Expert questions US quarantine's efficacy and fairness
The enforced quarantine of a nurse has sparked a debate in the United States over what should be done with people who have been in contact with Ebola patients, but show no symptoms themselves.
Quarantining people to prevent the spread of communicable diseases, including the Spanish flu and the plague, is a practice that has been around since before the Middle Ages, said Dr Howard Merkel, a professor at the Center for the History of Medicine at the University of Michigan.
But he warned that quarantine can have the unintended consequence of making people lie about their condition to avoid isolation. In this interview, he explains the issues.
To what extent has the United States previously used quarantine?
Quarantine has been overused and misused across time and frequently as a social and political tool. In America, it has been used to keep out undesirable immigrants. That's what happened in the 1890s with the Russian Jewish emigrants coming in droves.
There was a cholera epidemic in Europe in 1892 and president Benjamin Harrison ordered a quarantine of New York harbor on Russian Jewish emigrants—but not on cabin-class passengers coming on the same ship. It was a quarantine by class. Some of those did carry cholera, but most of them didn't. So it was kind of a wide net.
With HIV in the early years, before we knew how it was spread ... a lot of people wanted to quarantine gay men or intravenous users.
How do you explain the extreme reaction in the United States to the isolated cases of Ebola?
People are scared because people have different levels of education or understanding of medicine, or come from different backgrounds.
(When) you are watching or reading the media, it is all about Ebola. When a disease gets its own theme song on CNN, you know that things have been ramped up.
It is very rare in the US, it is extremely scary, it is extremely deadly. It is an unforgiving virus and it's remarkably gross and disgusting. The symptoms pattern is quite dramatic.
Are the quarantine measures recently enacted in New York and New Jersey effective?
It's an example of social quarantine. What governors (Chris) Christie and (Andrew) Cuomo did was more a political move rather than a science-based, medically advised decision.
People do not necessarily tell the truth, but mandatory quarantines are kind of an antediluvian thing, and they don't work very well either. People will lie for other reasons because they don't want to be taken away. It is basically using a sledge-hammer to drive a nail while you need a little hammer.
What should US authorities do to prevent the spread of Ebola?
If everyone has to stay like this nurse in a tent without a shower, portable toilets or a TV, they might say, 'I am not going to go.'
Those people are true heroes, true medical professionals who would understand that they need to stay at home and reduce their contacts.
All of these public health mechanisms really do depend on everybody sticking together as a community and telling the truth.
You have to have good protocols—rational, based on facts and science of the disease. You have to fine-tune your isolation and quarantine efforts so that they help the public health and don't harm it because if people feel that the public health officials are acting like police officers that are going to throw them in a cell somewhere that would have bad consequences as well.
You have to constantly be changing those protocols as you find out new information, but also it is up to everyone who is exposed to do the good thing. It sounds like common sense. No one would run away with a fever.
© 2014 AFP
