Survey Results: To Quarantine or not to Quarantine

[tnbutterfly - Mary]

To Quarantine or Not to Quarantine......That is the Question that we posed last Thursday. We just want to thank the 3800+ of you nurses who took the time to participate in the latest survey. Your voices have been heard and here is what you said about Kaci Hickox and other healthcare workers who have cared for Ebola patients.

Many posters felt that nurses who took care of Ebola patients should voluntarily quarantine themselves and not run the risk of infecting others....we should err on the side of caution. Some thought quarantine should be mandatory. Many comments were made that we don't know enough about Ebola, and that is causing a lot of discomfort. Some felt that quarantine was not necessary since she is asymptomatic, and some interesting comments pointed to hysteria and reactionism to the possible need for quarantine. Other comments included that the nurses should get paid for this time and several others weren't quite sure of the need for quarantine or not and wanted more information. Some felt "this nurse should be setting a good example for others."

There were 581 comments on this question

The second question garnered 441 comments.

Many comments were made to the effect that this nurse needed to more closely monitor her interactions with the media. Nurses usually have no public relations experience and for this nurse it was the cause of much negative publicity. "Kaci has turned this into a media frenzy." While many agree with her position, they feel she has handled this poorly.

Summary of comments

There were over 2300 comments:

Most responders said that until we know more we should quarantine with pay. Many felt that education and following CDC guidelines was the way to deal with healthcare workers exposed to Ebola. Another commonality was to provide more information to the public so that hysteria and panic was averted. Many posters felt that self-quarantine was the way to go and others felt that these healthcare workers should be monitored in a CDC facility.

[nurseprnRN, BSN, RN]

There's a totally hilarious thread on LinkedIn going where somebody says her grandpa founded the CIA and they have the lock on a patent for Ebola, and the president knows all about it, and there's this huge plot to infect the nation being run out of the White House aided and abetted by the CDC (granted, they haven't covered themselves in glory here, but still), and we are crazy if we don't prepare for the worst and see it for what it is, and on, and on, and on. Precious few voices of reason there, and most of them seem to have decided to leave and let the crazies enjoy themselves. I like to drop in and chuckle from time to time. And this is in a forum mostly populated by nurses, many with advanced degrees.

It will be so sad for these people soon. I mean, what do rabid catastrophists do when the calamitous catastrophe doesn't develop and so there's no proof of the big conspiracy and it all goes pooooooofffff? Every day that goes by without all those people in the bowling alley in NYC, or folks (or squirrels) on the biking trails of Fort Kent ME, or the schoolteacher's colleagues in KY, or more people in TX starting to come down with fevers and hemorrhages undermines the rationale (if I can use such a word, as it's hardly rational) for their hysteria. You know they'll never say, "Umm, okay, we overreacted and I guess we got it wrong," will they? Will they be disappointed if, like, nobody else dies? Or even gets infected? Bummmmmmerrrrr!

Here's a hint for them. Cue the late, great Gilda Radner (as Roseanne Rosannadanna): "Nevermind ..."

[LadysSolo]

I am an NP (for those who want educational level,) and commented when I took the survey that I thought self-monitoring was sufficient and quarantine was overkill. I am old enough to have been around for the HIV/AIDS hysteria. If I donated 3 weeks' vacation to go to Africa to take care of Ebola patients, and came back to a 3 week quarantine (mandatory) I could not do it, as I am the sole support of my family, and not independently wealthy. Who will pay my bills? I would have come back expecting to go back to work, and I feel self- monitoring should be sufficient.

[BostonFNP, APRN]

There are so many scary things about this including its similarity to the days of "GRID" and quarantine, the education level of nurses and the subsequent understanding of science and EBP, etc.

Sent from my iPhone.

[Susie2310]

tnbutterfly, I just wanted to say thank you for such a clear presentation.

[Over-the-hill-Nurse]

I am a nurse and I am in favor of quarantines. My decision was based on the information out there, how it affects individuals, our communities, and for population groups at risk. Basing it on the EBP, the resources, the persons involved. You have to be cautious about taking too narrow a view of what EBP can accomplish. All too often clinicians focus solely on using the data from research to guide their decisions. The evidence and research is critial but so are the other aspects of care in making decisions for the person or persons affected in our communities where we live. In decision making you have to include clinical evidence, clinical experience, the resources available, patient preferences, patient's condition, and patients characteristics. The 2 nurses that were involved in the care of the gentleman that traveled to Texas with the virus, used what was available to them to protect themselves and their co-workers, other patients, family, and friends. Was it a factor that they didn't use EBP or the fact that they did not have the proper ppe equipment, or their lack of knowledge of Ebola? Hospitals need to ramp up thier education of their staff, provide the proper attire, and inform the nursing staff, the families, and the infected person of the risks, the quarantine time, and how to protect themselves from the spread of the virus. I don't believe that there is enough information out there to make a decision on if those persons should be in quarantine or not. The clinical implications to individuals, communities, and for population groups at risk could be detrimental. I firmly believe that anyone exposed to this virus should be quarantined to protect from the spread of this virus. Poor understanding, fear, hysteria, lower education levels may very well also be a reason that 80% believe that quarantine should be instituted, I personally don't believe that we should throw caution to the wind. Too many lives could be at stake.

[GrumpyRN, NP]

I am a nurse and I am in favor of quarantines. My decision was based on the information out there,

But not evidence.

You have to be cautious about taking too narrow a view of what EBP can accomplish. All too often clinicians focus solely on using the data from research to guide their decisions.

How dare they......

The evidence and research is critical but so are the other aspects of care in making decisions for the person or persons affected in our communities where we live. In decision making you have to include clinical evidence, clinical experience, the resources available, patient preferences, patient's condition, and patients characteristics.

Yes, let uneducated, frightened people make decisions.

The 2 nurses that were involved in the care of the gentleman that traveled to Texas with the virus, used what was available to them to protect themselves and their co-workers, other patients, family, and friends. Was it a factor that they didn't use EBP or the fact that they did not have the proper ppe equipment, or their lack of knowledge of Ebola?

Very likely, they were new to the whole thing.

Hospitals need to ramp up thier education of their staff, provide the proper attire, and inform the nursing staff, the families, and the infected person of the risks, the quarantine time, and how to protect themselves from the spread of the virus.

Absolutely correct.

I don't believe that there is enough information out there to make a decision on if those persons should be in quarantine or not.

Evidence.

The clinical implications to individuals, communities, and for population groups at risk could be detrimental.

This is not 'The Walking Dead' or 'The Strain'.

I firmly believe that anyone exposed to this virus should be quarantined to protect from the spread of this virus.

Again, evidence.

Poor understanding, fear, hysteria, lower education levels may very well also be a reason that 80% believe that quarantine should be instituted, I personally don't believe that we should throw caution to the wind. Too many lives could be at stake.

Media need to stop the hysteria and start giving some proper information.

This is the kind of nonsense that happened with AIDS, people would not touch anyone infected, our local council would send round workers in hazmat suits merely to pick up a discarded needle. We need to get on top of the fear.

I felt I wanted to answer your points individually because it is the type of thing that we are going to see more and more of unless we get control of the rumourmongers and the conspiracy theorists and the just plain ignorance about the disease. Yes it's scary, yes it can be dangerous but it is more dangerous to allow fear to guide our actions.

[BostonFNP, APRN]

I am a nurse and I am in favor of quarantines. My decision was based on the information out there, how it affects individuals, our communities, and for population groups at risk. Basing it on the EBP, the resources, the persons involved.

Can you please share your sources that indicate quarantine for asymptomatic HCWs treating Ebola patients is EBP; we would all like the opportunity to read these.

All too often clinicians focus solely on using the data from research to guide their decisions. In decision making you have to include clinical evidence, clinical experience, the resources available, patient preferences, patient's condition, and patients characteristics.

The data/evidence that demonstrates no need for quarantine for asymptomatic HCWs is clinical evidence not in-vitro research data; in fact the in-vitro data is not applicable to the clinical management on a population level. The patient's preference really doesn't matter in this case, but most don't want to be unnecessarily quarantined. The patient's condition in this case is "healthy/asymptomatic" so that also supports that quarantine is inappropriate.

The 2 nurses that were involved in the care of the gentleman that traveled to Texas with the virus, used what was available to them to protect themselves and their co-workers, other patients, family, and friends.

Over 50 HCWs were involved in the care of Duncan in Texas. The conditions and training were inadequate, I think we all agree about that. Were the 48 other asymptomatic HCWs? Did they need to be? Please explain to us how the healthcare system can care for individuals with this illness if all HCWs with contact need to be quarantined for 21 days after every contact with the patient.

Hospitals need to ramp up thier education of their staff, provide the proper attire, and inform the nursing staff, the families, and the infected person of the risks, the quarantine time, and how to protect themselves from the spread of the virus.

Here is the widely available education that explains exactly how to prevent transmission (via UpToDate):

"Transmission is most likely to occur through direct contact of broken skin or unprotected mucous membranes with virus-containing body fluids from a person who has developed signs and symptoms of illness [59,60]. According to the World Health Organization, the most infectious body fluids are blood, feces, and vomit [61]. Ebola virus has also been detected in urine, semen, saliva and breast milk, and reverse-transcriptase-polymerase chain reaction testing has identified viral RNA in tears and sweat, suggesting that infectious virus may be present [62-65].Ebola virus can also be spread through direct contact with skin of a patient, but the risk of developing infection from this type of exposure is lower than from exposure to body fluids [59]. Virus present on the skin surface might result either from viral replication in dermal and epidermal structures, contamination with blood or other body fluids, or both.

The risk of Ebola transmission also depends upon the quantity of virus in the fluid. During the early phase of illness, the amount of virus in the blood may be quite low, but levels then increase rapidly and are very high in severely ill patients [59,66]. As an example, an epidemiologic study found that family members were at greatest risk of infection if they had physical contact with sick relatives (or their body fluids) during the later stages of illness, or helped to prepare a corpse for burial.

Ebola virus may be transmitted though contact with contaminated surfaces and objects. The Centers for Disease Control (CDC) indicates that infectious virus may persist from hours to days [67,68]. Although there are no high-quality data to confirm transmission through exposure to contaminated surfaces [67], the potential risk can be reduced by proper environmental cleaning."

I don't believe that there is enough information out there to make a decision on if those persons should be in quarantine or not. The clinical implications to individuals, communities, and for population groups at risk could be detrimental. I firmly believe that anyone exposed to this virus should be quarantined to protect from the spread of this virus. Poor understanding, fear, hysteria, lower education levels may very well also be a reason that 80% believe that quarantine should be instituted, I personally don't believe that we should throw caution to the wind. Too many lives could be at stake.

Wait a tick. There is years of clinical experience and subsequent data which supports the fact that asymptomatic individuals do not need mandatory quarantine. The implications of imposing unnecessary quarantine are more detrimental that most (lay) people realize. This is not throwing caution to the wind. It's practicing evidence-based medicine that has worked in controlling Ebola for a decade. Lives are at stake by imposing quarantine not the other way around.

[SpEdtacular, MSN, RN, EMT-P]

Exactly!

The reason I replied that I would hesitate to take care of an ebola patient if quarantine were mandated is because I've lived long enough in the USA to know that my employer isn't looking out after me. I am not sure I could sustain a three week quarantine on unpaid leave.

What kind of support system would be put in place for those quarantined? Would I qualify for disability or workman's comp? I doubt it since I'm not actually sick or injured. Chances are I would have to use all my PTO and when it runs out... then what? I can't go to the supermarket or the pharmacy, so how do I get food or my prescriptions?

Fear is making people irrational. Untreated Ebola has a ridiculously high fatality rate, so I don't think we have to worry about healthcare workers who develop symptoms hanging around the community and infecting people. HIV hysteria is an excellent comparison, especially since it's spread the same way. Worry about influenza which is airborne and spread by asymptomatic individuals; you're much more likely to catch that and die than you are Ebola

[GrumpyRN, NP]

Here we go again, the same response as the response in the 1980's to AIDs.

Catholic Archbishop: Ebola is punishment from God for homosexuality

AIDS - RationalWiki

THIS is why we need information, evidence and reasoned, calm debate.

Ebola has been around since at least 1976, if it was as dangerous as it is said to be then there would be no-one left in Africa, it would have killed about 70% of the population.

[ClaraRedheart, BSN, RN]

As a nurse in the DFW area (NOT critical care... med/surg) employed and trained by the same hospital conglomerate that was the lucky beneficiary of the first ebola patient in the USA... I take these things pretty seriously. The CDC, Hickox's employer failed us in their knowledge. We have what we SEE to go off of at this point. From what I've seen, Thomas Duncans family did not get infected... even though he had ebola and ebola symptoms for a few days while at home. The only people who DID get infected were healthcare workers who cared for him when the virus was the strongest in his body. So... while I hate to agree with anything Obama says: "You can't get ebola from riding a bus". The hysteria is getting to be ridiculous.

[canigraduate]

Back to the education level comments, I think it would be more relevant to see where people are getting their news from.

My guess would be that the fear-based responses come from TV and Internet watchers, and that the EBP responses come from people who follow up their "infotainment" with actual research.

Although, come to think of it, the education levels probably correlate with the info source.

[GrumpyRN, NP]

Back to the education level comments, I think it would be more relevant to see where people are getting their news from.

My guess would be that the fear-based responses come from TV and Internet watchers, and that the EBP responses come from people who follow up their "infotainment" with actual research.

Although, come to think of it, the education levels probably correlate with the info source.

I'm getting a lot of information from the BBC but my employer sends out information and the latest advice from our infection control and public health departments. I also look at the nursing press, mainly 'Emergency Nurse' from the RCN which is peer reviewed. We are updated regularly and we have to practice putting on full PPE.

Scottish government are involved through

Ebola and other Viral Haemorrhagic Fevers - Travel Health - HPS

I am educated to degree level, Bachelor of Nursing - I am not sure that qualifications translate but it would be 3 years full time at university for the basic qualification.