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No easy decisions on best way to handle Ebola patients

In this Oct. 12, 2014 file photo, Dr.

In this Oct. 12, 2014 file photo, Dr. Tom Frieden, head of the Centers for Disease Control and Prevention, speaks at a news conference in Atlanta. Credit: AP / John Amis

Quarantine proponents want a registered nurse sealed off from the world even though she has no trace of the Ebola virus. Opponents of that plan, including the nurse, Kaci Hickox, view the quarantine of patients declared healthy as a cruel and inhumane civil rights violation.

Medical and legal experts say both sides -- and the public as a whole -- have much to learn about Ebola as government guidelines for treating the virus continue to evolve and new, and sometimes conflicting, information surfaces daily.

Also, hype pervades much of the public's knowledge about Ebola, experts say, and is driving calls for quarantine.

"It's not nearly as contagious as the flu, measles, the common cold and many other infectious diseases," said Dr. Thomas Frieden, director of the Centers for Disease Control and Prevention at a news briefing Monday.

Unlike Ebola, those infections are easily passed through sneezing, coughing and talking at close range, Frieden said.

"We have to tailor our response to the science of Ebola," Frieden added.

Quarantine as a response infringes on civil liberties but is entirely constitutional, said Michael Dorf, a law professor at Cornell University and an expert on legal matters involving quarantine. State governments have broad powers to protect the public health, Dorf said.

In the case of Hickox, who had contact with Ebola patients -- it meant quarantining her in an isolation tent at University Hospital in Newark. She was transported home to Maine Monday even as New Jersey Gov. Chris Christie defended her isolation by saying he was acting in the interests "of all the people of New Jersey."

Hickox has been hailed a hero by leaders of public health agencies for helping fight Ebola in Sierra Leone. She has been exonerated of the infection in at least two preliminary tests, but faces more in the future.

"There could be harm to the public," said Garden City attorney Jerry Reisman Monday when asked about Hickox. "I say she should be quarantined." Doctors Without Borders, the charity that sent Hickox to Africa, has one of the most stellar infection-control rates in field medicine. Only three volunteers, including Dr. Craig Spencer, who is being treated at Bellevue Hospital in Manhattan, have contracted the virus since March.

Dr. Anthony Harris, president-elect of the Society for Healthcare Epidemiology of America, an organization representing professionals in hospital infection control, said quarantine is an extreme measure.

"If an organization like ours says don't worry about a person walking around and does not have symptoms of Ebola, then you should know that the information is evidence-based," Harris said.

Sophie Delaunay, executive director of Doctors Without Borders in Manhattan, said quarantine can damage efforts to recruit volunteers in West Africa.

"There are other ways to adequately address both public anxiety and health imperatives, and the response to Ebola must not be guided primarily by panic in countries not overly affected by the epidemic," she said Monday in a statement.

Studies of Ebola outbreaks dating back 40 years in Africa reveal that even when people live in close quarters, the infection does not readily pass among inhabitants. Only those who had direct contact with a patient's body fluids contract the disease, Frieden said.

Quarantine, however, has a long and storied past.

It is a key nonpharmaceutical measure that rose to prominence in the centuries before modern diagnostics, antibiotics and antiviral medications.

In 1918, quarantines helped spare much of the U.S. population from a rogue flu virus. In the United States, 28 percent of the population was infected and between 500,000 and 675,000 people died. The flu virus is an airborne pathogen.In the early 20th century, New York City was notorious for quarantine, banning people to "quarantine islands," that included North Brother, where Typhoid Mary died after 37 years of confinement.


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