Bowling Alone

The big news tonight is that the governators of New York and New Jersey decided to institute quarantine for everyone returning from West Africa after having contact with Ebola patients. This decision was driven by political considerations, including the costs (in time and money) expended due to the decision to do extensive contact tracing around Dr. Craig Spencer’s movements in New York City since 7 am on Tuesday, October 21.

Nothing that has happened during this tragic Ebola epidemic has called into question this simple fact: Ebola is not transmitted in the absence of symptoms. Nor is it transmitted to casual or household contacts during early infection. Consider Mr. Duncan, sent home from the hospital with fever, spending the early days of his Ebola illness with almost 20 close contacts (mostly family members), until he was finally taken back to the hospital after vomiting “wildly” in an apartment complex parking lot. Let’s count the community and family transmission events: ……..ZERO. 

Careful monitoring of symptoms and signs (fever) is sufficient for early detection of symptomatic Ebola infection and prevention of community transmission. Movement restrictions, including strict home quarantine, provide no additional benefit. The adverse consequences of misguided quarantine of caregivers are clear, however: fewer providers willing to assist in the outbreak area, and fewer providers willing to volunteer to join Ebola care teams in US hospitals, complicating preparedness efforts. If Ebola providers returning from West Africa are quarantined, how can we not also quarantine US healthcare workers who provide care for Ebola patients? How will such providers commute to work, if they depend upon public transportation? Conversely, how will we convince anyone to participate in care, if they cannot return home to family for the duration of caregiving (+ 21 days)?

Don’t take it from me, though. Listen instead to an infectious diseases doc who’s been fighting the outbreak in Sierra Leone:
Dan Kelly, 33, an infectious disease doctor and a founder of Wellbody Alliance, a nonprofit organization working in Sierra Leone, criticized the governors’ response as knee-jerk. 
“I think we are just digging the grave deeper,” he said in a telephone interview from Freetown, the capital. “Come on, that’s exactly the move to push people away from going to Sierra Leone and other affected areas. It’s going to escalate the epidemic and not help solve the crisis."
He added: “If we’re going to get in front of it, we need health care workers from abroad. They cannot feel shunned or discriminated against.”


  1. Great post Dan.

    I think one additional factors highlights how unlikely community transmission of Ebola is in the US: the continued Ebola-free existence of Nina Pham's dog Bentley. I'm not a dog owner, but my sense is that they interact with the environment in a far more intimate way than people do. As a midwesterner, I'm tempted to make a joke about how folks handle their bowling balls. But seriously, if Bentley didn't become infected, folks in the community won't get infected.

    Quarantining health care workers has got to be one of the stupidest and short-sighted decisions that I've seen.

  2. Great post, Dan.

    Complex situation in NY/NJ, where Cuomo/Christy are being driven by strong forces, ie politics/upcoming elections, money, and the powerful mass media. Meanwhile, it's a delicate balance public health and civil liberties— ie ensuring that limits on liberty (isolation, quarantine, travel restrictions) are justified, procedural due process, nondiscrimination.

    As politics/media drive public #fearbola, Ebola transmission is continuing in W. Africa, and American health workers become less likely to volunteer to go volunteer in ETUs. I don't like the direction things are going.

  3. This is not a scientific evidence decesion. Some body likes to have false security . If we did not assist in stoping the fire at its origin. It wil reach us.
    Our volanteer profesionals shoud be appreciated and not to punished.


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