Why Ebola Aid Workers Are Quarantining Themselves When Scientists Say They Don't Need To

Health workers of the International Federation of Red Cross (IFRC) and Medical charity Medecins Sans Frontieres (MSF) take part in a pre-deployment training for staff  heading to the Ebola area on October 29, 2014 at the IFRC headquarters in Geneva. West Africa is the epicentre of the Ebola outbreak which has claimed the lives of nearly 5,000 people. The often deadly virus is spread only through direct contact with the bodily fluids of an infected person showing symptoms such as fever or vomiting. AFP PHOTO / FABRICE COFFRINI        (Photo credit should read FABRICE COFFRINI/AFP/Getty Images)
Health workers of the International Federation of Red Cross (IFRC) and Medical charity Medecins Sans Frontieres (MSF) take part in a pre-deployment training for staff heading to the Ebola area on October 29, 2014 at the IFRC headquarters in Geneva. West Africa is the epicentre of the Ebola outbreak which has claimed the lives of nearly 5,000 people. The often deadly virus is spread only through direct contact with the bodily fluids of an infected person showing symptoms such as fever or vomiting. AFP PHOTO / FABRICE COFFRINI (Photo credit should read FABRICE COFFRINI/AFP/Getty Images)

Allen Mann is a missionary, not a doctor. Yet when he returned from a trip to the Liberian capital of Monrovia with the group Crossway International, some people in his small town of Payson, Arizona, treated his arrival with scorn and fear.

“One of our neighbors got a little paranoid, and started asking questions about Ebola on some radio show,” Mann said in a phone interview with The Huffington Post.
"I moved to Payson to avoid things like this. ... but now ebola may be on my doorstep," his neighbor wrote in an email to The Common Sense Show, a conservative radio broadcast. "I’m sure he and his family will be at the local grocery store and WalMart soon and this small town could be at risk."

After the story got picked up by local news outlets, Mann and his family found themselves sudden targets of ugly on-air and online criticisms, some escalating into threats.

“Some people commented in a lynch mob mentality, like, ‘Oh, we should torch his house’ and things like that,” said Mann. "Some people were just really angry at me for going and coming back, calling us all kinds of names like 'idiots' and 'irresponsible.' Some stuff worse than that, in language I’m not going to use.”

Mann wasn’t part of a health care team, and he made sure to refrain from physical contact with the pastors and community members he worked with in Monrovia: No shared food, no handshakes and no hugs. Yet out of caution and compassion, Mann had decided, even before his trip, that he would sequester himself in his house for 21 days after his return.

Now, Mann's self-quarantine is over, and he and his family are symptom-free. He said he has no ill will toward the people who criticized and threatened him, and is now on good terms with the neighbor who complained to the radio show.

Centers for Disease Control and Prevention guidelines would have categorized Mann as "low risk," and asked him to monitor his health, but not to restrict his travel or public activities. But Mann said it wasn't risk that made him decide to self-quarantine. It was perceived risk -- to community members and other outsiders -- that helped him decide to stay at home for 21 days.

"Mostly we just wanted to give our community peace of mind that we were not sick, not contagious and that we were not spreading it around," said Mann. He said his decision was rooted in "compassion to our home community," and that health workers returning to the U.S. from West Africa should show the same.

Some states are considering quarantine rules that exceed CDC guidelines for the same reasons Mann chose to isolate himself.

Nurse Kaci Hickox was the first to be targeted by a ramped-up state quarantine. After returning from a Doctors Without Borders mission helping treat Ebola patients in Sierra Leone, Hickox was quarantined for three days in a tent behind a New Jersey hospital and is now facing off with her home state of Maine over voluntary quarantine.

Hickox’s legal team said she would follow CDC daily monitoring guidelines, but blasted Maine's quarantine policies as unconstitutional and illegal.

Hickox, in news interviews, said she doesn’t plan to abide by Maine’s quarantine requests, especially since she has tested negative twice for the disease.

Non-profit medical corps like Doctors Without Borders and Save The Children are quick to denounce these mandatory restrictions, calling them anti-science because they don't conform to scientific facts about how Ebola is spread. They also say mandatory quarantines deter travel by people who can help stop Ebola at the source.

“We feel some of the current guidelines are an overreaction motivated by fear more than anything else,” said Sonia Khush, humanitarian director for Save The Children. “We’re very worried these will demotivate workers from going to West Africa, which is exactly where they’re needed now.”

According to Khush, no one in her organization had direct contact with Ebola patients, which is why no one has chosen to self-quarantine after returning to the U.S. Instead, they’re following CDC guidelines, like taking temperatures twice daily and monitoring for symptoms.

Doctors Without Borders said in a statement it strongly disagrees with "blanket forced quarantine for health care workers" and "respects Kaci’s right as a private citizen to challenge excessive restrictions being placed upon her.”

Elsewhere, state health departments seem to be handling things without incident. In Vermont, a doctor who may have had contact with Ebola patients has agreed to the state's request that he self-quarantine. After he traveled to Sierra Leone and Guinea to help those with Ebola, the state of Vermont asked him to comply with a 21-day self-quarantine to wait out the virus incubation period.

Tracy Dolan, acting commissioner of the Vermont Department of Health, said the doctor, whose name hasn't been released, was working in West Africa outside the umbrella of groups like Doctors Without Borders, so she couldn't be sure of his training and protection. She said it was possible that people working for aid groups would be asked to self-quarantine anyway once they return to Vermont.

"We’re going to take CDC guidance and then look at what we know about each individual,” said Dolan, who added "it’s a case by case basis.”

Other states are putting into place quarantine protocols after New York City doctor Craig Spencer became sick with Ebola after returning from Guinea. In addition to New York and New Jersey, which announced mandatory home quarantines, Virginia, Maryland, Florida, Georgia, Illinois and California have imposed some measure of enhanced airport security, monitoring measures or quarantine for health workers returning from an Ebola-affected country.

The CDC now routes all travelers from West Africa to one of five major international airports in the U.S., where they’re rigorously screened with temperature readings and questionnaires. The CDC also recommends that anyone returning from Ebola care in a West African country monitor themselves by taking a temperature twice daily and being vigilant for symptoms. States with precautions that go beyond the federal guidelines have drawn notice from civil liberties watchdogs.

"Forcing somebody to stay in a single place, even if its their own home, is an incursion on some of the most basic freedoms we have as human beings, which is to circulate in society, and move around in one’s town and country,” Jay Stanley, a senior policy analyst at the American Civil Liberties Union, told HuffPost.

“That being said, curbs on very basic freedoms are sometimes justified to fight disease, but that justification has to be real and it has to be medically necessary,” Stanley continued. “People would have the right to due process -- to challenge their confinement if they think the authorities are being unreasonable." Stanley said ACLU affiliates in all 50 states will be watching the enhanced security measures closely.

Yet public health authorities have a duty to protect public health, said University of Washington public health professor Peter Rabinowitz. Rabinowitz, an expert in diseases pass from animal to human, like Ebola, said “social distancing” is scientifically reasonable, considering how little is known about the rare virus.

“If people have had contact with Ebola patients, depending on the degree of the exposure, I think limiting your social contact when you come back is a reasonable thing to do,” Rabinowitz said.

From the very first day that Ebola was diagnosed in the U.S., CDC director Dr. Tom Frieden has insisted a person is not at risk of transmitting Ebola unless he or she is showing symptoms. Even then, an Ebola patient is most contagious toward the end of the disease cycle, when they're most likely to be in the health care system.

Family members who lived and slept in close quarters with Thomas Eric Duncan, the Liberian who was the first person diagnosed in the U.S. with Ebola, didn't contract the disease, for example. But Dallas nurses Nina Pham and Amber Joy Vinson did.

Ebola is highly infectious and even being in the same room as someone with the disease can put you at risk
Not as far as we know. Ebola isn't contagious until symptoms begin, and it spreads through direct contact with the bodily fluids of patients. It is not, from what we know of the science so far, an airborne virus. So contact with the patient's sweat, blood, vomit, feces or semen could cause infection, and the body remains infectious after death. Much of the spread in west Africa has been attributed to the initial distrust of medical staff, leaving many to be treated at home by loved ones, poorly equipped medics catching the disease from patients, and the traditional burial rites involving manually washing of the dead body. From what we know already, you can't catch it from the air, you can't catch it from food, you can't catch it from water.
You need to be worried if someone is sneezing or coughing hard
Apart from the fact that sneezing and coughing aren't generally thought to be symptoms of Ebola, the disease is not airborne, so unless someone coughed their phlegm directly into your mouth, you wouldn't catch the disease. Though medical staff will take every precaution to avoid coming into contact with the body of an infected person at all costs, with stringent hygiene there should be a way to contain the virus if it reaches the UK.
Cancelling all flights from west Africa would stop the spread of Ebola
This actually has pretty serious implications. British Airways suspended its four-times-weekly flights to Liberia and Sierra Leone until the end of March, the only direct flight to the region from the UK. In practice, anyone can just change planes somewhere else and get to Britain from Europe, north Africa, or the Middle East. And aid agencies say that flight cancellations are hampering efforts to get the disease under control, they rely on commercial flights to get to the infected regions. Liberia's information minister, Lewis Brown, told the Telegraph this week that BA was putting more people in danger. "We need as many airlines coming in to this region as possible, because the cost of bringing in supplies and aid workers is becoming prohibitive," he told the Telegraph. "There just aren't enough seats on the planes. I can understand BA's initial reaction back in August, but they must remember this is a global fight now, not just a west African one, and we can't just be shut out." Christopher Stokes, director of MSF in Brussels, agreed: “Airlines have shut down many flights and the unintended consequence has been to slow and hamper the relief effort, paradoxically increasing the risk of this epidemic spreading across countries in west Africa first, then potentially elsewhere. We have to stop Ebola at source and this means we have to be able to go there.”
Temperature screening at airports is an effective way to stop those who have the disease from travelling
The screening process is pretty porous, especially when individuals want to subvert it. Wake up on the morning of your flight, feel a bit hot, and you definitely don't want to be sent to an isolation booth for days and have to miss your flight. Take an ibuprofen and you can lower your temperature enough to get past the scanners. And if you suspect you have Ebola, you might be desperate to leave, seeing how much better the treatment success has been in western nations. And experts have warned that you cannot expect people to be honest about who they have had contact with. Thomas Eric Duncan, the Ebola victim who died in Texas, told officials he had not been in contact with anyone with the disease, but had in fact visited someone in the late stages of the virus, though he said he believed it was malaria. The extra screening that the US implemented since his death probably wouldn't have singled out Duncan when he arrived from hard-hit Liberia last month, because he had no symptoms while travelling.
Border staff should stop people coming in to the country who are at risk
LEON NEAL via Getty Images
They're not doctors, and it's a monumental task to train 23,500 people who work for the UK Border Agency how to correctly diagnose a complex disease, and spot it in the millions of people who come through British transport hubs. Public Health England has provided UK Border Force with advice on the assessment of an unwell patient on entry to UK, but they can't be expected to check everyone.
Screening at British airports should be implemented to stop unwell people coming in from affected areas
As mentioned before, the UK, especially London, is a major transport hub. Unlike the US, most of those coming from west Africa will have crossed through Europe, so infected people could be coming from practically anywhere, not just flights directly from those countries. This would require the UK to screen every returning traveller, as people could return to the UK from an affected country through any port of entry. This would be huge numbers of low risk people, at vast, vast expense.
Ebola doesn't have a cure
John Moore via Getty Images
There are several cures currently being tested for Ebola. They include the ZMapp vaccine which was administered to British sufferer William Pooley and two other Americans who caught the disease in west Africa and they all recovered. Supplies of the drug have now run dry, and it has not been through clinical trials to prove its effectiveness. Mapp Biopharmaceutical, the company that makes ZMapp, says the drug's supplies are exhausted and that it takes months to make even a small batch. But an Ebola cure is very much on the horizon, and would have come sooner had it been seen as any kind of priority for drug companies before it started reaching the western world.
Ebola is a death sentence
It is true that certain strains of Ebola have had a death rate of 90%. However, with this particular epidemic the stats are more positive, a death rate of around 60%. Those who have decent, strong immune systems, are able to access intravenous fluids and scrupulous health care are far more likely to survive, which is why the survival rate of westerners who contract the disease is far better. Experts have suggested that, rather than waste money on pointless airport screenings, funds could be used to improve infrastructure in the affected nations to help halt the spread of the disease at source.
Ebola turns you into a zombie
Renee Keith via Getty Images
Just, no.