Bloggers in the News: Quarantine of Uninfected Health Care Workers

Earlier today MSNBC put Dan in the middle, Hollywood Squares style, and asked him very good questions about SHEA's recent press release that supports active monitoring but warns against mandatory quarantine of health care workers. After watching this, my hope is that future discussions are this informative. Great work Dan.

 

Postmodern public health

An absurd situation has unfolded in New Jersey, where Kaci Hickox, a nurse who recently returned from Sierra Leone, is being quarantined. While she certainly could be incubating Ebola virus disease given her work with Ebola infected patients, she is asymptomatic, has had two negative Ebola tests, and currently poses no public health risk. To make matters worse, she was escorted to the hospital by a caravan of eight police cars and is being held in a tent (see photo) with no shower or flushable toilet. It is hard to believe that this is happening in the United States in 2014.

It seems that we have entered a new era of postmodern public health. No longer are decisions being made on evidence by experts who understand the epidemiology of infectious diseases, but by politicians who pander to the misinformed for political gain. It's reminiscent of the situation that existed for nearly a decade in South Africa where President Thabo Mbeki denied that HIV was the cause of AIDS, despite all evidence to the contrary.

David Gorski, in his blog Science Based Medicine, writes that from a post-modern viewpoint “scientific medicine is no more valid a construct to describe reality than that of the shaman who invokes incantations and prayers to heal, the homeopath who postulates “healing mechanisms” that blatantly contradict everything we know about multiple areas of science, or reiki practitioners who think they can redirect “life energy” for therapeutic effect. In the postmodernist realm all are equally valid, as there is no solid reason to make distinctions between these competing “narratives” and the “narrative” of scientific or evidence-based medicine."

Returning to reality for a moment, we need to emphasize that mandatory quarantine of healthcare workers from West Africa will not make us safer. In fact, it is highly likely that fewer American healthcare workers will take on the difficult task of treating Ebola in Africa, despite the need for controlling the epidemic there. And without controlling the epidemic at its source, developing countries will continue to be ravaged, and there will continue to be sporadic imported cases in developed countries. Moreover, if one believes that returning healthcare workers should be quarantined, then logic would dictate that healthcare workers who care for Ebola patients in the US should also be quarantined. This will precipitate a crisis since it is highly likely that most healthcare workers would be unwilling to provide care in that situation. And the incredible expense of caring for the Ebola patient in the US would increase greatly.

Kudos to Dr. Anthony Fauci for speaking truth to power today, and to the Society for Healthcare Epidemiology of America for issuing an official statement opposing quarantine of returning healthcare workers.

In an interview several years ago, Stephen Colbert said, "It used to be, everyone was entitled to their own opinion, but not their own facts. But that's not the case anymore. Facts matter not at all. Perception is everything. It's certainty.” And because of that, a few politicians have been able to trump the brightest minds in medicine and public health.

Photo: Kaci Hickox, CNN.

SHEA Supports Evidence-Based Measures to Prevent Ebola Transmission, Opposes Mandatory Quarantine for Healthcare Personnel

FOR IMMEDIATE RELEASE: CONTACT: October 26, 2014 Kristy Weinshel, 703-684-1008 kweinshel@shea-online.org

ARLINGTON, Va. (October 27) – The Society for Healthcare Epidemiology of America (SHEA) remains deeply concerned about the Ebola virus disease (EVD) outbreak. The recent news about Dr. Craig Spencer’s infection, along with the infections of the many other healthcare personnel (HCP) who have risked their lives to provide care during this tragic outbreak, illustrates how difficult it is to protect HCP serving patients with severe EVD.

SHEA supports the recent infection prevention guidance issued by the Centers for Disease Control and Prevention (CDC), and the commitment healthcare facilities across the country have made to train and prepare their teams for the care of patients with EVD.  SHEA continues to support the rigorous application of evidence-based measures to prevent EVD transmission. Based upon the strong evidence that Ebola is not transmitted by those who do not have symptoms of EVD, we do not support mandatory quarantine of individuals, including HCP, who have provided care for patients with EVD.  Our concern is about both the ramifications for HCP returning from West Africa and the potential application of this quarantine to all HCP caring for patients with EVD.  SHEA believes that mandatory quarantine will lead to fewer volunteers and increased difficulty in assembling care teams in West Africa and in other countries, including the United States, preparing to care for EVD patients.

SHEA and its membership of infection control and prevention experts support the active monitoring (twice daily, for fever and symptoms of EVD) of all HCP providing care for EVD patients, including returnees from Ebola outbreak areas in West Africa. Mandatory quarantine should only be implemented for those who do not adhere to such monitoring.

SHEA continues to work with the CDC and all relevant stakeholders to ensure the safety of HCP and to promote positive outcomes for those who contract Ebola. 

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SHEA is a global professional society representing more than 2,000 physicians and other healthcare professionals with expertise and passion for healthcare epidemiology and infection prevention to improve patient care in all healthcare settings. SHEA's mission is to prevent and control healthcare-associated infections and advance the field of healthcare epidemiology. The society advances its mission through advocacy, science and research, expert guidelines and guidance on key issues, the exchange of knowledge, and high-quality education.  SHEA focuses resources on promoting antimicrobial stewardship, ensuring a safe healthcare environment, encouraging transparency in public reporting related to HAIs, focused efforts on prevention and more. 

Visit SHEA online at www.shea-online.org, www.facebook.com/SHEApreventingHAIs and @SHEA_Epi

link to SHEA press release: http://www.shea-online.org/View/ArticleId/318/SHEA-Supports-Evidence-Based-Measures-to-Prevent-Ebola-Transmission-Opposes-Mandatory-Quarantine-for.aspx