A National Mandatory Quarantine Is the Right Approach, President Obama

After being fiercely criticized by the ACLU, the CDC and even the United Nations Secretary General over his new 21-day mandatory quarantine policy for all healthcare workers exposed to Ebola, New Jersey Governor Chris Christie has received a very welcome vote of support from a worldwide star in the medical community : Nobel Prize-winning doctor and medical rsearcher Dr. Bruce Beutler, an American who won the 2011 Nobel Prize for Medicine and Physiology for his work researching the cellular subsystem of the body’s overall immune system -- the part of it that defends the body frosm infection by other organisms, like Ebola. He is currently the Director of the Center for the Genetics of Host Defense at the University of Texas Southwestern Medical Center in Dallas - the first US city to treat an Ebola patient and also the first to watch one die from the virus. ~~~~~ In an exclusive interview with NJ Advance Media, Dr. Beutler reviewed Christie’s new policy of mandatory quarantine for all health care workers exposed to Ebola, and declared : “I favor it,” and added that it may not go far enough. ~~~~~ But, while the doctor’s support provides much-needed credibility for Christie as he threatens to quarantine more healthcare workers returning from the Ebola fight in West Africa, it also comes with some chilling words from Dr. Beuhtler : “I favor it, because it’s not entirely clear that they can’t transmit the disease,” Beutler said, referring to asymptomatic healthcare workers like Kaci Hickox, the Doctors Without Borders nurse returning from treating Ebola patients in Sierra Leone, who was quarantined in New Jersey for 65 hours before being transported to her home state of Maine Monday afternoon, where she was placed in a 21-day quarantine. Dr. Beutler explained : “It may not be absolutely true that those without symptoms can’t transmit the disease, because we don’t have the numbers to back that up...It could be people develop significant viremia [where viruses enter the bloodstream and gain access to the rest of the body], and become able to transmit the disease before they have a fever, even. People may have said that without symptoms you can’t transmit Ebola. I’m not sure about that being 100 percent true. There’s a lot of variation with viruses.” In fact, in a study published online in late September by the New England Journal of Medicine (1) and backed by the World Health Organization, 3,343 confirmed and 667 probable cases of Ebola were analyzed, and nearly 13% of the time, those infected with Ebola exhibited no fever at all. Why, then, does he think the CDC would so emphasize Ebola is not communicable in patients without symptoms? “There’s some imperative to prevent panic among the public,” says Dr. Beutler, “But to be honest, people have not examined that with transmissibility in mind. I don’t completely trust people who’d say that as dogma.” ~~~~~ Permitting home confinement and monitoring for medical workers exposed to Ebola but currently without symptoms was, as Beutler put it in engineering jargon, “a move away from goodness.’” However, undeterred, the US Centers for Disease Control and Prevention (CDC) on Monday again changed direction, issuing new guidelines that call for voluntary home quarantine for workers with the highest risk for Ebola infection. The new guidelines also specify that most medical personnel returning from Sierra Leone, Liberia and Guinea would not need to be kept in isolation, as Hickox had been ever since she arrived at Newark International Airport on Friday up until being transported to Maine on Monday. Dr. Beutler does not agree. “Even if someone is asymptomatic, you cannot rely on people to report themselves if they get a fever,” according to Dr. Beutler, who added, “You can’t just depend on the goodwill of people to confine the disease like that - even healthcare workers. They behave very irresponsibly.” ~~~~~ In defending his mandatory quarantine policy, Christie has repeatedly pointed to the fact that NBC’s chief medical editor, Dr. Nancy Snyderman, after returning from Ebola besieged West Africa, was spotted violating her voluntary quarantine to get takeout from a Princeton eatery last week. And, despite her forced detainment by the New Jersey health department, Hickox insisted hat she was “feeling physically healthy” and except for a single, non-contact thermometer reading that registered her as having a 101 Fahrenheit fever, has had normal 98.6 F temperatures ever since her quarantine began. ~~~~~ “These are no arguments at all,” said Beutler. “Anyone could say that about any disease. It doesn’t matter that she was afebrile - she should be quarantined for 21 days.” In addition, Hickox has complained that “her basic human rights were violated” and has since retained a civil rights attorney, but Beutner says he is puzzled by the argument. “These people act like they are returning as conquering heroes - and they should be treated as conquering heroes, but part of being a conquering hero means making sure no one gets infected by you. Just look at the the foolish quarantine where astronauts came back from the moon [where there were no germs] and in this case, we know there is an infection.” Dr. Beutler says that from a global perspective, it’s unlikely that the virus will take hold as an epidemic in the US, but in Africa, Beutler says it already “has gone ballistic - way, way beyond the past epidemics. One could project that maybe millions could be infected. It may be that it won’t spread like wildfire in the United States but even if one or two more people die, it will be too many.” ~~~~~ When asked if Governor Christie has it right, Dr. Beutler said : “I’d be a little bit more strict than he is being....I realize this would be inconvenient, but I don’t think it would prevent treating the disease." Dr. Beutler says “the ideal scenario is where a patient is isolated from all family members,” preferably in a specialized hospital ward, not in a home. The thought of an afebrile parent passing Ebola on to a child - as ostensibly can happen 13 percent of the time, would disturb me. The point of quarantine of is to make sure they [Ebola viruses] are not carried elsewhere. It’s a little bit frustrating. Some of the things that are being done are not completely motivated by safety. For some reason, there’s an imperative to maintain open borders no matter what - to err on the side of total individual freedom rather than on the side of public health,” he said, adding, “If you really want to isolate a disease, then you have to isolate the people who carry it.” ~~~~~ At least one country, other than the 32 countries in Africa long since imposing a quarantine for the Ebola-affected countries, has taken the step of halting visas for Liberia, Guinea and Sierra Leone. Australian Immigration Minister Scott Morrison announced today a total ban on visas for the three countries. "These measures include temporarily suspending our immigration program, including our humanitarian program from Ebola-affected countries, and this means we are not processing any application from these affected countries." All non-permanent or temporary visas are being cancelled and permanent visa holders who have not yet arrived in Australia will be required to submit to a 21-day quarantine period, he added. ~~~~~ As for Governor Christie -- he has a short message for nurse Kaci Hickox if she decides to sue the state for being detained for more than 65 hours. “Whatever. Get in line,” Christie said during a campaign event today, according to NBC News. “I’ve been sued lots of times before. Get in line. I’m happy to take it on.” ~~~~~ Dear readers, Governor Christie says he will be on the winning side of the Ebola mandatory quarantine issue. So far, Illinois, Florida, 32 African countries, Colombia, Australia and the US Army agree with him. Those who disagree -- President Obama, the CDC, the UN and public health advocates -- consistently refuse to accept a mandatory quarantine for those returning from West Africa for only one reason - it would reduce the number of doctors, nurses and healthcare workers volunteering to go to Ebola hotspots. The medical volunteers are largely silent on the question, except for one nurse who seems bent on being the star of a get-Christie campaign. More powerful groups have tried...and failed. It is time for sanity from the US public health leadership and Barack Obama. Impose a national mandatory quarantine. If it proves unnecessary, it can be lifted. But once unleashed in America, the Ebola virus will never be put back in the bottle. Do it now. (1). Here is the cite to the New England Journal of Medicine article. http://www.nejm.org/doi/full/10.1056/NEJMoa1411100#abstract