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Once again, it is a nurse who has taken the Ebola media spotlight this week. Kaci Hickox, a nurse who cared for Ebola patients in Sierra Leone found herself quarantined against her will in New Jersey upon her return to the US, in spite of the fact that she tested negative for the virus. After a 3 day isolation in less than desirable accommodations, she was transported home where she was supposed to remain under home quarantine but is now declaring that the quarantine is unnecessary and counterproductive, and is openly defying the order by going out in public.
Additional breaches in voluntary quarantine from those returning from Ebola-plagued Africa occurred when NBC medical correspondent, Dr. Nancy Snyderman in New Jersey and Dr. Craig Spencer in New York left their homes and ventured out into public spaces.
On Monday, the U.S. Centers for Disease Control and Prevention (CDC) called for voluntary home quarantine for workers with the highest risk for Ebola infection. It also specified that most medical personnel returning from Sierra Leone, Liberia and Guinea would not need to be kept in isolation.
In spite of this, New Jersey Gov. Chris Christie, mandated a 21-day mandatory quarantine policy for all healthcare workers exposed to Ebola. Although this move has received much criticism, it did get the support of Dr. Bruce Beutler, an American doctor and researcher and Nobel Prize winner for Medicine and Physiology for his work researching the the body’s overall immune system. He is currently the Director of the Center for the Genetics of Host Defense at the University of Texas Southwestern Center in Dallas. He favors Christie’s quarantine policy “because it’s not entirely clear that they can’t transmit the disease,” referring to asymptomatic healthcare workers like Kaci Hickox.
New York and Illinois have also have followed suit and mandated mandatory 21-day home quarantine policies. Although there is plenty of scientific evidence indicating there’s very little chance that a random person will contract Ebola unless they touch bodily fluids of an infected person, the thought is that the authorities need to do something to calm Americans’ fears. As Mike Osterholm, an infectious disease epidemiologist at the University of Minnesota, says, "You want to try to eliminate not just real risk, but perceived risk."
There are thoughts on both sides of this issue which has led to heated discussions at times. There are concerns about the potential impact with both pathways of re-entry requirements for Ebola healthcare workers. What are your thoughts about this? Please take our survey to share your opinions. Let your voice be heard.
EBOV was detected initially in 2 of the 3 patients it studied, one of the three did not have a positive EBOV PCR at the day 7 test. This even combined with any other data we have available certainly suggests that for many patients a positive PCR may occur simultaneously with a cytokine release, but we don't have conclusive evidence that this is always the case. So the question becomes what the burden of proof should be. Should we err on the side of protecting against what we haven't ruled out or should we just assume something probably won't happen despite sufficient evidence to call this an established fact.
The initial quarantine in New Jersey was not warranted, but the home quasi-quarantine is actually what is recommended by the CDC which is what she refused and was ordered by a court to follow. What I disagree with is her argument that it's not possible for her to have Ebola at that point and potentially develop symptoms, which scientifically is false.
What court ordered her to follow home quarantine/monitoring? Did I miss something?
Were those patients exhibiting symptoms in the study or were they asymptomatic?
No test is going to have a 100% specificity and 100% sensitivity, but the ebola tests are extremely reliable when used in conjunction with physical symptoms/exams and exposure background.
I think the biggest misunderstanding is that some of these ebola research articles are being taken out of context, and several people keep going back to articles that aren't clinically applicable i.e. the ebola can last a long time if kept at 39 degrees Fahrenheit or the "airborne" ebola studies.
[h=1]'Judge issues order enforcing Ebola isolation of defiant Maine nurse"[/h]
(Reuters) -" The confrontation between the state of Maine and a nurse who treated Ebola patients in Sierra Leone heated up on Friday when a judge issued a temporary order enforcing a quarantine after she defied state officials and took a bike ride.
The order from Charles LaVerdiere, chief judge of the Maine District Court, instructs nurse Kaci Hickox to submit to "direct active monitoring," and "not to be present in public places" like shopping centers, movie theaters or workplaces except to receive necessary healthcare."
"The temporary order permits her to engage in what the judge called "non-congregate public activities" like walking or jogging in the park but instructs her to maintain a 3-foot (1 meter) distance from other people."
I thought I post this ahead of the conspiracy theorists.
This still doesn't prove anything, but it does address some very specific ebola experiments/methods that will need to be done to alleviate concerns on the transmission of ebola . Also, to make sure that we are utilizing the right disinfectant techniques (using hand sanitizer and bleach) and not making ourselves more artificially susceptible by using these products.
You also have to also wonder if these researchers are trying to get public support to get more grant money to study ebv....
The initial quarantine in New Jersey was not warranted, but the home quasi-quarantine is actually what is recommended by the CDC which is what she refused and was ordered by a court to follow.
I didn't read anywhere that she went to crowded public places or did anything to put other people at risk. She even voiced that she would refrain from doing so. If her boyfriend wanted to stay with her that is his decision. Same for the reporter who shook her hand. It's not like she tackled him. As for her bike ride, for criminy's sake she lives in a remote part of Maine in a small town whose population doesn't even equal the number of nurses employed by my hospital. Exactly what risk did she pose? What part of the quarantine did she violate? The judge ruled she could take walks and go for bike rides.
And why only quarantine those people who worked in Africa who clearly had far better protection than the staff who took care of the index patient in Texas? If a quarantine is necessary for them why don't we quarantine all HCWs in the US who take care of Ebola exposed or potential Ebola patients too? That would mean nurses, doctors, lab techs, phlebos, xray techs, housekeepers, laundry personnel, food services, etc. Where does it stop?
Tell me how that would work at your hospital, and the hospital/ward stay operational for 2 week stay of an ebola patient? Do the physicians, techs, and everyone else do the same thing? Now, let us assume the ebola patient came through the ER you could essentially put a whole ER shift of staff on 3 weeks of quarantine. One ebola patient would be enough to close most small hospitals in 1-2 days with these requirements.
Does this still sound reasonable? To me it sounds like unrealistic expectations based on fear and not scientific evidence.
I'm just now catching up on this. I work for a pretty big hospital so we have the staff to do this. Smaller places? Not so much. We can do it even though it isn't necessary. As you can see from this ever growing thread, the fears of the public (however unfounded) are guiding quite a few policies on this.
wtbcrna, MSN, DNP, CRNA
5,128 Posts
What court ordered her to follow home quarantine/monitoring? Did I miss something?
Were those patients exhibiting symptoms in the study or were they asymptomatic?
No test is going to have a 100% specificity and 100% sensitivity, but the ebola tests are extremely reliable when used in conjunction with physical symptoms/exams and exposure background.
I think the biggest misunderstanding is that some of these ebola research articles are being taken out of context, and several people keep going back to articles that aren't clinically applicable i.e. the ebola can last a long time if kept at 39 degrees Fahrenheit or the "airborne" ebola studies.