Friday, October 31, 2014

Ebola, the President, and Quarantines: Who will protect Americans, and how?

Ebola nurse Kaci Hickox
Today we saw an ebola nurse defy the order of the Governor of her state to remain in quarantine, after she returned from ebola-stricken Africa.

Kaci Hickox took to the streets to indicate her opposition, by riding her bicycle.

And Governor Paul LePage of Maine was not amused:

Kaci Hickox took her campaign against an Ebola quarantine out for a spin on Thursday. The Maine nurse, openly defying an order to stay home after she treated patients in West Africa, sped off on a bike ride on a sunny morning with her boyfriend, Ted Wilbur. She returned after about an hour.
“I hope that we can continue negotiations and work this out amicably,” Hickox told reporters. “There is no legal action against me, so I’m free to go on a bike ride in my hometown.”

Authorities in Maine are pursuing a court order to enforce the quarantine through Nov. 10. Hickox says she is completely healthy and free of symptoms, and that the quarantine is unnecessary and unconstitutional.

Several hours after the bike outing, Gov. Paul LePage said that efforts to negotiate with Hickox had failed. Citing confidentiality laws, he did not specify his next steps. But his office pledged in a statement: “The governor will exercise the full extent of his authority allowable by law.”In an interview with NBC affiliate WSCH, LePage suggested it was all right for Hickox to leave home, as long as she doesn’t touch anyone or go into a public establishment. He said a police cruiser outside the home was there for Hickox’s protection. “Her behavior is really riling a lot of people up,” he said. He said he hoped for legal clarification later in the day on enforcing restrictions on her movement. The governor said he was looking out for the 1.3 million people of Maine.
“I don’t want her within three feet of anyone,” he said.

Kaci Hickox’s stance throws into high relief a topic that right now concerns not only the President, but the Governors and Legislatures of several States. There is no vaccine for ebola, and the lethal disease (it has a very high mortality rate for those infected) has caused thousands of deaths in several countries of Africa.

The quarantine order has today been rejected by a judge.

Problems now facing President Obama and the USA:
The Administration’s handling of the ebola crisis inside the country has been inept, to say the least. Slow to react, the President was faced with confusion, fear, slow responses by the Center for Disease Control, and increasing hysteria in the media.

Finally, he appointed his very own Ebola Czar, with the mandate to coordinate the Administration’s response to the crisis.

But the process to date within America’s borders leaves unanswered a number of very important questions regarding the preparedness of the only superpower to handle similar crises in the future.

The problems are how to contain an infector pool, how to respond quickly to a new, lethal and highly infectious disease that appears within the country, what to do with infected persons, how to seek a cure in a rapid way, and who is in charge. None of the responses to date gives much assurance that America is ready to cope with a serious outbreak of a lethal, highly infectious disease appearing within its own borders.

Nor, for that matter, can citizens of any other developed state (such as the UK, Germany, France, Canada, and others) be assured that their levels of government are ready to cope with such an onslaught, and to protect their societies.

I have dealt with such problems in a post today to my author blog, which describes how a similar threat was dealt with in my novel, Silent Lips. The questions are not easily answered, and success is not assured.

Problem: How to contain the Infector Pool

The countries in Africa grappling with this deadly scourge have been unable to date to solve this problem. Because ebola is spread by contact with an infected person during the infection period, it is very easy for those tending the sick to fall victim. So far, ebola has not been spread through the air, but only by bodily contact with fluids of the sick persons.

Preventing such contact is the primary goal of all efforts to prevent ebola spreading. This means putting infected people into containment structures that limit their contact with others, and making sure that all medical and other personnel wear appropriate biohazard clothing. Intense training in the removal of such clothing is also needed.

But what if there are not enough containment structures, and not enough protective clothing?

What then?

The simple answer is that ebola will spread, unless none of the sick are attended to.

Even if all helpers moved away from the sick, ebola will spread of infected people move into fresh populations.

This brings us back to the steps being taken by Governor LePage and by others, to require that any person who has – or might have – come into contact with a person infected with ebola, whether in Africa or in the US, be placed in physical quarantine for the incubation period of some 21 days.

Problem: Is Quarantine legal in the USA?

There is some doubt whether it is. Some Governors have said that they will insist on mandatory quarantine of persons at risk, regardless of legality, in order to protect the citizens of their states.

But what if ebola – or a similar, highly contagious and very lethal disease – should spread inside the USA? Would the US be prepared for this, on a massive scale? Would any developed country?

A US President might consider the spreading of such a highly contagious disease to be a national state of emergency, but even then there is some question whether compulsory quarantine of persons or of areas (or cities) would be legal. The Constitution provides for a national state of emergency declaration by the federal government in cases of unrest etc, but there is no mention of quarantine in case of a spread of disease (a pandemic). The CDC website locates the President’s power to quarantine in the commerce clause of the Constitution.

Can the US federal government or any state government quarantine a nurse or doctor who goes to Africa to aid ebola victims and returns without any sign of infection? The safest course would be to quarantine all such high-risk persons for the 21 day infection period, but can this be done legally? Nurse Hickox was supported in her fight by a court today, as mentioned above.

This issue needs to be resolved speedily and clearly, before any American can be assured that he or she is fully protected by the governing powers.

Problem: How quickly can America react to a disease threat?

The ebola reaction was slow, and many fumbled in actions they took. Some Governors have decided to take matters into their own hands, to protect their state’s inhabitants.
However, the quick reaction force – the CDC – did not step in fast enough. The speed of reaction to a possible threat (think how long the ebola crisis has been brewing in Africa, and how unprepared American authorities seem to be despite such early warning). How fast could they react if a new, more deadly, and faster spreading threat arose within the US?
And who would lead the charge? Where is the prepared, highly-trained, quick-response disease hit team? We have seen no signs of such a team, yet.

Problem: Does America have enough available resources for such a disease?

An MSNBC report said that there were less than a dozen high-security, maximum-protection containment units/beds available in the country.

Even a slight hiccup could have caused all such containment units to be filled.

Ebola container
So the question is: how many biohazard containment units are required to cope with a wide threat of a highly contagious disease appearing within America, and who will be trained to run them?

Where should they be located?
Problem: What protocols should apply to the search for a cure?
If such a highly contagious and lethal disease that suddenly starts spreading inside the US, would normal strict protocols governing the development of a potential vaccine or potential cure be appropriate?

Should not a quicker, more relaxed process be available in cases of high emergency?

The debate needs to start on this aspect asap.

Enough thoughts for a rainy Friday afternoon.

1 comment :

  1. “It is not too hard to imagine forced quarantines and people being rounded up and shipped off to Ebola detention facilities.

    In fact, if Ebola were to start spreading like wildfire in this country, many people would actually start demanding such measures.” From:


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