass, Helga Kuhse, Julian Savulescu, the list goes on and on...the only bioethicist that I can think of that doesn't cause immediate revulsion at how, by every definition of the word, evil they are is Jacob Appel...who is wont to go off on craziness himself....just not evil, tyrannical craziness like his peers.

[PM]

viral load

[PM]

Okay, not sure why the rest of my comment didn't show up. Anyway, great name for a band.

[Almanian!]

I need to go dump a viral load right about now...

[Mint Berry Crunch]

Been in use since 1996.

I particularly recommend the "Hillbilly Whore Hackin Revival" EP. It clearly showcases their most mature songwriting, and "Pus-Filled Colostomy Bag" is their definitive track.

[Francisco d'Anconia]

See?

[Mike M.]

"Ebola is fake and nothing to worry about. Manmade global warming on the other hand is real and something we should all freak out about."

Really great stuff from one of the guys who told us that Ebola would never even make its way into America in the first place.

[Swiss Servator, spare a franc?]

Ya gotta have faith!

[FUQ]

Mr Bailey lives in backwards land apparently.

[Ron Bailey]

MM: don't mislead - this is what I actually wrote on September 5 in "Study: Ebola Coming to America":

A new study in the journal PLoS Currents Outbreaks calculates that there is an 18 percent chance that a case of Ebola will arrive in the United States by the end of this month. The researchers inputed airline travel data and various outbreak scenarios into a computer model to come up with probabilty figures for the arrival of Ebola in 16 different countries. Is it time to panic? Absolutely not. The researchers also report that ... the number of people likely to be infected through contact with a person bringing Ebola to our shores maxes out at around 10 individuals.

So far four people, all of whom had direct contact with sick people have come down with the disease in the U.S.

See also my July 29 article, "An Ebola Epidemic Will Not Occur in the U.S."

[John]

Ron,

Everyone one of those cases costs at least a half a million dollars to treat and leaves whatever hospital stuck doing it bankrupt because its patients are afraid to go there.

The problem with that study is that it assumes every new case will be treated the same way as the first one. That is just not true. If we get these cases in any significant number, health care workers will refuse to treat them and hospitals will refuse to admit them.

That study is a great example of letting statistics lie to you. If we are lucky and only get a few more cases, we will probably be okay. But if we are not lucky and get say ten of them in a week, we could quickly reach a critical mass where we are no longer able to properly treat and quarantine infected people. Then all bets are off.

Is that likely to happen? Probably not. But it is a change somewhere north of zero and one that would have enormous consequences. The people who are dismissing it are being foolish.

[FUQ]

Not to mention that Ron keeps pushing his pseudoscience climate change bullshit as 100% fact that will kill us and dismisses a disease that is killing people.

No, I don't believe we are in danger of an Ebola outbreak in the US but to dismiss common sense to push your political agenda is stupid.

[Francisco d'Anconia]

O-R-M

[John]

I have no idea what O-R-M means.

[Francisco d'Anconia]

Operational Risk Management. There are two aspects to ALL risk. When deciding whether to take the risk you must weigh both.

One must look at the potential consequences to include the worst case scenario. Obviously the more catastrophic the potential consequences are the more you should attempt to avoid them.

BUT, and here is where almost everyone fails in managing risk, one must look at the probability of the worst case scenario actually happening.

For instance, should we evacuate the earth because the sun might go out?

Worst case consequences- All life as we know it exterminated.
Probability of it happening in the next 1000 years- One in a hundred trillion.

Am I going to worry about the sun going out?

Same with Ebola. Yeah, it's got a 50% kill rate for those infected. That's bad. But the probability of it spreading out of control are pretty damn low. THAT's how you make risk decisions, to include decisions to quarantine.

[John]

The consequences of it spreading is more than just the people who die. It is the cost of treating them, of people refusing to go out in public or travel or go to work and also the second order effects of all of that.

Even a small outbreak would put an enormous strain on our health care system which would in turn kill other people who can't get care because of Ebola. Not to mention all of the harms the economic damage would do.

Those consequences are huge. Meanwhile, what are the costs of banning travel to and from the infected country and quarantining any of the medical people who come back from there? Miniscule compared to the costs of even a small outbreak.

I honestly don't see a rational case against quarantining here. I don't know what the hell has gotten into Bailey on this subject other than he is letting his politics dictate his views of reality.

[Francisco d'Anconia]

Those consequences are huge.

See? You just did it. (You must be in the military as no one in the AF could ever acknowledge there is a second part to the formulation either.) You looked at the consequences WITHOUT addressing the probability of those consequences occurring.

I would hope that whomever is making the decision to quarantine is looking at both and making their decision based upon that, rather than feelz.

At some point, the risk is worth putting forth the extra effort. Apparently someone thinks the probability of an American epidemic is low enough that a quarantine isn't required.

[John]

You looked at the consequences WITHOUT addressing the probability of those consequences occurring.

Yes because they are too separate issues. You are correct that it takes both the consequences and the probability to give you a proper decision. They are however two seperate numbers and they bear a linear relationship to each other. That is, the higher one number is the lower the other has to be to justify action.

The fact that the consequences are huge does matter. It matters because the larger the consequences, the lower the probably necessary to justify action.

At some point, the risk is worth putting forth the extra effort.

Yes, and that point is a function of BOTH the consequences and the probability of it happening, not just the probability. Here, we have a low probability, but still a non trivial one, and a huge consequence. That justifies some action be taken, though not every action.

[Francisco d'Anconia]

The fact that the consequences are huge does matter. It matters because the larger the consequences, the lower the probably necessary to justify action.

True, it does matter. I never said it didn't. But the decision positively requires you address the probability, regardless of the consequences.

If it didn't, in my example, you'd be evacuating the earth for fear of the sun going out.

[John]

That is the issue. Is this evacuating the earth on the threat of the sun or something else?

It is not just a question of probability and consequences. It is also an issue of the cost and effectiveness of taking the action.

If Ebola were lose in Canada or Mexico, a travel ban would be pointless since it is unlikely to stop anything. But it is lose in West Africa, a place we share no borders with and do very little actual business with. So a travel ban is both practical and not likely to cost very much. Same thing with quarantine of health workers. There are not that many of them and doing so isn't going to cost much.

When you compare the cost of those two measures to the consequences of an outbreak and the probability of getting one without doing that, I think it is pretty clearly a sensible thing to do.

[Francisco d'Anconia]

Costs are part of consequences.

I think it's probably an overreaction, based upon both consequences and probability. But I'm just guessing, as I'm not a doctor/disease specialist, and have no way of calculating the probability of containment.

I think this has simply become another political football. With all the other shit out there to bag on Obama about, this one is pretty low on his incompetence scale.

[John]

I think it is pretty high on the incompetence scale. They have fucked this up from the start. The fact that the nature of the threat may save them just means they are lucky. Obama would have reacted no differently had this been an outbreak of something more dangerous. Since the next outbreak of something might be more dangerous, the incompetence matters and matters a lot.

[Francisco d'Anconia]

How many Americans (in America) has it killed? 2?

Yes, they changed the guidelines several times. That points to at least some incompetence, but compared to most government agencies, particularly DHS (just fucking with you), they've done a pretty decent job and from my estimation, given it the attention it deserves.

[John]

First, the fact that only two Americans have been killed so far is hardly dispositive about the future. Second, even if it is, it just means they got lucky not that they were competent.

What this entire thing shows is that these people make decisions based on politics not reality. Eventually, that will end very badly.

[DarkHelmet]

There are not a lot of things more dangerous than Ebola, for heaven's sake. Highly contagious, level 4 biohazard with a 50% fatality rate. If you don't take something like that seriously what exactly do you consider dangerous?

[Azathoth!!]

For instance, should we evacuate the earth because the sun might go out?

Yes, of course. And 'we' will.

THAT's how you make risk decisions, to include decisions to quarantine people who've been treating ebola patients

Everyone keeps leaving off that imporatnt clause. It's not a general quarantine--it's a quarantine of people who've been arond ebola.

And that, for some reason, is crazy to these people. That, for some reason, is not common sense.

And people wonder why there are folks thinking maybe there's a little bit too much faith being placed in the CDC right now.

[JParker]

More specifically, it has a 50% fatality rate in countries with minimal sanitation and medical facilities.

The fatality rate in the US is likely to be far less.

[DarkHelmet]

Really? Based on what? What are the historical data on Ebola fatality rates in advanced Western countries? Oh, wait -- we have no data on such a thing at all because it's never happened.

How about we stop making assumptions regarding something we understand so poorly?

[Almanian!]

1) Quarantining people without symptoms makes no scientific sense.

I dunno - again, this worked in the Middle Ages with the plague. Now I'm gonna wait for symptoms before I act? That sounds like a good way to encourage the spread of a disease.

2. Quarantine is next to impossible to enforce.

Gosh, well, if it's HARD, then by all means they shouldn't do it.

5. Health care workers who take care of those who really do have Ebola at big hospitals, such as Bellevue or Emory, are at the greatest risk.

Yes. And...? Hospitals are where sick people get treatment - that's why a "quarantine" for diseases like Ebola prolly make some sense. SO IT DOESN'T SPREAD.

6. Who will volunteer to go to West Africa to stamp out the epidemic, if they know they face three weeks of confinement upon their return?

That's for people to decide on their own. Team America's OK for ebola?

Look, I don't necessarily agree with quarantine, but I find the arguments against it much less persuasive than if we didn't have ample evidence that "the experts" have no fucking clue what to do, and we keep seeing more cases come to the US.

*walks away from grenade I just lobbed on the table*

[Red Rocks Rockin]

6. Who will volunteer to go to West Africa to stamp out the epidemic, if they know they face three weeks of confinement upon their return?

That's for people to decide on their own. Team America's OK for ebola?

This is what I find to be the most specious argument. Some of the other ones are relatively reasonable concerns, but if a 3-week quarantine is the deciding factor in whether or not a doctor or nurse chooses to go to a third-world shithole for several months, they probably weren't that dedicated to the cause to begin with.

[John]

Go to said shit hole and risk getting a deadly virus.

[Drake]

Who would expect to be exposed to a deadly virus and not be quarantined? What the fuck is wrong with these people (and Bailey)?

Of course you quarantine people who have been exposed. Fuck. Just the financial implications are justification.

[John]

Yeah who will volunteer? I mean risking getting Ebloa apparently is nothing compared to the threat you might have to be quarantined for a few weeks when you come back. If people stop volunteering to go there it won't because doing so means risking your life. No. It will be because you might have to be quarantined when you return.

Ron is not covering himself with glory on this topic.

[BladdyK]

I agree with a quarantine. The fact is, you have to respect the problem, and the problem is that if Ebola infects a bunch of people, it is going to be very hard to control it.

For one, the people being treated now are using an experimental drug and antibodies. If you have the situation where a thousand or a hundred get infected at the same time, you may run out of resources, and that you don't want.

I mean, this is not the flu. This is something that has a better than even chance of killing you. It seems that the medical workers have a great deal of confidence that they know when they are infectious, the problem is that they might not know. What if that nurse spiked a fever on the plane and got nauseous? What if the doctor was contagious when he went to the bowling alley, even mildly so? The healthcare workers want us to trust them, but they haven't really shown the will to manage themselves.

Also, a three week quarantine being an impediment to going to Africa? Who writes this? First, if you are treating Ebola patients directly, what do you expect? Columbia Presbyterian wouldn't let the doctor come back to work until his three weeks was up, so why is that some sort of undue burden for others? I understand that people don't want to be told what to do, but if their common sense seems to be lacking, then what do you want the rest of us to do?

[John]

All of this and more. If you are treating Ebola victims, why would you not want to be quarantined? What, do aid workers take special pleasure in putting their families at risk?

[RBS]

Didn't that nurse from NJ just hire a civil rights attorney? And she had a fever

[John]

Then there was the doctor who walked around like he was returning from Europe or something. People are nuts. We have a whole bunch of people in this country who seem to believe that reality will conform to their politics. I bet you anything that doctor in New York is a good believing Prog and thinks quarantining people coming from the area is racist and therefore against his politics and thus acted accordingly.

Unfortunately, all that post modernism they teach in college is just crap. While Humian doubt is probably true in the most abstract sense and we do in many ways project our views onto the world via our perception, Humian doubt won't save you when you step in front of a bus and no amount of deconstructing your racist Western conceptions is going to kill the Ebola virus. There really is a real world out there that can kill you. I just hope Ebola isn't the mechanism that the real world uses to assert itself back into these people's lives.

[Almanian!]

And she had a fever

And I think we all know - there's only one cure....

[JParker]

She showed a fever using an LCD skin temperature thermometer, which tends to be rather inaccurate (in this case because she was flushed due to her frustration while being held at the airport). Rather than use that simply as a quick screening measure, and using a more accurate approach to verify, the locals panicked and rushed her into quarantine, where her temperature was verified to be normal.

[Heroic Mulatto]

I mean, this is not the flu.

Irony?

[Cytotoxic]

I dunno - again, this worked in the Middle Ages with the plague.

THIS IS NOT THE PLAGUE.

[Mickey Rat]

You are right. It is a different way to die horribly.

[PapayaSF]

I don't necessarily agree with quarantine, but I find the arguments against it much less persuasive than if we didn't have ample evidence that "the experts" have no fucking clue what to do, and we keep seeing more cases come to the US.

^This. Note the number of doctors, nurses, and scientists who have been killed by this strain of Ebola.

[Azathoth!!]

People seem to have forgotten that quarantine works best when you can quarantine those you know to have been exposed.

[Paper Wasp]

I'm not getting what's so hard about the quarantine, either. OK, so they could throw some magazines and/or an iPad or something in with this loudmouthed whiny cunt of a nurse, and maybe then, she'd stop bitching until the iPad batteries die or something.

But it's not unreasonable to quarantine someone who's been exposed to an infectious disease with a high mortality rate, and not just because of the potential for actual new cases, but the potential for economic damage caused by hysteria (as John mentioned above: people refusing to go about their lives and enter public places, refusing to go to hospitals because OH NOZE AN EBOLA PERSON WAS THERE!!11!!!).

She's not coming back from Bora Bora; she's coming back from some Third World shithole with an infectious disease epidemic. You make a personal choice to stay in a Third World shithole with an Ebola epidemic, expect to run into more trouble when you get home than just declaring pineapples at Customs.

[DarkHelmet]

That's no grenade, brother. That's a fine bit of common sense which a certain segment of our society simply does not want to acknowledge. Not yet, anyway. I figure it'll take about ten more cases on U.S. soil for these reverse Chicken Littles to take this thing seriously.

[Almanian!]

It's been 19 days since Duncan died, and so far only two nurses who took care of him when he was at his most infectious became ill.

But if we get to three, then the shooting war starts!

Protocols! Processes! They were followed! But...a quarantine is insane.

[John]

1. Quarantining people without symptoms makes no scientific sense.

They are not infectious. The only way to get Ebola is to have someone vomit on you, bleed on you, share spit with you, have sex with you or get fecal matter on you when they have a high viral load. ...

That is what they keep saying but their actual behavior indicates they don't have much confidence in that. Further, symptoms includes having a fever. Isn't that why the CDC went so crazy over the nurse from Dallas who flew after being exposed?

Lastly, if Ebola is really that hard to transmit, I don't see how it could be spreading so much in Africa. Africans are not suicidal and don't as far as I know make a habit of vomiting on each other. Yet, the disease seems to be spreading exponentially there.

[UnCivilServant]

There is one question with regards to the spread that I have been unable to get confirmation one way or another is whether or not the muslum portion of the population has continued with their traditional funerary customs for ebola victims.

Also, there are plenty of reports of violence against aid workers and accusations that westerners are deliberately spreading the disease (irrational mob behaviour is not unexpected in a plague situation). They may not believe that the proscribed precautions will help, or may simply be unable to carry them out.

[PapayaSF]

I asked about that around here a while ago. I was told that even Christian Liberians have similar funeral customs. But yes, I think the media and the Top Men have been reluctant to announce: "Oh by the way, you Muslims: those funeral practices mandated in the Koran? You have to stop doing those things."

[Mike M.]

It's kind of hard to square this idea that it's extremely difficult to spread with some of these scenarios the World Health Organization has been throwing out there recently. I mean, 1.4 million cases by January possible as a worst-case scenario? Both of these things just can't possibly be true at the same time.

I guess we're all supposed to believe that people in west Africa are eating each others' feces and drinking each others' urine because it's a part of their culture or something, but I'm as skeptical as you are.

[PapayaSF]

Apparently washing the bodies of Ebola victims, as mandated in the Koran, is a large part of it, and I think Christians in that region may do the same thing.

[Cytotoxic]

Lastly, if Ebola is really that hard to transmit, I don't see how it could be spreading so much in Africa.

Because they like to touch their deceased ancestors and are not hygienic. They do things like steal contaminated bedding.

Would it kill you guys to either 1) know what you're talking about or better yet 2) shut up? Please, just stop. You are clueless. You have no idea what you're talking about and it is painfully obvious.

[John]

Would it kill you to give a better explanation than "black people are just stupid and won't learn"?

That is really your only answer to this.

[Cytotoxic]

You just went Full Retard.

[John]

No. I just threw your argument back in your face and you are so fucking retarded it shocks you to see it.

That is your argument. Ebola is spreading in Africa because Africans are too stupid to stop it.

[ImanAzol]

The same people who rape 6 month olds because sex with virgins cure AIDS? Yes, they're retarded.

Refusing to acknowledge this because of their skin color makes YOU the racist.

[ImanAzol]

The same people who wear dresses because death can't find you in a costume? Who don't take precautions against crocodiles because "the crocodiles always eat people, so there's no point in avoiding crocodiles"? The same people who believe leopards are mystical spirits? The same people who shit on the side of the road and walk through it barefoot?

Islam was a huge advance for Africa. It brought them basic hygiene and rule of law.

Most of them are retarded as fuck. The average IQ in some of those countries is in the 40s, due to malnutrition in infancy.

Yes, they really are that fucking stupid, retarded, backward and savage.

And it has nothing to do with their skin color.

[DarkHelmet]

Have you actually read the accounts of the health workers in African who have been killed by this thing? They weren't stealing contaminated bedding or washing there ancestors. They were treating patients wearing gowns and masks. And yet they caught it.

[DarkHelmet]

If it is so hard to get, how did the nurses get it? They were wearing protective clothing. There is no evidence that the patient vomited or bled on them.

Obviously the virus isn't THAT hard to catch or it would be an epidemic in western Africa.

There is evidence that the virus can be transmitted by water droplets in the air from sneezing, for example.

Also remember that the virus is constantly mutating. There is no way to know for sure what it can and can't do at any given point in time.

[DarkHelmet]

"wouldn't" be an epidemic, sorry.

[The Late P Brooks]

"We must be seen to be doing something!"

[John]

Maybe. Fuck it Brooks, just send these people out on the subway every morning. What the hell.

[JW]

"Why the Cuomo/Christie Ebola Quarantine is Stupid"

it's a question for the ages.

[Mike M.]

Who will volunteer to go to West Africa to stamp out the epidemic, if they know they face three weeks of confinement upon their return?

The people volunteering to go over there to treat people are already risking their lives by doing so, you idiot. Taking three weeks afterwards to be sure they're clean doesn't seem like an extraordinary burden under the circumstances. Hell, they should volunteering for that if they had any sense.

[The Late P Brooks]

This suggests that it is highly unlikely that people who bowled with Dr. Craig Spencer are are at risk.

But, don't you get it?

THEY COULD HAVE!!!111!1!!!

They call it the Precautionary Principle for a reason, you know.

[John]

So Brooks do you just think we should never quarantine anyone? Is it your opinion that there is no danger here of any kind?

[JW]

It's never too early to completely and utterly lose your shit, P.

Something has to be done. ANYTHING.

[JWatts]

"This suggests that it is highly unlikely that people who bowled with Dr. Craig Spencer are are at risk."

Can Ebola transfer through sweat? Or drinking out of the wrong beer cup? Because I see that kind of contamination happen at the bowling alley. And the doctor did self quarantine himself the next morning. Can anyone be completely sure that he wasn't running a fever while he was bowling, because he noticed he had a fever the next morning?

We have a lot of questions and not many answers.

[Scruffy Nerfherder]

I think perhaps if they had someone actually competent in charge, people would be more reassured. Frieden is an idiot.

There will be times that the government will be required to trample people's individual rights in order to preserve public safety. A fatal viral outbreak would seem to qualify. However, the government wastes its authority on bullshit things like cigarette smoke and too much salt.

[Almanian!]

^^this

Totally. I'm no panic monger, and am not concerned about ebola, ISIS, etc.

HOWEVER. The "experts" put in front of us - every day - to "reassure" and placate the populace, and stifle the silly mob reflex....THEY'RE WRONG ABOUT A BUNCH OF SHIT AND KEEP CHANGING THEIR STORY!

Just like "it's not the crime, it's the coverup" - "it's not the potential pandemic that probably won't happen - it's the incompetent boobs creating doubt as to the real threat level, thus leading sensible people to question their platitudes and assurances."

That's it.

[toolkien]

Maybe if we had a color coded scale that represented the threat level.

[DarkHelmet]

How does 'bio hazard level 4' sound to you? Because that's what we're talking about here.

[PapayaSF]

The instant classic example of Top Men b.s. is Frieden's straight-faced statement that you can't get Ebola from riding a bus, but if you have symptoms, you shouldn't ride the bus because you might give it to someone else. He wasn't stumbling over his words, either. No wonder pretty much anyone paying attention distrusts the Top Men on this.

[Octavian]

I wish I could upvote this.

So far the main problem here in the US isn't the virus, its the dramatically eroded public confidence in government "experts" like that fool Frieden at the CDC.

Personally I think medical professionals returning from West Africa who've come in contact with ebola patients would happily submit to quarantine. You know, as a responsible, precautionary measure. Or maybe they're not the professionals they claim to be...

[C. S. P. Schofield]

The "no quarenteen" argument fills me with an overwhelming lack of confidence. Maybe it shouldn't, but it does. The argument needs to be made better, if it needs to be made at all.

[The Late P Brooks]

grandstanding by governors is not a sensible way to develop public health policy.

I hate to break it to you, Ron, but this isn't really about "health policy". Government exists to force you to do what you're told.

[Almanian!]

Hey! Don't tread breathe on me!

[DK]

Can't they be trusted to do the right thing and self-monitor when they get back?

Apparently not. I'm not for a quarantine, but they need to be monitored more closely and do more sensible things than ride on a subway. Let's say Dr. Asymptomatic eats a bad sandwich and pukes on the subway. No one will get Ebola, but they can't know that for sure and you certainly won't convince most people not to be worried. And, not for just 21 days. Since the virus is still sexually transmittable for up to 3 months, they will be worried about that.

It also should be standard policy to do the various experimental blood tests. This will help determine their efficacy. Other than making sure they are not using these blood samples for some other purpose, I don't see anything wrong with taking a blood sample.

[mr burns]

The whole purpose of the quarantine is to watch to see if people become symptomatic which can take up to 3 weeks. We don't quarantine the symptomatic we admit and treat them .

Anyone who wants to quarantine the symptomatic rather than treat them has no compassion and questionable ethics. Although if we manage to infect a large city by failing to quarantine the currently exceedingly small number of potential disease vectors we may well end up having to do this, like letting a forest fire burn out. But it should hardly be the initial approach .

So objection 1 is ludicrously stupid,and the others fare no better. For another example: quarantine accommodations can certainly be made more pleasant than life in rural western africa, and medical volunteers can be compensated for their time in quarantine.

[Cytotoxic]

Quarantine is far too difficult to reinforce.

[John]

Except that we do it all of the time and successfully in cases of TB and MERS. That is just not true. It is a lie you are telling yourself because you have become one of those people who thinks your politics and ideology actually dictates reality. Sorry but reality and nature don't give a shit about your politics.

[Cytotoxic]

My politics is based on reality. (It's really rich when the Christian conservative starts getting all 'Reality is real' on you).

TB is endemic, even in first world countries. You probably know someone who's infected. 1/3 of the world is. Good news is 90% of the infected are in the asymptomatic, latent phase that is non-contagious. This latent phase is dependent on a strong host immune response, which is dependent on host health. The biggest reason TB doesn't spread in the first world is that we are generally in good health. Quarantine wouldn't have a hope of working otherwise.

Not against quarantine per se but there is nothing wrt Ebola that justifies it in North America.

[John]

You are just pig ignorant on this. We have no fly lists for people who have MERs and contagious drug resistant TB. And we enforce those with great effectiveness. And when we don't and the person manages to fly into the country, the state quarantines them until they are no longer contagious.

You are just profoundly ignorant about how public health law actually works. And worse, you don't want to learn because learning would require you tempering your politics. And for people like you, politics is everything.

[DarkHelmet]

How about:
1) it is highly contagious
2) it has a 50%ish fatality rate
3) there is currently no cure
4) there is currently no vaccine

[JewPenis]

It is not highly contagious. Unless you normally play with the blood and feces of the sick.

When will you dummies wake up to the fact that so far, NO American victims of Ebola have died during this current outbreak.

In terms of Americans, there is not a 50% fatality rate. There is a 0% fatality rate. There is a 100% recovery rate.

4 cases...no deaths.

This is 'Reason' magazine, not 'Hysteria' magazine, so stop complaining about the writers here looking at the science, you imbeciles!

[mr burns]

reinforce ??? just use more rebar . But I think you meant enforce. The idea that we are unable to quarantine potentially infected individuals for 3 weeks is ridiculous . We manage to imprison very dangerous people for their entire lives.

[mr burns]

The Obama administration doesn't want any form of border to control to be perceived positively so quarantine , although obviously beneficial, must be rejected . Some schools of rabid libertarianism are also ideologically committed to open borders, although immigrants will number in the millions so long as some states offer welfare benefits exceeding the benefits with which we reimburse our serving military. Perhaps shared open borders idealogy trumps reason.

[kbolino]

It is true that "open" borders in a welfare state is a recipe for inevitable economic disaster. The "easy" solution of "securing" the borders, however, just prolongs the inevitable. The welfare state is unsustainable; while border security reduces the pressure on the expense side of the equation, it also increases pressure on the revenue side. Since in a welfare state, the former tends to grow and the latter tends to shrink anyway, ultimately the end state is economic collapse, secure borders or no.

As regards the handling of infectious disease, in basically every case the incompetence of this government is to blame for the abysmal handling of it. If you are going to steal from people and make promises to them, then you had damn well better do your best to fulfill them. If you can't, then it's time to close up shop and give back what you took. People can deal with things like quarantines and travel restrictions on their own, unless you're standing in their way.

[mr burns]

I strongly suspect that open borders leads to economic collapse much faster than border security does. Maybe economic collpase is necessary to excise welfare . I hope we can manage it through political reform , but that will never happen if we add millions of welfare seeking immigrants.

[Cytotoxic]

If you disagree with what Bailey is saying at all you are dumb. You are dumb and you don't care. No, your feelings and half-assed 'skepticism' aren't a basis for argument. This has been an interesting litmus test on just how seriously H&R can be taken wrt science and it has not passed with flying colours.

[John]

No. It has been an interesting litmus test of who lets their politics determine their view of reality. You and Bailey talk yourself into believing nonsense things like "quarantines never work" because believing that they do violates your politics. Meanwhile, most of the rest of the board, even though they are generally loath to support government action, does so here because they understand sometimes reality doesn't fit your politics. Basically, you and Bailey would believe anything as long as it fits your politics.

[Cytotoxic]

Most of this board is apparently in favour of "doing something! (TM)" based on their feelings. You keep shouting BUT REALITY which is hilarious because every single piece of epidemiological data is on my and Bailey's side. It's hilarious the less evidence you have the harder you shout "BUT REALITY".

[John]

Most of this board is apparently in favour of "doing something! (TM)" based on their feelings.

No. That is what you have told yourself because to believe otherwise requires you questioning your politics. This is not based on feelings at all. It is based on the fact that the less contact someone exposed to Ebola has with other people, the less likely it is to spread. It is really that simple. Feelings have nothing to do with it.

The people acting on "feelings" here are the people objecting to this because they worry it will unfairly stigmatize Africans or make health workers feel bad.

[PapayaSF]

Sure, the Top Men know everything there is to know about this strain of Ebola, and about all the possible mutations. That's why no doctors, nurses, and scientists have gotten infected, right?

[DarkHelmet]

BAM!

But does he know he's been hit?

[Mike M.]

Hey folks, did you see the story that U.S. military personnel serving in Liberia are being quarantined in Italy for 21 days upon leaving the country? It's not optional, either, and it includes officers as well as enlisted personnel!

The Shitheel-in-Chief and his underlings aren't calling it "quarantine" though, they're calling it "isolation". Never mind that almost everyone with a high school education understands that quarantine MEANS isolation.

Funny how quarantine magically works for our troops, but for some reason is unacceptable for the civilian medical volunteers? Why in the world would that be?

[PapayaSF]

Because the government is lying to calm the rubes.

[Mike M.]

I know. And I just can't wait to see what kind of talking points the Regime and all its minions are going to concoct to try and explain this one away.

[JWatts]

Well is Ronald Bailey going to write a follow up post on the unscientific behavior of the US military?

[PapayaSF]

I think I like Mickey Kaus' idea of the government renting some nice resort and turning it into a luxury quarantine facility.

[jmomls]

Excellent idea. Invade Cuba, return it to the mob, open up a sanitorium.

Profit.

[PapayaSF]

Also note: It is known that the 21-day thing only covers 95% of Ebola infections, so there is some talk that a 42-day quarantine would be better.

[jmomls]

*Those who go are heroes who face hell on earth. Can't they be trusted to do the right thing and self-monitor when they get back?*

Obviously...THEY CAN'T!

And please, I don't want to hear anyone whining about being quarantined for a few measely weeks. Jesus H. Chrysler on a Dodge Dart, Anne Frank lived in a f*cking attic for YEARS.

You know, what? Screw it. Let this plague loose in America. The herd needs to be thinned.

[ImanAzol]

I'm with you. Watching a few million lefticles shit themselves to death would be a great object lesson for all rest of the tards.

[DarkHelmet]

We've got nurses flying to Cleveland and doctors going bowling in NYC. Yeah, we can trust them to self-monitor. No problem. Just like we could trust patient zero to tell the truth on his entrance screening form.

[Laird]

Not one of these alleged "reasons" is absolutely true, or even reasonably accurate without a large helping of qualifiers. Overall, a totally stupid article. Reason really seems to have its head up its collective rectum on this whole Ebola issue.

[Bruce Hall]

There are legal issues which must be addressed. Should a person be detained when there is no obvious risk to themselves or others... just the possibility of contracting a lethal disease? Presently, there are no laws that require such action which is in violation of due process. There certainly are ethical concerns, but not legal ones.

Apply the same thinking to gun control. You have a constitutional right to own guns even though they could be misused and kill someone. Of course, such misuse subjects the abuser to serious punishment. Should gun owners be "quarantined"... subject to onerous control measures in obtaining guns, because they could misuse their guns?

Now, if a person has been in an Ebola-infected area and has symptoms "consistent with" Ebola... and disregards the risk to others thereby spreading the disease..., that person should be subject to criminal punishment (presuming that they survive) for not taking measures to prevent spreading a disease with a high death rate. That may be a moot point if they die and those they infect die, but until the law addresses the risks, it is their right to avoid quarantine when asymptomatic.

[ImanAzol]

Guns don't jump from person to person, nor cause any health issues.

Your argument is shit.

[retiredfire]

I believe there ARE laws that allow involuntary confinement if one is a public health risk.
The question might come down to how many say these people are a risk and how many say they aren't.
The biggest problem is that most of the people, who can make such an assessment, are protected from liability and, while that may free then from making a difficult decision, it also frees them to make a political one.

[AD-RtR/OS!]

You quarantine them if they have been in an Ebola area within the last x-wks and keep them there until the incubation period has ended - that's the way you ensure that they don't become symptomatic while running about, like that NY doctor.
As was said for years:

Better Safe, than Sorry.
...and...
An ounce of prevention is worth more than a pound of cure.

[AD-RtR/OS!]

...and, for you zealous Libertarians:
A virus such as Ebola has no respect for the end of your nose.

[retiredfire]

1. Quarantining people without symptoms makes no scientific sense.
They are not infectious. The only way to get Ebola is to have someone vomit on you, bleed on you, share spit with you, have sex with you or get fecal matter on you when they have a high viral load. ...
Did either of the nurses that contracted the disease state that any of these things happened to them, or was it just "well, it must have, somehow".
How many are willing to bet their LIFE on it?
2. Quarantine is next to impossible to enforce.
If you don't want to stay in your home or wherever you are supposed to stay for three weeks, then what? Do we shoot you, Taser you, drag you back into your house in a protective suit, or what?
That is voluntary quarantine, like what Dr, Nancy was under until she broke it and it became mandatory - they seem to be able to enforce that.

[retiredfire]

5. Health care workers who take care of those who really do have Ebola at big hospitals, such as Bellevue or Emory, are at the greatest risk.
If you quarantine them you are taking your best professionals offline for three weeks ? and there are not a lot of replacements.
Yeah, that is a good argument, let those most at risk to spread it do so, because they are hard to replace. Does it occur to the author that they would share the space with others exposed but non-symptomatic, until the cases at that hospital and the non-symptomatic are cleared. If it is that rare and won't multiply its effect, that shouldn't be for that long.
The last item has been addressed adequately by the concept that anyone who would expose themselves to the deadly virus shouldn't balk because they would face a mandatory three week quarantine.
The only argument that has made any sense is the one about the one about the quarantined losing out on their earnings, while in isolation. That could be dealt with through a government stipend. For heavens sake, it isn't that many people and the government wastes that much money before breakfast, every day.

[Duelles]

Could you explain why so many healthcare workers in Africa wearing hazmat wear got infected. . . .and did not 1/2 of them die? Were their precautions not good enough? It may be to primitive for us to fully comprehend. News has been confusing.

[DarkHelmet]

Bingo. And African healthcare workers actually take this stuff seriously. They know more about it than some desk jockey working emergency admitting in an urban U.S. hospital.

[wagnert in atlanta]

Let's just fisk the arguments.

0) New York University bioethicist Arthur Caplan offers a nice summary of seven reasons why this policy is stupid.

Arthur L. Caplan, Ph.D.Bioethicist. Born in Boston, Caplan did his undergraduate work at Brandeis University where he majored in philosophy. He did his graduate work at Columbia University, where he received a Ph.D. in the history and philosophy of science.

So, not an MD. Nor a epidemiologist, virologist, Master of Public Health, or specialist in tropical medicine. The question of isolation of possible Ebola carriers is only peripherally a question of medical ethics. He's no more qualified to speak on this subject than NYU President John Sexton (a lawyer) is.

1) Quarantining people without symptoms makes no scientific sense.

So you say -- and so say many others. On what authority? Ebola seems to be spreading like wildfire in West Africa -- killing both African and European health workers who have strong incentives to stay well, so they can serve more sufferers and so they don't die. Isn't it possible that Ebola is infectious before the victims are symptomatic -- at least occasionally? And what constitutes being symptomatic? Can we really draw a line and say a temperature of 100.3 is asymptomatic and 100.4 is symptomatic?

[wagnert in atlanta]

2) Quarantine is next to impossible to enforce.

Oddly, nurse Kaci Hickox, the only person put into quarantine so far, would disagree with you. Not only does she find it effective, she thinks it's a violation of her civil rights. Then there's Dr. Nancy Snyderman of NBC, an actual doctor put into "voluntary" quarantine, which she promptly broke when she got hungry for soup from her favorite NJ eatery. Suppose that's why Chris Christie made quarantine involuntary?

Something happened to 3 and 4

5) Health care workers who take care of those who really do have Ebola at big hospitals, such as Bellevue or Emory, are at the greatest risk.

And at Texas Presbyterian, where two nurses got sick with Ebola after being exposed to Thomas Eric Duncan, Liberian Ebola sufferer. They were out in the community when they developed symptoms -- and one took two airline flights, one when she felt sick. Between inconveniencing your ER staff and endangering the public at large, which is the proper thing to do?

6) Who will volunteer to go to West Africa to stamp out the epidemic, if they know they face three weeks of confinement upon their return?

People who know why it's a good idea to isolate themselves for the incubation period of a deadly disease after being exposed to it. That was easy. Ask me another.

There's no #7, either.

[DarkHelmet]

Two months ago I was ready to partition the country into two groups: those who actually want the government to take half their paychecks and those who prefer to have first claim on their own income.

Now I see another subdivision is necessary; those who take deadly infectious diseases seriously and those who don't.

[REMant]

1. Ebola could very easily get out-of-hand
2. Medical-types (and science writers) usually think they are supermen
3. A quarantine hurts no one
4. There's no reason for workers to be running back-and-forth to West Africa anyway
5. The whole opposition to quarantine is so that a part-African president won't have to appear to be shunning black ppl just before an important election

[Tamfang]

Letting medical workers monitor their own health would be like letting airline pilots carry weapons.

[JWatts]

I'm going to choose a different variation on your sentence. And we'll let the readers decide which version makes more sense.

"Letting medical workers monitor their own health has absolutely no connection to letting airline pilots carry weapons.

[akulkis]

Ronald Bailey, are you f****** insane?

This is one of the very FEW legitimate purposes of government...

[Kevin Bjonrson]

What ways would be effective, if not quarantine?

1. stop the movement of people from west Africa into the US.
If health care workers want to go there and change bedpans,
let them, but they shouldn't be allowed back in until they
have been tested and found free of the virus. They should
stay in a virus-free area until the rest results come in.
Which probably means, a European country (since there are
few direct flight west-AfricaUS).

2. remove FDA restrictions that hinder the use of alternative
methods like ozone; and improve doctor education. Conventional
method offers little hope so there is no point in sending over
conventionally-trained doctors to epidemic areas. We don't have
the money for that and most doctors are clueless on alternative
medicine.