In an attempt to address the heated national debate over how to treat people entering the country from Ebola-stricken countries, the federal government on Monday issued interim guidance on the monitoring and movement of people who may have been exposed to the deadly virus.
The new guidance from the Centers for Disease Control and Prevention (CDC) is for monitoring people who may have come into contact with Ebola and to help decide whether their movements should be restricted.
It says people who are at high risk of Ebola but do not have symptoms should be closely monitored and have their movements restricted but would not be required to undergo mandatory quarantine.
The federal agency does not have the power to enforce the guidance – it is up to individual American states to decide for themselves.
The guidance says the level of restriction would depend on the risk category people fall into, based on their level of exposure to Ebola. There are four categories: high risk, some risk, low (but not zero) risk and no risk.
People in the high-, some- or low-risk category who have symptoms of Ebola would have the highest level of movement restriction. They should be isolated immediately and the public health authorities should be contacted so they can arrange for the individual’s safe transport to an appropriate medical center for Ebola evaluation.
Symptoms are defined as fever or temperature =100.4°F/38°C, or any of the following: severe headache, muscle pain, vomiting, diarrhea, stomach pain, or unexplained bruising or bleeding.
If, following medical evaluation, individuals classed as high, some or low risk are found not to have Ebola, then their movements are restricted according to the category of risk they fall into.
High-risk individuals – for example anyone returning from West Africa who pierced their skin with a needle or became exposed to blood or body fluids while caring for an Ebola patient with symptoms – can undergo “direct active monitoring” at home. But they would be told they cannot use public transport for 21 days, and they could be barred from air travel.
High-risk individuals would not have to stay at home – but they would be told not to go to public places such as shopping malls and movie theatres, although they could participate in “non-congregate” activity such as jogging in the park, as long as they kept at least 3 ft away from other people. And they would be told not to work outside the home.
In a telephone briefing, director of CDC Dr. Tom Frieden said active monitoring means the person would be accountable to the local health department or state health department. Their temperature would be monitored twice a day, and they would also have a detailed conversation every day with a health official about their symptoms and any planned activities or travel: “there would be an individualized assessment of what makes sense for that individual at that time,” he added.
From data the CDC has analyzed from Africa, it appears that more than 90% of cases occur in the first two weeks following exposure.
People categorized as being of some risk for Ebola – for example if they were in direct contact with a symptomatic Ebola patient in West Africa while using appropriate protective equipment – should also be actively monitored. And it would be up to local authorities to decide whether to impose restrictions on travel, work, and attending public gatherings, “based on a specific assessment of the individual’s situation,” notes the CDC guidance.
People at low risk – for example people who have traveled to a country with an Ebola epidemic but who did not come into contact with Ebola patients – should have their temperature and symptoms monitored, but would be able to travel freely.
No action is needed for people in the no risk category – if they have any symptoms they should undergo routine medical evaluation, as for any illness. People in this category include anyone who has been in contact with an asymptomatic person who had contact with an Ebola patient, and people who were in an Ebola-stricken country over 21 days ago.
Dr. Frieden says the new guidance focuses on individualized assessment, and uses the agency’s experience to increase the protection of Americans, which is the first priority. He also praises the “heroic work” that health care workers are doing to protect the US in West African countries, and says the guidelines outline what can be done to protect them and the rest of the public.
But some authorities are not happy and say they are going to impose tighter restrictions. The New York Times report that Gov. Andrew M. Cuomo of New York and Gov. Chris Christie of New Jersey consider the guidance to be unsafe. The US Army chief of staff, Gen. Ray Odierno, has ordered a “controlled monitoring period” that could force hundreds of troops returning from Ebola-stricken countries to be isolated for 21 days on their American bases, away from their families.
However, there is also a view that adding another 3 weeks of isolation to the 5 or 6 weeks that health care volunteers may give of their time to help with the Ebola crisis could be enough to put them off going altogether.
The global priority in the fight against Ebola must be to contain it in West Africa, and for that the countries affected need as much help as they can get – nurses and doctors volunteering from the US and elsewhere are an important part of that help.
In a statement on Monday, Doctors Without Borders/Médecins Sans Frontières (MSF), concurs with the CDC guidance that forced quarantine is not necessary for asymptomatic health workers returning from the Ebola outbreak, because it “is not grounded on scientific evidence and could undermine efforts to curb the epidemic at its source.”
“Diligent health monitoring of returnees from Ebola-affected countries is preferable to coercive isolation of asymptomatic individuals,” say MSF.
The medical humanitarian organization points to the example of American physician and MSF aid worker Dr. Craig Spencer who returned to New York from Guinea and was subsequently diagnosed with Ebola. He “immediately reported the onset of fever symptoms, setting into motion his secure transfer to Bellevue Hospital in Manhattan, where he is receiving comprehensive treatment.”
Sophie Delaunay, executive director of MSF-USA, says there are other ways to address 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. Any regulation not based on scientific medical grounds, which would isolate healthy aid workers, will very likely serve as a disincentive to others to combat the epidemic at its source, in West Africa.”
Meanwhile, Medical News Today learned that trials are due to start in Guinea in November that will test whether antibodies from the blood of Ebola survivors are safe and can help infected people fight the virus.