Ebola Panic Control

A nurse's successful quarantine challenge is a victory for reason and due process.

After a judge rejected Maine's attempt to quarantine Kaci Hickox, the state's attorney general said she was "very pleased," while the state's governor called the decision "unfortunate." The difference between these two reactions is the difference between a rational, scientifically informed response to Ebola and a demagogic response that sacrifices liberty to a popular panic.

Last week Charles LaVerdiere, chief judge of the Maine District Courts, ruled that any potential threat posed by Hickox, a nurse who returned to the U.S. on October 24 after treating Ebola patients in Sierra Leone, could be adequately addressed by "direct active monitoring" aimed at detecting the onset of symptoms should she become ill. Since Hickox "currently does not show any symptoms of Ebola and is therefore not infectious," LaVerdiere said, forcibly isolating her at her home in Fort Kent would not be justified.

To obtain the court order it sought, the state had to present "clear and convincing evidence" that Hickox posed a "public health threat" and that a 21-day quarantine was "the least restrictive measure" to deal with it. LaVerdiere concluded that "the State has not met its burden at this time to prove by clear and convincing evidence that limiting Respondent's movements to the degree requested is 'necessary to protect other individuals from the dangers of infection.'"

Maine Attorney General Janet Mills welcomed the ruling. "The judge recognized the 'misconceptions, misinformation, bad science and bad information being spread from shore to shore…with respect to Ebola,'" Mills said. "I believe we must do everything in our power not to fan the flames of fear but to encourage public health professionals such as Kaci Hickox to continue their brave humanitarian work."

Maine Gov. Paul LePage, by contrast, had some hot air ready to fan those flames of fear. "We don't know what we don't know about Ebola," LePage said while campaigning for re-election last Friday. "I don't trust [Hickox]. And I don't trust that we know enough about this disease to be so callous."

Yet as LaVerdiere pointed out, the state's own testimony showed the quarantine demanded by LePage was unnecessary. In an affidavit, Sheila Pinette, director of Maine's Center for Disease Control and Prevention, observed that "Ebola Virus Disease is spread through direct contact with the blood, sweat, vomit, feces and other body fluids of a symptomatic person." She added that "individuals infected with Ebola Virus Disease who are not showing symptoms are not yet infectious."

In other words, as The New England Journal of Medicine explains, "an asymptomatic health care worker returning from treating patients with Ebola, even if he or she were infected, would not be contagious." The journal also notes that "fever precedes the contagious stage." Contrary to what LePage seemed to imagine, someone with a normal temperature who has tested negative for the virus will not suddenly start vomiting on fellow shoppers during a trip to the grocery store, setting off an epidemic.

Hickox, mindful of her neighbors' discomfort, nevertheless says she does not plan to go into town until after the incubation period ends on November 10, three weeks after she finished her work in Sierra Leone. If so, why did she bother challenging LePage's attempted quarantine?

"Sometimes we fight for our rights," Hickox told the Portland Press Herald, "but it doesn't mean we have to act on them." By showing that the routine quarantine of health care workers returning from West Africa does not satisfy the constitutional test typically applied in such cases, Hickox's case may help promote a more levelheaded approach in other states.

Like Hickox, The New England Journal of Medicine warns that the "unfair and unwise" quarantine policies adopted by states such as New York, New Jersey, and Connecticut will "impede essential efforts to stop these awful outbreaks of Ebola disease" by deterring medical professionals from volunteering for work that is "stemming the epidemic at its source." Magnifying the Ebola threat in our imaginations could magnify it in real life.

© Copyright 2014 by Creators Syndicate Inc.

Comments

[invisible furry hand]

the difference between a rational, scientifically informed response to Ebola and a demagogic response that sacrifices liberty to a popular panic

We all know which one is more fun

[Anon E. Mouse]

To be honest, I hope this bitch dies of Ebola, and I hope she starts vomiting and shitting herself at a press conference, just to prove a point. Since June of 2014, over 400 health care workers have contracted Ebola, and at least 230 health care workers have died from Ebola. Every fucking one of them thought they knew what they were doing, and every fucking one of them was wrong.

[Steve G]

So to you this is about the hubris of her as a health care worker?
'cause I'd still support her fight against the gov if she was just someone who handed out meals or built hospitals or whatever. The issue at hand is the wisdom of telling someone who is asymptomatic for days/weeks to get quarantined. People seem awfully hung up on her being a smarty pants "bitch"

[Heroic Mulatto]

So to you this is about the hubris of her as a health care worker?
'cause I'd still support her fight against the gov if she was just someone who handed out meals or built hospitals or whatever.

Well, that's the thing. Some here consistently confuse their own form of anti-intellectual populism with some flavor of libertarianism.

[Cytotoxic]

THIS. I've had more than enough of half-assed yokeltarian 'skepticism'.

[JWW]

The real point here is that these people in the health field should have the good sense to keep to themselves for 21 days after returning from treating people with ebola. Government involvement shouldn't be necessary. But people like this woman just can't be bothered to keep to themselves.

My stance is that if they don't want to quarantine, fine, but if by not self quarantining they infect someone else with ebloa, then they should be charged with manslaughter.

[Steve G]

people like this woman just can't be bothered to keep to themselves

Huh? How to you reconcile this ^ with this:

Hickox, mindful of her neighbors' discomfort, nevertheless says she does not plan to go into town until after the incubation period ends on November 10, three weeks after she finished her work in Sierra Leone

[WTF]

So if she is really self-quarantining, what the hell is she bitching about?

[Zombie Apocalypse]

The point is that if she becomes symptomatic, she's already potentially infected countless people who will then also require quarantine. This isn't a "fight against the gov"; it's a fight against science, and stupid won. The effectiveness and necessity of quarantines for people who have potentially been exposed to a deadly, contagious disease with a 50% mortality rate isn't up for debate. You don't wait for a carrier to spread disease before you quarantine them. It doesn't work like that.

[Cytotoxic]

The point is that if she becomes symptomatic, she's already potentially infected countless people who will then also require quarantine.

No she won't RTFA.

[Zombie Apocalypse]

So you're an expert on Ebola now?

[Suthenboy]

That is pretty harsh man.

I don't think she is the issue. Quarantine = Arrest. Government agents or elected officials quarantining people at will is more than a little dangerous. So they quarantine her...then everyone she came into contact with...hell, why not whole towns?

Here is a good idea; section off the country and restrict people's movement to prevent Ebola from spreading. Ebola is a statists dream come true.

[Zombie Apocalypse]

"...hell, why not whole towns?"

That's the point of an individual quarantine; to keep you from having to isolate whole towns while the disease runs it's course. This isn't the flu. It will kill at least 70% of everyone who contracts it should it break isolation. That reality is sufficient to justify the temporary quarantine of any individual who has been exposed.

[Agile Cyborg]

Why the fuck should she die to prove your point? I slightly grasp some people fearing contagion but Ebola is a nothing disease in this country. A big, fucking, fat, dreaded zero.

[Anon E. Mouse]

"...Ebola is a nothing disease in this country. A big, fucking, fat, dreaded zero."

Only by shear luck. You people keep saying that "it could never happen here", but there's really nothing to base that claim on. Sure, we can handle one case, or five, or maybe even fifty, but there's a point at which the system collapses on itself. The objective is to not reach that point, and to do that, quarantines are the only viable solution.

It's a cost-benefit game. The potential costs are so fucking high that there is no benefit to allowing someone who has wallowed in Ebola to roam the streets at will. Don't want to be quarantined? Don't travel to places where Ebola is a factor. It's that simple. Want to save lives? That's cool, but be prepared to sit at home watching South Park reruns for 3 weeks when you get back. That's not asking too much.

[UCrawford]

Agreed.

[Cytotoxic]

Only by shear luck. You people keep saying that "it could never happen here", but there's really nothing to base that claim on.

Well aside from everything we know about the virus, sure, go ahead and shit your pants.

[Zombie Apocalypse]

What we don't know about this virus would fill just as many pages as what we do know.

[Zombie Apocalypse]

BTW Cytotoxic, you don't know what the fuck you are talking about. This virus has penetrated the highest levels of containment protocol on over 400 occasions. It is either MUCH more contagious than we're being lead to believe, or there are an awful lot of healthcare workers trained in isolation techniques, that aren't really trained that well at all. Either way, we are well and truly fucked if this shit breaks containment in a heavily populated area. Once it breaks out, there is no stopping it without some pretty fucking drastic measures. But you go right on thinking that TOP MEN...the same ones who said you can give it on a bus but can't get it, or that you have to eat the mucous or feces of an infected person to catch it, have your best interest in mind. Their objective is to prevent panic, NOT prevent the disease, and they have stated as much.

[Libertarian]

Every fucking one of them thought they knew what they were doing, and every fucking one of them was wrong.

And every one of them risked their lives in order to save others. The bastards.

[Anon E. Mouse]

Voluntarily risking your life does not grant one the moral authority to risk other people's lives.

[UCrawford]

Good. They can still sit in quarantine for three weeks so they're not a threat to others, then bask in your adulation afterwards.

You're following a losing tack if you're going to trot one of those liberal emotion-based arguments here.

[wwhorton]

To be honest, you're an idiot. How many of those health care workers died stateside? How many? What was that?

How 'bout this, pal? How 'bout you continue to have your little fever dreams because you've seen Outbreak recently but you DON'T use those fears to try and take away the liberty of others. Oh, and while you're at it, get cancer.

Toodles!

[Anon E. Mouse]

How 'bout this, pal? Fuck off. I've never seen "Outbreak", but I did do a few days at the Chemical Defense Training Facility at Ft Leonard Wood.

Where these health care workers died is irrelevant. What is relevant is that the vast majority of them were working in high-level containment units, and the standards for those units are universal, no matter where you are. What that tells anyone with half a fucking brain, is that either this shit is FAR more contagious than we're being lead to believe, or healthcare workers are being careless in the face of a deadly contagious disease, or both. Take your pick, because the reason it's killing healthcare is also irrelevant. The point is that even with the best facilities, and the best training, it's still killing people. That's pretty fucking important to note.

There are only four hospitals in the United States that have high-level containment units specially designed for treating exotic infectious diseases such as Ebola, according to the U.S. Centers for Disease Control and Prevention. Each has the capacity to treat only a handful of Ebola patients at once. Quarantines are the only fucking way to keep them from being overwhelmed, like it or not.

[RUExperienced]

There's no point being logical on this. Her right to be a bitch and make a point for the CDC clearly overrides any concerns others may have. Really, who cares that the virus apparently can penetrate unbroken skin?

[Fist of Etiquette]

We are so not going to survive the zombie apocalypse.

[JWW]

Thats why its called the zombie apocalypse. 😉

[Fist of Etiquette]

Then I vote to change the name. WHO'S WITH ME?

[Rich]

I am, IF it's "the apocalypse formerly known as 'the zombie apocalypse'".

[Zombie Apocalypse]

Probably not...

[Almanian!]

BEAT that dead horse! BEAT IT WITH A STICK!

Don't we have an election to argue about? Let's get on with it!

[Agile Cyborg]

The country just collectively self-mutilated and you find humor in this, you damn depraved Reasonoid?

[Almanian!]

Guilty

[Rich]

Almanian!'s humor is infectious.

[Agile Cyborg]

Staph with every laugh.

[DJF]

I thought that quarantine was the scientific approach to deadly infectious disease?

[Sam Haysom]

Exactly. In reality their differing positions come down entirely to which party they belong to. But really a Tea Party backed governor just won re-election in Maine of all places. He did this entirely by turning the election into a referendum on Hickox. Pure political brilliance. I'm sure LePage is just fine with Reason sqwaking.

[Zombie Apocalypse]

It is, unless it's a political inconvenience.

[Trigger Warning]

I'm glad she challenged the state and won; LePage was pretty blatantly overstepping his authority.

I believe good arguments can be (and have been) made about how her behavior is about not succumbing to panic, shoddy science, and fear-mongering, but if it were me I would be more cautious. She's not making the profession (and I mean specifically nursing) look very competent. We're supposed to be stewards not only of the profession, but of the public's health and trust. I don't think an overabundance of voluntary caution is unwarranted regarding Ebola. It shows people (who are potentially your patients) that you care enough about them to sacrifice a bit of your freedom and time, however remote the chance you've become infected.

So, glad she told LePage to get bent, disappointed in her as a professional.

[wwhorton]

What about her conduct has been less than responsible? I mean, talk about voluntary caution, she's imposing a quarantine ON HERSELF, VOLUNTARILY. Are people missing that part of the article or something?

[Trigger Warning]

I must have. Apologies.

[Anon E. Mouse]

What part of her bike ride through a phalanx of reporters and cops was consistent with a quarantine again?

[Sam Haysom]

Judge freedom warriors by their words not their actions.
Fighting for freedom is tough.

[stephenansarinnov]

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????? http://www.netjob70.com

[Bill H]

You apparently have read both the complaint and the court's opinion. Thus, you are aware that the state called for measures essentially in accord with the CDC's guidelines. Those guidelines call on public health officials to determine, on a case by case basis, whether asymptomatic individuals at some risk, like Hickox, should have restrictions imposed on their movement.
The judge restricted that request without evaluating the CDC guidelines. Instead, it implied that the evaluation simply ended with the fact that Hickox did not have symptoms. That's either not good science, or the CDC is engaged in bad science.
If, from the beginning, Hickox agreed not to go into town, then the state would not have sought to limit her movements, as demonstrated by the state's willingness to allow her in non-congregate public places so long as she stayed three feet from anyone (as per the CDC discretionary guidelines). She comes across as a showboat.

[Gindjurra]

Perhaps we should have the governor quarantined for 21 days...just to be on the safe side?

After all, we don't know what we don't know about Ebola, and for all we know, panic-mongering and believing bad science COULD be symptoms...

[Zombie Apocalypse]

Quarantines aren't "bad science", genius.

[Great+Grandma]

I completely disagree with the writer of this article wherein he applauds the nurse for fighting her quarantine. He is obviously very young and has never lived before inoculations to eradicate diseases like polio. I have lived through epidemics where people were smart enough to quarantine themselves as recommended by their doctor to protect others from polio. I was grateful to them.

I personally think this nurse is selfish and wrong and I am looking forward to a little shadenfruede if she is unfortunate enough to find she was terribly wrong.

[Matt787]

Even libertarians need to acknowledge that under certain circumstances intervention is warranted. Do the math- We inconvenience a few hundred people for 21 days because they were in close contact with the disease. Plus we have no reliable way to test for infection. Remember if you catch this thing your chances of living/dying are 50/50. Plus there are tremendous costs involved in treatment and we expose more health care workers to it.

This isn't gun control, warrantless searches, an armed raid on your house or mandating you can never marry who you want. 21 days in your house is not even in the same universe of the civil liberties violations we experience every day. You can control who or what you shoot at, but not who you transfer ebola to.

[Matt787]

We can't turn back the clock if we f!#@ this up!