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The Case Against Mandatory Ebola Quarantines For Health Workers

RENEE MONTAGNE, HOST:

The Obama administration yesterday recommended voluntary home quarantine for people at high risk of Ebola infection, but said most health workers returning from West Africa would only require daily monitoring, not isolation. A number of health experts are making the argument that putting health care workers in quarantine could lead to a greater spread of Ebola beyond Africa. The New England Journal of Medicine published an editorial yesterday criticizing recent quarantine policies put forward by several states. Dr. Lindsey Baden is the deputy editor of the Journal and an infectious disease doctor. He's also one of the authors of that editorial. Good morning.

LINDSEY BADEN: Good morning, Renee.

MONTAGNE: Now, we're of course hearing reports of several states imposing a quarantine on health care workers who've cared for patients with the Ebola virus. But one might ask, is an excess of caution not a good idea in this case? Wouldn't it seem this is the time for that?

BADEN: Ebola evokes such fear in all of us. It is important for us to think carefully about how best to control this epidemic. And the best way to control it is to intercede at its source in West Africa. And the policies that we entertain and employ should keep in mind this very essential element.

MONTAGNE: That is then - interceding at the source means more health workers being willing to go over there, being available to do that. And the harder we make that, this editorial argues, the worse it is for the disease spreading.

BADEN: Correct. The source is in West Africa in the three countries that are the epicenter of this horrible epidemic. And in order to gain control of this infection, we must stop ongoing transmission in that region. It will - the virus will not respect borders, will not respect custom agents. It will be transmitted well beyond the borders of those countries if we are not able to contain the epidemic and resolve it there.

MONTAGNE: Now, this New England Journal of Medicine editorial that you were one of the authors of, it clarifies when Ebola is actually contagious. And in fact, you write many people think a fever means a person is quite contagious already. Just briefly, what are the facts?

BADEN: Prior to the onset of symptoms, individuals - there's no evidence of individuals being contagious prior to the onset of symptoms or with the immediate onset of symptoms. At the time that symptoms begin, the diagnostic test, such as the sensitive blood TCR, is often negative. Subsequently, with the onset of significant illness over the following several days, that is when contagiousness increases substantially and incredible caution is required in the care of those individuals with substantial vomiting and diarrhea and other kinds of symptoms that could increase the spread or contamination of the virus. But at the time of the onset of fever, there is limited virus that's being shedding.

MONTAGNE: And you point out to support this that Thomas Eric Duncan, the man who died from Ebola in Texas, his family was not infected even though they lived with him in the early stages.

BADEN: And we are seeing that. And that is an example where several days of contact with family members led to no transmission, while during care, there is evidence that transmission occurred.

MONTAGNE: Just finally then, it seems that the public messaging so far and some of what people are getting I think from news reports - correctly or incorrectly - that the actual science is at odds here with what people are hearing.

BADEN: There is a challenge with the fear and concern that is evoked and the state of the science in terms of the evidence of how best to respond. And the best way to manage the fear is by looking at the science, employing what we learn, and as we learn more, we should improve our approaches. And so it should be an iterative process where we continue to improve our response to this outbreak. But the science needs to guide us, and we need to manage the fear that is invoked.

MONTAGNE: Dr. Lindsey Baden is deputy editor of the New England Journal of Medicine. Thank you very much for joining us.

BADEN: Thank you, Renee. Transcript provided by NPR, Copyright NPR.