The New England Journal of Medicine, one of the most prestigious academic medical journals in print, is out Monday with a scathing editorial on the recent Ebola quarantine policies imposed in New York and New Jersey.
The policy, the editorial's authors write, "is not scientifically based, is unfair and unwise, and will impede essential efforts to stop these awful outbreaks of Ebola disease at their source, which is the only satisfactory goal.... In the end, the calculus is simple, and we think the governors have it wrong."
After the first case of Ebola was reported in New York City on Friday, both states imposed a policy of mandatory 21-day quarantines of health care workers returning from Ebola-affected countries. Those policies provoked criticism of overreaction and fears that it would stifle the flow of much-needed volunteers to West Africa. In response to the criticism, New York Gov. Andrew Cuomo relaxed the guidelines to allow health care workers to stay in quarantine at home.
The NEJM editorial agrees with the outcries. "The governors' action is like driving a carpet tack with a sledgehammer: it gets the job done but overall is more destructive than beneficial," the authors write.
It's an overreaction, they explain, because the science consistently finds that a patient is only contagious when he or she is symptomatic. And more than that, they write, "we now know that fever precedes the contagious stage, allowing workers who are unknowingly infected to identify themselves before they become a threat."
So upon onset of a fever, there is still some time before a person with Ebola becomes contagious—that's why the nurses who cared for Thomas Eric Duncan were more easily infected than the family he stayed with before falling ill.
NEJM says Craig Spencer, the doctor who fell ill in New York, is the model for self-reporting. When he started showing a fever, he reported his symptoms and treatment began before he became highly contagious.
The authors conclude:
We should be honoring, not quarantining, health care workers who put their lives at risk not only to save people suffering from Ebola virus disease in West Africa but also to help achieve source control, bringing the world closer to stopping the spread of this killer epidemic.