First, do no harm

Kaci Hickox, the nurse who wound up as the first victim of New Jersey Governor Chris Christie's mandatory ebola quarantine, wasted no time in lawyering up and threatening to sue over her "inhumane" treatment.  It's not yet known whether Christie's decision today to allow her to spend the rest of her quarantine in Maine will change her mind. In the meantime, the pros and cons of the quarantine rules imposed in Illinois and New York state as well as New Jersey, and firmly opposed by the White House, are getting plenty of airplay.

The case against the quarantines is spelled out in this Slate piece by Josh Voorhees.  The argument is basically twofold.  First, there's no reason to think that quarantining asymptomatic individuals who've been in contact with ebola patients will do anything to reduce the risks of a larger-scale outbreak within the US.  Second, if the threat of being quarantined on returning home deters doctors and nurses from traveling to West Africa to deal with the outbreak there, then controlling that outbreak and preventing it from spreading further will become much more difficult.

Those are important points, and certainly Voorhees is convinced by them.  However, it seems harsh to conclude, as Voorhees does, that the states that are imposing these quarantines are doing so for political rather than medical reasons. Consider this quote from Kaci Hickox: "We need to be careful about letting politicians make medical decisions".  That would be easier to argue if the decisions made by medical professionals in recent weeks had been better.  The second nurse to come down with the virus in Dallas, after treating the patient from Liberia, saw no reason not to fly to Cleveland and back during the incubation period for the disease.  What makes this so worrying is that she contacted the CDC for advice and was told to go right ahead.  Voorhees mentions this case but says airily that the CDC now admits that may have been a mistake. Indeed so, and it's the sort of mistake that prompts politicians like Chris Christie to take draconian steps like the mandatory quarantine.

Then there's the case of the doctor now under treatment for ebola at Bellevue in New York City.  After returning from a stint in West Africa,  he resumed his normal routine, riding the subway and going bowling, even though he started noticing signs of fatigue and lethargy.  He only presented himself at Bellevue when he developed a fever.  Again, this is not the kind of astute medical decision to inspire Gov. Christie et al to leave things to the professionals.  

The fear that quarantines will deter medical professionals from going to Africa to tackle the ebola outbreak there is a real one, but there's a flipside to that too.  If doctors and nurses are allowed to re-enter the US without any quarantine and the result is a sudden spread of the disease within the US, the almost inevitable response will be for the Federal Government to focus all its efforts on eradicating the disease at home, rather than allowing even more professionals to travel to West Africa and risk becoming infected. That would be in nobody's best interest, especially not West Africa's.  

It remains to be seen whether the three states that have imposed these restrictions will bow to Washington's wishes and rescind them. On the whole it seems unlikely: having taken the initial step, no Governor is likely to take the risk of changing his mind and then seeing the disease get loose within his jurisdiction.  Until the promised ebola vaccines are rolled out, heavy-handed measures like quarantines will remain part of the story.