On Ebola, Quarantines And Similar Oct 4, 2014 17:55:44 GMT -6
Post by jeffolie on Oct 4, 2014 17:55:44 GMT -6
On Ebola, Quarantines And Similar
I'm sure you've heard that the Dallas Ebola patient's family has been forcibly quarantined.
I've been pinged repeatedly since this story first broke on my views with regard to armed quarantines and similar, and some fanciful views (in my opinion) have been put forth, including by some folks that I hold in generally high regard and consider to be some of the more-thoughtful among us.
Let's start with a few of the suggestions:
•Quarantine anyone coming into the country that comes from either a "hotspot" nation or where the origination point does not have effective quarantine regulations and powers. That's a nice sentiment, but the quarantine requirement in this case would be three weeks. The first question is where do you put them since any could be infected and, if they are, you can't reasonably condemn an entire hotel! You could force travelers to pay for this (obviating the expense issue that otherwise exists but that would immediately terminate all business travel to and from any place on your designated list as most business trips are for far less time than the quarantine period. Think long and hard before adopting such a position folks.
•Lock down the borders. Uh, how? Terminate all international inbound travel? Ok, go ahead and try that. Note that the individual in question lied about his exposure and thus risk and was not symptomatic at the time of the flight, which means there was no way in a reasonable period of time to verify whether he was lying or not. This is an intractable problem unless you lock down the border entirely because people can (and do!) originate somewhere, travel through a place in which there is a problem, officials there may cooperate (in exchange for a bribe or just simply on principle) with not stamping a passport and you can (in most cases) travel in and out of such areas without using a documented means (e.g. other than an airplane.) Both we and the affected nations are already screening people, including Liberia where this guy originated. Again, verification is impossible in the few seconds or minutes you need to both change your status and the amount of time you have to verify a passenger's claims.
Ebola, thankfully, is a rather poorly-transmitted virus. It's "N" value, that is, the number of people (on average) infected by a person who has it, is about 2. For comparison purposes this is about the same as HIV, but of course HIV infects people over a very long period of time where ebola only infects people during the period from symptoms appearing until recovery (or death and proper disposal of the body.) To put some perspective on this measles has an "N" value of something around ten times that figure.
The bad news is that measles rarely kills but ebola often does. But -- one must be careful here because ebola's history is one from nations with poor health care in general and specifically, poor compliance with even basic sanitary considerations in the health care setting, say much less anywhere else. Measles is quite commonly fatal in the same sort of environment; fatalities in the 20% range are not uncommon in those parts of the world..
The CDC proposed prospective quarantine regulations that were killed in 2010. These, again, sound good -- but would they have caught this case? No, because this individual lied about his exposure and he was clear of symptoms at the time of both boarding and arrival. Further, the proposed regulation would have only granted a three day window of observation, which is sufficient if someone is becoming symptomatic but grossly insufficient in the case of a disease with a potential three week incubation period.
So cut the crap - these so-called regulations would have done nothing in this case, nor will they be effective in preventing the entry of diseases of this type into the United States. 100% 4-week quarantines and closed borders ex passage through such a quarantine would, but that presumes no violations of the protocol and essentially ends all leisure and short to intermediate-term business travel on an international basis, putting all of the related industries, such as the cruise industry, out of business immediately.
So what do you do when someone has potentially been exposed and refuses to self-quarantine? Is the use of force reasonable in these circumstances? Good question; under the law as it currently stands it can certainly be done, but whether it should, and whether those laws are proper, is an open question without simple answers.
Ebola is somewhat of a novel case in that most viral and bacterial infections can be spread prior to the appearance of symptoms, and are very easily spread. That is why their "N" value is much higher than ebola's. On the other hand even the most-virulent flu strains don't kill roughly half of their victims with appropriate medical support and even more without.
So what do we do here?
First, stop with the tinfoil panic nonsense! This is a very inefficient disease as viruses go. That's good as it means the risk of getting nailed is not very high, even if sick people are in your vicinity. It requires quite-close contact to transmit the virus and even when virologists tried to rig up an airborne scenario (and they did) they got rather poor results. Poor = nowhere near the transmission rate (100%) expected.
Second, if you wind up exposed do expect to be quarantined. I can't support the ethics of quarantine of someone who isn't symptomatic (until and unless the same people enforcing the quarantine also claim transmission occurs prior to symptom appearance -- yes, government goons, this means you) but from a panic control perspective what they're doing makes sense.
Third, if this thing gets loose and takes off in the population forget about any sort of quarantine being effective. It won't be, period, full-stop. There aren't enough cops (by a long shot) to stick one on every suspected exposed person's house, say much less two or more. Forget about it. Further, even a small instance of this spreading on a national basis (e.g. 100s of cases in each of a number of metro areas) results in the instantaneous overload and collapse of our hospital infrastructure to provide treatment -- period -- and there is nothing we can do about that prospectively.
Fourth, if this thing gets loose you better be prepared to bug in, as I have noted before, because there is no other option that will materially change the odds of outcome for your personal case. And by "bug in" I mean at least six months of "bolt the door, do not come out" capability, and probably more.
There is not 1 person in 100 reading this who has prepared to do so, nor will 1 in 100 of you do so now. Nor, on an odds basis, does it make sense; the odds of you needing to actually execute on that are very low, but if it happens there will be no opportunity to prepare at that time -- you will either have already done so or not, and that's that.