As you may know, there is a brewing controversy over what to do with healthcare workers returning from the Ebola hot zone in West Africa. After Craig Spencer came down with Ebola, several governors imposed quarantines on returning healthcare workers. Controversy erupted and, I believe, we are down to home quarantine for 21 days.
A few thoughts:
First, it’s true that there has been a bit of an over-reaction. So far, we have only had two people infected while in this country and both of them were healthcare workers taking care of a dying man without adequate protection. Naturally, we need to be vigilant. The virus is unlikely to mutate to become airborne but it may mutate to become far more infectious. As Nobel Prize winner Bruce Beutler has noted, we don’t have as much information as we’d like about how infectious this strain is. But, even with those caveats, the policies being advocated in some quarters are unwarranted at this stage.1
Second, the most important thing about fighting Ebola is stomping it out in Africa. If we do not stop Ebola in Africa, it will spread. It will spread to bigger cities. It will spread to other countries. Right now, we only have to worry about people who have actually been in West Africa. If this goes on and blows up to hundreds of thousands of cases or millions, we will have to worry about everyone. A house in our neighborhood is on fire. We’ve had a few cinders land on our roof. But the most important thing is not that we spray water on our roof; it’s that we put out the fire before the whole neighborhood is ablaze.
Anything that discourages healthcare workers from going to West Africa to fight this thing is likely to make things worse. Quarantine sounds like an easy burden to impose. But, in The Hot Zone, Richard Preston describes the psychological trauma that quarantine imposes on workers at USAMRIID. This is not a light burden. And isolating them in hospitals is a good recipe for getting them sick with the opportunistic diseases that infest every hospital in the world.
That having been said, it’s not irrational to be afraid of this disease. It’s not irrational to think that healthcare workers — who are the most at risk and who have close contact with dozens of people very day — should back off until they are clear. We have been very lucky so far that this hasn’t erupted in a school or something. We’ve been very lucky that infected people have sought help immediately. We have been very lucky that this hasn’t mutated to be much more infectious. All it takes is one idiot to wait until he literally drops dead in the street for this to become a serious serious problem. All the reassurances about how we can contain this are going to be cold comfort to someone who gets infected by a returning healthcare worker.
The dilemma is that treating potential victims like pariahs increases the odds of that nightmare scenario. It encourages them to hide their symptoms and to lie. So what do we do?
To me, these problems are interlocked: getting more healthcare workers to West Africa and keeping them from spreading the disease when they return are the same problem. So here is what I would propose:
Healthcare workers who go to West Africa should be guaranteed early spots in the line for experimental drugs like ZMAPP. These drugs are difficult to produce and will come online in small quantities (you can read a great summary of this from the aforementioned Preston). The biggest worry healthcare workers have about Ebola is not that they will lose their jobs; it’s that they will die. Promise them that they will get the best possible care. They deserve it.
Congress should authorize a fund to give hazard pay to healthcare workers who volunteer to fight Ebola in West Africa. We have to be careful here to not undermine the volunteer organizations that are the frontline for these epidemics. But they are being overwhelmed. They desperately need reinforcements. This fund would also pay for healthcare, life insurance and maintaining their existing jobs. This in addition to the funds needed to provide medical equipment for them to work with.
This fund would will also pay volunteers to undergo a three-week home quarantine on their return, during which they will be monitored for symptoms and maintain a log of any contacts.
We have laws that protect military reservists from being financially or legally ruined when they are called up to active duty during a war. Extend those laws to healthcare workers who volunteer to fight Ebola or are in quarantine after their return.
If we are going to go to war with Ebola, we have to treat it like a war. Doctors and nurses are our soldiers in this war. Pay them, reward them, protect them. Treat them in a manner that is good for public safety but also recognizes the tremendous risks they are taking and the tremendous good they are doing. Whatever else one may think of Craig Spencer or Kaci Hickox, they have risked their lives to try to save people, most of whom are a different nationality and race from them. Let’s recognize that even as we move to secure our public health.
1. Of course, the same media telling us we are over-reacting were also saying Ebola would never come here in the first place.↩