A debate is intensifying in the United States over quarantining healthcare workers who return from West Africa but do not show signs of Ebola. On Wednesday, Maine’s governor said that he would seek legal authority to enforce a 21-day home quarantine on Kaci Hickox, a nurse who has tested negative for Ebola after treating patients in Sierra Leone. Hickox made national headlines when she publicly criticized New Jersey Gov. Chris Christie for quarantining her in a tent outside the hospital. Hickox said she would challenge Maine’s restrictions just as she did in New Jersey. “I completely understand that the state’s purpose is to protect the state of Maine,” Hickox said last night. “I have worked in public health for many years, and that has always been my purpose, as well, but we have to make decisions on science, and I am completely healthy.”
Lawrence Gostin talking:
I really don’t think she should be there for 21 days. I, like her, believe—and I’ve spent my entire life defending the public’s health. And if I actually thought that she or any of the other health workers coming from the region were a risk to the public, I would support a quarantine. But the Supreme Court has said that if you confine somebody who has committed no crime, it’s, quote, “a massive deprivation of liberty.” It’s not a trivial thing. We have to make sure that we balance civil liberties with public health. In this case, all the public health experts are telling us that it’s unnecessary—the CDC, the World Health Organization. There’s no organization that I know of that believes it’s right to quarantine for three weeks somebody that really is, as President Obama said, is a hero. They’ve sacrificed. They’ve done things that most of us wouldn’t do. They’ve put themselves at risk, gone in a compassionate way. And I do think we need to treat them better than we are. This is self-defeating. We think that we’re actually decreasing our risk by quarantining her, but actually we’re increasing it, because if we impede people from going to the region, then the epidemic there will spin out of control, and that is where our risk lies.
We know from science and epidemiology that if a person is completely symptom-free, if they haven’t had any known exposure, with their skin or anything else, they have no temperature, and if the health department would proactively monitor them—I’m all in favor of that—then if they want to get in their car, or if they want to have a walk on the street, they’re endangering no one at all. And as I say, from a matter of law, the doctrine of quarantine requires that you have an individual assessment of significant risk. And it doesn’t exist here. The CDC itself does not put her in a category that would warrant quarantine. They have guided the states in that way. They’ve asked the states to behave in a way that comports with science. And unfortunately, we’re coming up to elections. Politicians are wanting to follow the polls. They’re basing their decisions on fear rather than science. And while sometimes that might be an OK thing to do, not if you’re depriving somebody of liberty, and not if you’re really making a situation in West Africa worse than it is.
in fact, unless they’ve actually issued a formal quarantine order under the state’s public health law, the police actually have no authority over her. She has committed no crime. There has been no assessment that she actually, from a scientific point of view, poses any risk to anyone. I don’t see that they’ve got any authority. Now, if they get a court order, they’re going to have to convince a judge that their decision is based upon rationality and science. And I don’t see how they can do that when the entire scientific community disagrees. And they’re just—they’re fanning the fear in the public. The public are wondering, “Why are we getting all these confusing messages?” The president’s saying one thing, the governor’s saying another thing, the WHO and CDC have their own position.
I was very proud of the United States for sending military troops into West Africa. I actually wish that the military troops could provide direct patient care. But President Obama ruled that out because he didn’t want them to be exposed to any risk—for political reasons. I can understand that. But now, when they’ve not had any patient contact—they may have had no exposure whatsoever—and then come back, and every single one of them will be quarantined 21 days, it defies rationality. Why would you want to do that?
The other thing is, is that we have people coming and going to West Africa all the time. We have U.N. diplomats, high-level American officials, high-level World Bank officials, that will be coming to and from New York City and other places. Do we intend to quarantine them all?
quarantine people with AIDS, thank goodness, but we did harass them, discriminate against them. Ryan White, a poor little young boy who had HIV infection, was embarrassed, kick out of school. These are not humane, compassionate ways of dealing with things. Unfortunately, you know, epidemics, particularly fearful ones, bring the worst out in society and civilization and humanity. But we need to find the better parts of ourselves and treat human beings with compassion, and only restrict them if it’s absolutely necessary for the public welfare. And in this case, it clearly is not.
I just had said that epidemics bring out the worst in us, but here’s a case of where epidemics can bring out the best in us, where it can bring us together, which shouldn’t be a Democrat-Republican issue. It shouldn’t be a Cuba-American issue. It’s a global issue for all of mankind and humankind.
What America needs to do is really ramp up the response in West Africa. We need to be training a reserve work core of experienced doctors and nurses, putting them into the region, supporting them, treating them with respect. And we need to be providing money. And more than anything, we need to mobilize the international community. At least the U.S. has troops there. There are a lot of countries that don’t. I’m really astounded at the delay and the lack of attention that’s been given to what is really one of the worst crises I’ve seen since the AIDS epidemic.
MSF, Médecins Sans Frontières, Doctors Without Borders, is really suffering now. They’re saying that because of this controversy over the quarantining of healthy people, that it means that they are getting less recruits, fewer doctors, nurses, health workers offering to go abroad.
we have to stop being so insular and just thinking about ourselves and our own—we have a few very isolated cases. In West Africa, they will have tens of thousands, maybe even hundreds of thousands, of people with Ebola. So we’ve got to put it in perspective. And we have to really all come together, as Americans and as an international community, and put our focus in West Africa. You know, if we don’t, and for some reason it jumps to another populous city like Delhi or Beijing, then we could have a global catastrophe, something that would really come back to haunt us. So, this is in our self-interest, but more than that, it’s in our shared humanity, that we really need to focus our attention, resources, human resources and engineering to really build up hospitals, doctors and public health systems. And we have to learn from this lesson. We have to learn what to do in the future. And what that is, is to build the health systems up in low- and middle-income countries so that these things don’t spin out of control.
— source democracynow.org
Lawrence Gostin, university professor and faculty director at the O’Neill Institute for National and Global Health Law at Georgetown University. He is also the director of the World Health Organization Collaborating Center on Public Health Law.