Now to today's topic... A forced quarantine is a PITA for everyone involved--the quarantine-ee, the public officials who have to make the decision to quarantine a person, the public officials (usually law enforcement) who have to enforce the quarantine order, and the public in general. As we can see by this currently trending case, there are a number of issues that don't easily fall into place when it comes to setting and enforcing a quarantine.
Some years back quarantine was a pretty big issue when SARs was happening although, for all the talk at high levels about setting and enforcing quarantines, not much came of it after the disease had abated. Now we have ebola which highlights some very important issues regarding quarantine (death within a couple of weeks after exposure will certainly bring the issue to the forefront). In no particular order:
- Someone has to have the last and final word on the quarantine process yet currently no one wants to do that. One would think it would be the CDC but it looks like the decision (and the potential lawsuits) are being foisted off onto governors, mayors, and other government folks without an infectious disease degree among the lot of them.
- The quarantine process needs to be standardized. Either everyone is quarantined for 21 days after being in an ebola area or no one is. Either everyone with a fever is quarantined after returning from an ebola area or no one is. Right now it is hit or miss.
- The quarantine process (after it is standardized) needs to be refined. Obviously this will take time but after quarantining everyone who is returning from an ebola area for 21 days, over a period of months researchers will then need to look at the data and see if this particular quarantine process is useful and necessary or not useful and not necessary (this will change for each disease). Then refinements to the process can be made. Right now people want to change the process every other day which is confusing and ineffective.
- Of course you will always have people who think the quarantine rules don't apply to them. Someone can be highly contagious (as we saw with Patient 0 in Dallas) and they still won't think that officially or unofficially quarantining themselves would be a wise idea. There are a lot of self-entitled fools running around so this should play into your preparedness efforts in the event of a highly contagious, deadly disease outbreak.
- With this in mind, keeping people quarantined requires a huge effort and a great deal of manpower. Whether it is taking care of an infected person in a medical facility or ensuring that someone who is quarantined to their home actually stays there, the number of people required to take care of one person is huge (can you imagine what would happen if we have thousands and thousands of ebola patients a la Nigeria?).
- Also from the 'people will be people' file, I imagine a vast majority of people will ignore serious warnings of a a deadly infectious disease because #1 they can't afford not to work and don't get sick leave, #2 they often let culture overcome common sense (like sneaking the bodies of ebola victims into private burial sites instead of having the bodies burned as is now being required in some areas), and #3 people aren't used to staying home for 21 days in a row. In fact, most aren't used to staying home for three days in a row without getting cabin fever.
- From the "am I in the Twilight Zone" file: Every time someone says "we can't quarantine someone who is recently back from treating ebola patients because then no one will want to go help ebola patients," it makes me want to do a face palm. Because people are good enough to volunteer to help ebola victims does it mean they should be allowed to not be quarantined and be allowed to possibly spread the disease to others? That doesn't even make sense.
- Does the public good trump your rights to freedom, etc? It should. The problem here is that there is so much confusion and misinformation on the subject of quarantining people who may have been exposed to ebola that there doesn't look like a clear public health threat so people want their freedoms. Now.
- The nicknames that people and buildings and towns, etc pick up from being linked to a deadly disease will stick for a long time. The ebola nurse, the ebola hospital, the ebola apartment building, the ebola flight.
- This entire situation is a no-win for those involved. Whether people are making quarantine decisions, enforcing quarantine decisions, or chiming in with a worthless public opinion fanned by the flames of social media, the bottom line is staying alive and not dying from a deadly disease which many people seem to forget.