RN Detained and Quarantined As Ebola Hysteria Reaches a New Low

[MissyWrite]

NJ and NY have instituted a policy of placing health workers into mandatory 21-day quarantine upon their return from West Africa if they came into contact with Ebola patients.

This new policy is a reaction to unfounded public hysteria surrounding Dr. Craig Spencer's return to NYC after working with Doctors Without Borders, and his subsequent diagnosis of Ebola, after he had taken the subway and gone bowling. People fear Ebola can be spread through casual contact with an asymptomatic person, even though public health experts say there's plenty of scientific evidence indicating that isn't the case.

Is this policy based on the facts about Ebola transmission? Is it based on science? No, it's not, and in fact no one is saying that it is:

"Voluntary quarantine is almost an oxymoron," New York Governor Andrew Cuomo said. "We've seen what happens. ... You ride a subway. You ride a bus. You could infect hundreds and hundreds of people."

"Public health experts say there's plenty of scientific evidence indicating that there's very little chance that a random person will get Ebola, unless they are in very close contact -- close enough to share bodily fluids -- with someone who has it.

Still, there's also a sense that authorities have to do something because of Americans' fears -- rational or not -- and belief that the country is better off being safe than sorry.

Osterholm says, "You want to try to eliminate not just real risk, but perceived risk."

Mike Osterholm is an infectious disease epidemiologist at the University of Minnesota.

Because of this irrational "perceived" risk, Kaci Hickox, 33, an RN who has been caring for Ebola patients while on assignment with Doctors Without Borders in Sierra Leone, was detained at the airport, interrogated for hours, and placed in mandatory quarantine at a New Jersey hospital upon her return to the U.S. on Friday.

She has tested negative in a preliminary test for Ebola, and she does not have a fever, but the hospital says she will remain under mandatory quarantine for 21 days. She is not allowed to leave the hospital, unless officials reconsider that decision.

Here are some excerpts from her experience so far:

I am a nurse who has just returned to the U.S. after working with Doctors Without Borders in Sierra Leone - an Ebola-affected country. I have been quarantined in New Jersey. This is not a situation I would wish on anyone, and I am scared for those who will follow me...

I arrived at the Newark Liberty International Airport around 1 p.m. on Friday, after a grueling two-day journey from Sierra Leone. I walked up to the immigration official...

I told him that I have traveled from Sierra Leone and he replied, a little less enthusiastically: "No problem. They are probably going to ask you a few questions."...

He put on gloves and a mask and called someone. Then he escorted me to the quarantine office a few yards away. I was told to sit down. Everyone that came out of the offices was hurrying from room to room in white protective coveralls, gloves, masks, and a disposable face shield.

One after another, people asked me questions. Some introduced themselves, some didn't. One man who must have been an immigration officer because he was wearing a weapon belt that I could see protruding from his white coveralls barked questions at me as if I was a criminal.

Two other officials asked about my work in Sierra Leone. One of them was from the Centers for Disease Control and Prevention.

I was tired, hungry and confused, but I tried to remain calm. My temperature was taken using a forehead scanner and it read a temperature of 98. I was feeling physically healthy but emotionally exhausted.

Three hours passed. No one seemed to be in charge. No one would tell me what was going on or what would happen to me.

I called my family to let them know that I was OK. I was hungry and thirsty and asked for something to eat and drink. I was given a granola bar and some water. I wondered what I had done wrong.

Four hours after I landed at the airport, an official approached me with a forehead scanner. My cheeks were flushed, I was upset at being held with no explanation. The scanner recorded my temperature as 101. The female officer looked smug. "You have a fever now," she said. I explained that an oral thermometer would be more accurate and that the forehead scanner was recording an elevated temperature because I was flushed and upset.

I was left alone in the room for another three hours. At around 7 p.m., I was told that I must go to a local hospital. I asked for the name and address of the facility. I realized that information was only shared with me if I asked.

Eight police cars escorted me to the University Hospital in Newark. Sirens blared, lights flashed. Again, I wondered what I had done wrong.

At the hospital, I was escorted to a tent that sat outside of the building. The infectious disease and emergency department doctors took my temperature and other vitals and looked puzzled. "Your temperature is 98.6," they said. "You don't have a fever but we were told you had a fever."

After my temperature was recorded as 98.6 on the oral thermometer, the doctor decided to see what the forehead scanner records. It read 101. The doctor felts my neck and looked at the temperature again. "There's no way you have a fever," he said. "Your face is just flushed."

My blood was taken and tested for Ebola. It came back negative........

http://www.dallasnews.com/ebola/headlines/20141025-uta-grad-isolated-at-new-jersey-hospital-as-part-of-ebola-quarantine.ece

This is what happens to nurses when public ignorance and hysteria is placated by politicians.

We've already seen nurses blamed for just about everything Ebola-related since the first case in Dallas, and now we see a nurse being held against her will, for no reason except to make scared people "feel safer."

"It does present serious civil liberties questions," said Norman Siegel, a civil liberties lawyer in New York and the former executive director of the New York Civil Liberties Union. "Historically, we've had these kinds of issues occur previously, and the courts then resolved the individual liberty issue against the larger concerns of the public's health concerns. So it then becomes a factual issue, the fact that she tested negative."

"It's completely unnecessary," said Harvard's Ashish Jha, the director of the Harvard Global Health Institute).

"I'm a believer in an abundance of caution but I'm not a believer of an abundance of idiocy."

[Semolina]

Apparently Christie is joining Cuomo in backing down a bit so the nurse may get to go home.

http://www.nytimes.com/2014/10/28/nyregion/nurse-in-newark-to-be-allowed-to-finish-ebola-quarantine-at-home-christie-says.html?hp&action=click&pgtype=Homepage&version=LedeSum&module=first-column-region&region=top-news&WT.nav=top-news

[sistrmoon, BSN, RN]

The comments on the quarantined nurse articles are awful. It seems the majority opinion is that she is selfish, entitled and "too bad buttercup! You cared for Ebola patients, 21 days in quarantine is what you get." Some even say she should go ahead and die so she won't be a risk to others. These articles are a prime example of "never read the comments." Ugh.

[MissyWrite]

The comments on the quarantined nurse articles are awful.

They certainly are! I saw her called a 'prima dona,' and 'a disgrace to the nursing profession.' And so much more.

Scary how easy it is for Americans to give up their rights and freedom (oh, I mean someone else's rights and freedom) for no reason except their unfounded fear and the self-serving manipulation of a politician. Very scary.

And I'm scared for the nurse's safety now that she's been released. There is really an 'angry mob bearing torches' mentality out there about her.

[chadrn65]

Quarantined Ebola Nurse Kaci Hickox to Be Released by New Jersey - ABC News

"The New Jersey Department of Health issued a statement this morning that Hickox has been "symptom free for the last 24 hours," and that it decided to discharge her after consulting with the Centers for Disease Control and Prevention.

"After consulting with her, she has requested transport to Maine, and that transport will be arranged via a private carrier not via mass transit or commercial aircraft," the department said.

"Senior officials in the Christie administration said she will be driven in a car and escorted by officials from the state and Doctors Without Borders, the agency the Hickox worked for in West Africa".

"Health officials in Maine have been notified of her arrangements and will make a determination under their own laws on her treatment when she arrives," the New Jersey statement said".

[MissyWrite]

I have a nagging question, and maybe those of you in favor of the health worker mandatory quarantine (which I am not) can answer it. I haven't seen this addressed anywhere, at least not yet:

Dr. Craig Spencer is hospitalized with Ebola in NYC. The staff caring for him, as far as I know, are not quarantined. They leave work and go about their business. They ride the subway, go out for dinner, and maybe even go Ebowling. Who knows, they may even play some Basebola, which would entail touching bats and balls that others would then touch.

Why is that?

And what about when he's (hopefully) discharged from the hospital -- will the staff be quarantined at that time? If so, why would they be subject to a quarantine then, but not now? After all, they have had contact with an Ebola patient, and that is the criteria for quarantine.

[Susie2310]

Call me crazy, but if one is working in the heart of this disease, there SHOULD be a quarantine, until such time as there is no more risk.

What is not sensible about this?

Nurses very publicly bring to the attention of the public the lack of preparedness of health care facilities to deal with Ebola: lack of proper PPE, proper training, etc. They advocate for the highest level of PPE and proper training. The public listens. Health authorities listen. Politicians listen. A health care worker who recently returned from caring for Ebola patients was showing symptoms of Ebola and has tested positive for the virus. Other health care workers in this country who cared for Ebola patients have become infected with Ebola. A patient exposed to Ebola in another country died here in the US. It is the job of the public health authorities to take these events seriously, and to act to protect the general public. Medical experts are not certain as to how Ebola is transmitted from person to person. It appears some nurses are saying two things: 1) We want, and demand the highest level of PPE and training to protect ourselves (and the general public) from contracting Ebola when we care for patients who have/may have Ebola, and 2) We do not think it is reasonable for nurses/health care workers to be subjected to the inconvenience of quarantine when we care for patients with Ebola. I say such a position is highly contradictory, especially coming from nurses, whose work entails working with and caring for the general public when they are sick, when a short period of quarantine may prevent transmission of the disease to the general public. This thread reminds me of why a public health nursing course is valuable. Remember, even medical experts in disease transmission are not certain how the virus is transmitted from person to person. The general public are being sensible, not hysterical, in wanting quarantine for people who have cared for Ebola patients.

[sistrmoon, BSN, RN]

I'm actually in favor of quarantine, but I don't think the way it was gone about in this instance is exemplary at all.

[macawake, MSN]

It is the job of the public health authorities to take these events seriously, and to act to protect the general public.

Wouldn’t that for example be the CDC, rather than a politician who may have other motivations to appease the general public a.k.a. voters, apart from purely scientific ones?

Also so far, not a single member of the general public in the US has actually been infected locally. Not even a close family member has been infected, and that includes those who’ve shared living quarters with a symptomatic person (Dallas index patient).

Medical experts are not certain as to how Ebola is transmitted from person to person.

You and others keep repeating this. I wonder what the root of this misconception is. Infectious disease experts are not at all concerned that an asymptomatic person is contagious. They know that they aren’t. There are some unknowns about Ebola, that isn’t one of them.

A person’s bodily fluids are contagious when the viral load is high. Coming in contact with these fluids means there's a risk of becoming infected. This has been explained ad nauseam by experts, I don’t understand why it’s so difficult to embrace. There’s decades worth of empirical data available to support this.

It appears some nurses are saying two things: 1) We want, and demand the highest level of PPE and training to protect ourselves (and the general public) from contracting Ebola when we care for patients who have/may have Ebola, and 2) We do not think it is reasonable for nurses/health care workers to be subjected to the inconvenience of quarantine when we care for patients with Ebola. I say such a position is highly contradictory

Again, I think that’s apples and oranges. It’s infectious vs not infectious. I don’t see a contradiction. Not only don’t I see the contradiction, but I also have serious concerns that this decision will make our efforts to contain the current outbreak in West Africa even more of a challenge. If that becomes reality, it will come back and bite us in our collective rear end.

This thread reminds me of why a public health nursing course is valuable.

I have taken public health nursing classes, but I’m not sure I understand why it should make me interpret research and other available information any differently.

The general public are being sensible, not hysterical, in wanting quarantine for people who have cared for Ebola patients.

Pretty much all of us suffer from confirmation bias to some extent.

I was thrilled to find out that a smart bioethicist agrees with me (or I with him, rather) If you harbor uncertainties about how Ebola is transmitted, and how it’s not, it stands to reason that you wouldn’t find the general public hysterical. If you feel the same way as they do, the hysteria label probably isn’t one that you’re willing to consider.

Since you support a mandatory quarantine, what do you think that the quarantine period should be? Twenty-one days? If so, why should it be twenty-one days?

Should all healthcare workers, including those who’ve cared for patients in US hospitals, be placed under quarantine?

The reason why I asked about the length of the quarantine, is that twenty-one days is what scientists and medical experts have concluded is the maximum incubation period.

If you trust them on that, why don’t you trust them on the fact that the Ebola Virus Disease isn’t transmitted in the asymptomatic phase? Perhaps we should quarantine people for 42, 84 or 168 days to be really, really, really sure that there’s no risk. Or simply throw away the key. (In case anyone thinks that this sounds like a brilliant idea, I’m not being serious).

I, like every other healthcare worker, want as few human beings as possible to get infected by Ebola. I wouldn’t argue against the implementation of quarantines, if I thought that they in any way would help stop the further spread of EVD. I don’t think that isolating non-infectious healthcare workers, who could instead be doing something useful and productive, will help contain this outbreak.

[OCNRN63, RN]

These are excellent examples of how people cherry-pick facts in order to make them fit their beliefs. Great job of explaining the facts, macawake.

[Susie2310]

Wouldn't that for example be the CDC, rather than a politician who may have other motivations to appease the general public a.k.a. voters, apart from purely scientific ones?

Also so far, not a single member of the general public in the US has actually been infected locally. Not even a close family member has been infected, and that includes those who've shared living quarters with a symptomatic person (Dallas index patient).

You and others keep repeating this. I wonder what the root of this misconception is. Infectious disease experts are not at all concerned that an asymptomatic person is contagious. They know that they aren't. There are some unknowns about Ebola, that isn't one of them.

A person's bodily fluids are contagious when the viral load is high. Coming in contact with these fluids means there's a risk of becoming infected. This has been explained ad nauseam by experts, I don't understand why it's so difficult to embrace. There's decades worth of empirical data available to support this.

Again, I think that's apples and oranges. It's infectious vs not infectious. I don't see a contradiction. Not only don't I see the contradiction, but I also have serious concerns that this decision will make our efforts to contain the current outbreak in West Africa even more of a challenge. If that becomes reality, it will come back and bite us in our collective rear end.

I have taken public health nursing classes, but I'm not sure I understand why it should make me interpret research and other available information any differently.

Pretty much all of us suffer from confirmation bias to some extent.

I was thrilled to find out that a smart bioethicist agrees with me (or I with him, rather) If you harbor uncertainties about how Ebola is transmitted, and how it's not, it stands to reason that you wouldn't find the general public hysterical. If you feel the same way as they do, the hysteria label probably isn't one that you're willing to consider.

Since you support a mandatory quarantine, what do you think that the quarantine period should be? Twenty-one days? If so, why should it be twenty-one days?

Should all healthcare workers, including those who've cared for patients in US hospitals, be placed under quarantine?

The reason why I asked about the length of the quarantine, is that twenty-one days is what scientists and medical experts have concluded is the maximum incubation period.

If you trust them on that, why don't you trust them on the fact that the Ebola Virus Disease isn't transmitted in the asymptomatic phase? Perhaps we should quarantine people for 42, 84 or 168 days to be really, really, really sure that there's no risk. Or simply throw away the key. (In case anyone thinks that this sounds like a brilliant idea, I'm not being serious).

I, like every other healthcare worker, want as few human beings as possible to get infected by Ebola. I wouldn't argue against the implementation of quarantines, if I thought that they in any way would help stop the further spread of EVD. I don't think that isolating non-infectious healthcare workers, who could instead be doing something useful and productive, will help contain this outbreak.

Quarantine is a public health measure and in this country states have varying quarantine laws.

The federal government has control over issues related to public health at ports of entry to the country, including airports and shipping ports.

I hope this is helpful.

[MissyWrite]

If you harbor uncertainties about how Ebola is transmitted, and how it's not, it stands to reason that you wouldn't find the general public hysterical. If you feel the same way as they do, the hysteria label probably isn't one that you're willing to consider.

Macawake, you have gotten down to the crux of the matter. If a person believes there are uncertainties regarding how the virus is transmitted, then they will of course feel they're being perfectly reasonable.

But why do they believe that? It can only be their source of information. I have not heard one epidemiologist, scientist, expert of any sort, say that Ebola might be contagious in an asymptomatic person.

Perhaps we should quarantine people for 42, 64 or 168 days to be really, really, really sure there's no risk

Another good point. Why do people believe the experts when they say 21 days is the longest possible incubation period, yet not believe the same experts when they say the virus is not transmittable when a person is asymptomatic?

It's not a rhetorical question, so if anyone wants to share their thoughts, please do.

I started on this site with a few posts criticizing the PPE recommended by the CDC. I felt it was woefully inadequate. It was, and the CDC agreed and changed their guidelines. But I'm against mandatory quarantines for healthcare workers. It may seem like a contradiction, but it's not. Caregivers are the ones at risk (something that has been shown consistently) -- they care for patients when the viral load is high and body fluids are produced in large quantities, and that is when the virus can spread. And I know that HCWs are not a risk to others -- nor is any other asymptomatic person -- because the virus is not spread when a person is asymptomatic.

If the virus was transmittable during the asymptomatic phase, wouldn't the world have seen evidence of that?

[brandy1017, ASN, RN]

Frankly I think a quarantine is not a bad idea and since the CDC has been running around and destroying every Ebola patient's home and its belongings in their decontamination effort, I would think they would prefer to be quarantined other than their home. Honestly I don't understand the need to destroy everyones belongings, seems way overkill to me! Personally I love my home and wouldn't want someone to come in and destroy everything. Now that I could see a lawsuit over, not a quarantine that is meant to protect everyone so you don't have to run around and find out who they were in contact with if they test positive for Ebola.

The nurses quarantine may not be ideal, but coming from the accommodations available in West Africa it couldn't be that bad!