Many published reports say that state quarantines are ineffective or otherwise contrary to the best available scientific advice. A look at that scientific advice shows that it is policy-driven, not scientific. Exhibit A: the editors of the New England Journal of Medicine say that quarantines such as those enacted by multiple states and enforced by New Jersey are “not scientifically based.” But their argument is mostly about a disagreement on policy, not a dispute about science.
Once the first case of Ebola infection was diagnosed in the US, it was inevitable that it would attract great attention. What was not inevitable is the federal government’s epic failure in risk communication.
A search for on Amazon.com yields 1,288 hits. Many of these volumes are applicable to today’s Ebola crisis. Just one of them — a slim volume on the office book shelf that was published in 1990 based on research and experience dating many years before that — provides a representative guide.
Federal officials could have avoided many of the problems they now face if they had consulted this easy-to-read 150-page book (or any one of a hundred others) and acted upon its advice.
Travel Restrictions to Reduce Ebola Risk in the US:
Part 5: How to maximize a quarantine’s effectiveness
Enforcement is crucial to a quarantine’s effectiveness. If a quarantine is unpleasant (as Kaci Hickox described hers), or it is managed by personnel who betray limited competence and disrespect for the burden imposed on the person sequestered, those who are the intended targets (i.e., true positives, those who are infected with the Ebola virus) will commit substantial resources to its avoidance. From a public health perspective, these resources are worse than wasted. They confer no public health benefit; they raise the incremental cost of detecting true positives; and they increase the likelihood that true positives will evade quarantine and infect others.
Can anything be done to avoid this?
The nurse quarantined in New Jersey is expected to be released — sort of.
Yesterday we explained why travel restrictions were part of a plausibly effective strategy to reduce the risk of Ebola infections in the US, notwithstanding well-publicized opposition from senior government officials including President Obama. Like every other public health intervention, their effectiveness would depend on how well they were designed and implemented. But they are a critical component of the successful strategy employed by Nigeria and Senegal, and they are equally critical to how US authorities actually respond once an Ebola case has been detected. Yet for some unexplained reason, US officials refuse to apply the same logic they use to manage infection to the prevention of infected travelers from entering the country.
Today’s news is that the first Ebola case has been confirmed in New York City. The case shows why travel restrictions would be much more effective at preventing the introduction of Ebola into the US than the airport-based screening strategy adopted by the US government, which in this case failed.