Expand CDC Precautions Based Upon Evidence-Based Science: Quarantine, Not a Ban

All major public health organizations, including the International Red Cross, challenge the scientific merits of a travel ban on African nationals traveling from Ebola-affected countries. It doesn't take a leap to appreciate the political and possibly even xenophobic implications of calling for such a ban shortly before hotly contested midterm races.

The time for politicization must end. We have very little time to avert the predicted 1.4-million-new-cases-by-January scenario, with its attendant risks in an interconnected world, unless we get serious and integrate evidence-based strategies now.

We need to prevent the spread of disease regardless of the country of origin of potentially infected individuals coming and/or returning to our country.

Instead of a travel ban, and in addition to the voluntary home monitoring recently recommended by the CDC, we must require that all travelers from countries experiencing an Ebola epidemic, including U.S. citizens returning to the States, isolate in place at home for 21 days and immediately report any Ebola-like symptoms. And if an individual who is not a U.S. citizen doesn't have a site in which to isolate once in the U.S., serious consideration should be given to denying that person entry to the U.S. in the first place.

Why should the CDC take this additional step of imposing a 21-day isolation period upon return for U.S. citizens, many of whom are health workers? We know that symptoms, and therefore contagiousness, may not occur immediately upon return to the U.S., and that upon experiencing symptoms, one might find herself, say, in a bowling alley, at a hospital emergency department, in the subway, or in a Manhattan restaurant, thus potentially exposing scores of additional passersby. Such casual-contact contagion requires complex contact tracing by our already overburdened public-health infrastructure. Our public-health epidemiologists and contact-tracing nurses are busy every autumn and winter with the seasonal flu and are already, this year, dealing with a variety of other sundry diseases, including measles and whooping cough, both of which have reemerged in our country because of reduced vaccination rates for diseases where vaccinations actually do exist.

Some may wonder why returning U.S. health workers, in particular, should be isolated when we need them working in U.S. health systems. It's precisely because of their day-to-day interactions with the sick and elderly; the uninsured and underinsured, who often delay treatment when symptoms emerge; and the immunocompromised (those with cancer, for example). Such interactions put returning health workers in a position to inadvertently spread this deadly disease here at home.

We applaud these health workers (and their health systems for sponsoring them) who take on the enormous personal health risk and interrupt their daily lives to take the fight to Africa. This is not to penalize these public-health heroes but to acknowledge that we are learning in place with this epidemic and need to protect all the patients with whom these aid workers come into contact.

Such a response would not rely upon the color of a returnee's passport to predict the likelihood of spread but upon the evidence that already exists about when this disease is contagious.