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A Rebel Breaking Out of Prison

By       Message Leslie Horvitz       (Page 1 of 1 pages)     Permalink    (# of views)   No comments

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From Ebola training response.
Ebola training response.
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was having lunch with a friend yesterday when our conversation inevitably turned to the subject of Ebola. My friend is smart, well-read and successful. "Yes, I know all the arguments," he said, referring to the risk that enforced quarantines of health workers returning from West Africa could discourage other doctors and nurses from volunteering to work in the Ebola-affected region. He was skeptical about self-monitoring. "What happens if they get sick and infect other people before they get to the hospital? How can we be sure that everyone who comes back from Liberia is going to be responsible enough?" I could point out that so far no one who was in close contact with the four people who've fallen ill with Ebola in the U.S. has contracted the disease. I could have said that Ebola isn't very infectious when the first symptoms appear and that it's only in the later stages of the disease that it becomes dangerous. But he wouldn't have been persuaded. As far as he's concerned, being quarantined is little to ask of health workers and others who might have been exposed to Ebola.

His view certainly enjoys widespread support. Even U.S. soldiers will be isolated on their bases for 21 days -- the incubation period -- after they return from West Africa where they've been constructing hospital facilities. But because Ebola is so communicable and has such a high mortality rate -- 60-90 percent -- and because it is so exotic it has precipitated a panicky reaction out of all proportion to the number of individuals who've actually fallen ill with the disease.

Does a quarantine do more harm than good? Or maybe the question should be: What kind of quarantine does the most good? Should it be coercive or voluntary?

States have broad authority to impose quarantines although in the past they've usually been narrowly targeted. In the 1990's, for instance, New York City adopted a tuberculosis control program that called for the detention and mandatory treatment of people with TB who failed to take their medication. In recent days, governors of several states including New York, New Jersey, Connecticut, Maine, Georgia, Louisiana and California have imposed strong measures on people who might have been exposed, whether or not they test positive for Ebola. Abroad, the response from governments has been even more draconian: Canada and Australia, both led by conservative governments, have barred the entry of all citizens of Liberia, Sierra Leone and Guinea.

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People felt as if they'd been sentenced "for an unknown crime, to an indeterminate period of punishment," Albert Camus wrote in his novel "The Plague." The novel is set in Oran, Algeria in the 1940's, and he was describing the Bubonic plague, but his observations could be equally applicable to Dallas or New York or Los Angeles today: "And while a good many people adapted themselves to confinement and carried on their humdrum lives as before, there were others who rebelled and whose one idea now was to break loose from the prison-house."

In the case of Ebola, the rebel breaking out of the prison-house is a 33-year-old nurse named Kaci Hickox who managed to turn a morning bike ride with her boyfriend into an act of defiance. By now, most Americans are probably aware that Hickox, a volunteer for Doctors without Borders (Medicines sans Frontiers) in Sierra Leone, was the first person to be quarantined under a hastily improvised New Jersey law; she was detained at Newark's Liberty Airport on Oct. 24 even though she exhibited no symptoms of Ebola. She was held over the weekend in a tent at the airport (with a Port-o-San but without a shower) before being allowed to fly back to her home in northern Maine. There she was supposed to monitor her condition and take her temperature twice a day -- and not leave the house until the incubation period was over. She had no intention of following orders. "I truly believe this policy is not scientifically nor constitutionally just, and so I am not going to sit around and be bullied around by politicians and be forced to stay in my home when I am not a risk to the American public," she said in an interview, pointing out that there was no legal restrictions in force to keep her confined. She declared that she was ready to go to court "to fight for my freedom." Her position is backed by the Centers of Disease Control and Prevention, Doctors without Borders, and the American Nursing Association. But political leaders -- and their constituents -- remain skeptical. "This nurse is making a good case, but if anybody in Maine or anyplace else catches Ebola, they'll say, 'Why didn't the governor do more?'" said Maurice Carroll, the director of the polling institute at Quinnipiac University in Connecticut. In her state Gov. Daniel Malloy has confined at least eight people to their homes under mandatory quarantine policies.

Hickox seems to relish the role of provocateur and Maine's governor Paul LePage -- no stranger to provocation -- has responded in kind. "While we certainly respect the rights of one individual," he said, "we must be vigilant in protecting 1.3 million Mainers, as well as anyone who visits our great state." On Oct. 31, he obtained a temporary court order restricting Hickox's movements but in hours the judge issued a new order, saying that because she wasn't infectious "the State has not met its burden at this time to prove by clear and convincing evidence that limiting [Hickox's] movements to the degree requested" is necessary. So the score stands at Hickox 1 and LePage 0. But the dilemma -- the delicate balancing act between public health and personal liberty -- is still far from resolved.

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Ebola isn't only an incredibly infectious disease. It's also a terribly inconvenient one for a couple of reasons. First, it's impossible to diagnose whether someone is infected until the symptoms appear and even the early symptoms -- like fever -- can be mistaken for symptoms of other illnesses. As of now, no test of any kind can distinguish an infected but asymptomatic individual from someone who is free from the disease. More pertinently, Ebola has struck just before the midterm elections so it has become as politicized as gun rights, abortion and voting laws. (Perhaps the best comparison is HIV/AIDS in the early 1980s.) Republicans like LePage, who is up for reelection, and New Jersey Governor Chris Christie are demanding stricter quarantine laws even as some Democrats like New York Mayor Bill DeBlasio counter that self-monitoring and voluntary quarantines are far more effective. (By the end of October, nearly 180 people were being monitored in New York City.)

President Obama cautioned against hysteria. "When I hear people talking about American leadership, and then are promoting policies that would avoid leadership and have us running in the opposite direction and hiding under the covers, it makes me a little frustrated." Obama said. But then pretty much everything makes Obama a little frustrated these days, especially when critics see his response to the Ebola crisis as being too little too late. Nor has the CDC inspired much confidence in the public when it initially issued conflicting instructions regarding proper protocol for the treatment of Ebola patients.

Ebola has provoked irrational -- and harmful -- reaction (and overreaction) often based on ignorance and fear. Elementary schools bar children from class because they've been in countries in Africa with no recorded cases of Ebola. Recently, Louisiana's Governor Bobby Jindal warned that any doctor attending a meeting of the American Society of Tropical Medicine and Hygiene in New Orleans who treated Ebola patients will be shut up in their hotel rooms. Understandably, several doctors have cancelled. But ordinary Americans shouldn't be faulted as much as their political leaders who are quick to play their fears and panic to win reelection or to boost their popularity.

"At the beginning of a pestilence and when it ends, there's always a propensity for rhetoric," Camus wrote. It would be gratifying to think that Americans could get beyond the rhetoric. It would be nice, but I doubt that it's going to happen any time soon.


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Leslie Alan Horvitz is a NY Times Best Selling Author of over thirty novels including his latest medical thriller entitled, SYNBIO. Horvitz has been writing non fiction and fiction including The Donors, Double Blinded, The Dying and Causes (more...)

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