Thursday, October 30, 2014

An Inconvenient Truth

Another at-bat for Common Sense:
TRENTON — After days of blistering criticism from the ACLU, the CDC and even the United Nations secretary general over Gov. Chris Christie’s new, 21-day mandatory quarantine policy for all healthcare workers exposed to Ebola, the New Jersey governor has gotten a much-needed vote of support from a heavyweight name in the medical community: Nobel Prize-winning doctor and medical researcher, Dr. Bruce Beutler.

Dr. Beutler, an American medical doctor and researcher, won the Nobel Prize for Medicine and Physiology in 2011 for his work researching the cellular subsystem of the body’s overall immune system — the part of it that defends the body from infection by other organisms, like Ebola.

He is currently the Director of the Center for the Genetics of Host Defense at the University of Texas Southwestern Medical Center in Dallas — the first U.S. city to treat an Ebola patient and also the first to watch one die from the virus. In an exclusive interview with NJ Advance Media, Beutler reviewed Christie’s new policy of mandatory quarantine for all health care workers exposed to Ebola, and declared: “I favor it.”

Unfortunately, while the doctor’s support might provide much-needed credibility for Christie as he threatens to quarantine ever more healthcare workers returning from the Ebola fight in West Africa, it also comes with some chilling words.
“I favor it, because it’s not entirely clear that they can’t transmit the disease,” Beutler said, referring to asymptomatic healthcare workers like Kaci Hickox, a Doctors Without Borders nurse returning from treating Ebola patients in Sierra Leone who was quarantined in New Jersey for 65 hours before being transported to her home state of Maine on Monday afternoon.

“It may not be absolutely true that those without symptoms can’t transmit the disease, because we don’t have the numbers to back that up,” said Beutler, “It could be people develop significant viremia [where viruses enter the bloodstream and gain access to the rest of the body], and become able to transmit the disease before they have a fever, even. People may have said that without symptoms you can’t transmit Ebola. I’m not sure about that being 100 percent true. There’s a lot of variation with viruses.”
In fact, in a study published online in late September by the New England Journal of Medicine and backed by the World Health Organization, 3,343 confirmed and 667 probable cases of Ebola were analyzed, and nearly 13 percent of the time, those infected with Ebola exhibited no fever at all.
Why, then, does he think the CDC would so emphasize Ebola is not communicable in patients without symptoms?
“There’s some imperative to prevent panic among the public,” says Dr. Beutler, “But to be honest, people have not examined that with transmissibility in mind. I don’t completely trust people who’d say that as dogma.”

As such, allowing home confinement for medical workers exposed to Ebola but currently without symptoms was, as Beutler put it, “a move away from goodness,’ as an engineer might say.”

The U.S. Centers for Disease Control and Prevention changed direction and called for voluntary home quarantine for workers with the highest risk for Ebola infection. However, it also specified that most medical personnel returning from Sierra Leone, Liberia and Guinea would not need to be kept in isolation, as Hickox had been ever since she arrived at Newark International Airport on Friday up until her release and transfer to home quarantine in Maine early Monday afternoon.

“Even if someone is asymptomatic you cannot rely on people to report themselves if they get a fever,” said Dr. Beutler, adding, “You can’t just depend on the goodwill of people to confine the disease like that – even healthcare workers. They behave very irresponsibly.”

Christie has repeatedly pointed to the fact that NBC’s chief medical editor, Dr. Nancy Snyderman, after returning from Ebola besieged West Africa, was spotted violating her voluntary quarantine to get takeout from a Princeton eatery last week.

Despite her forced detainment by the New Jersey health department, Hickox insisted hat she was “feeling physically healthy” and except for a single, non-contact thermometer reading that registered her as having a 101 Fahrenheit fever, has had normal 98.6 F temperatures ever since her quarantine began.

“These are no arguments at all,” said Beutler. “Anyone could say that about any disease. It doesn’t matter that she was afebrile – she should be quarantined for 21 days.”

Hickox has complained that “her basic human rights were violated” and has since retained a civil rights attorney, but Beutner says he is puzzled by the argument.

“These people act like they are returning as conquering heroes — and they should be treated as conquering heroes, but part of being a conquering hero means making sure no one gets infected by you. Just look at the the foolish quarantine where astronauts came back from the moon [where there were no germs] and in this case, we know there is an infection.”

From a global perspective, it’s unlikely that the virus will take hold as an epidemic in the U.S., but in Africa, Beutler says it already “has gone ballistic – way, way beyond the past epidemics. One could project that maybe millions could be infected. It may be that it won’t spread like wildfire in the United States but even if one or two more people die, it will be too many.”

So, does Gov. Chris Christie have it right?

“I’d be a little bit more strict than he is being,” said Beutner, “I realize this would be inconvenient, but I don’t think it would prevent treating the disease.”

Christie has not been willing to publicly explain how home quarantine would work in cases like, for example, where a healthcare worker also had children at home.

“You’re in your home,” Christie deadpanned to the question when asked it was asked of him in Groton, Connecticut Monday night, “and you’re quarantined.”

“I know at times that you all would like to make things a heck of a lot more complicated than they are,” said Christie, “In home quarantine means: In-home. Quarantine. If they are asymptomatic, they can be quarantined in their home.”

Beutler disagrees with this, saying “the ideal scenario is where a patient is isolated from all family members,” preferably in an specialized hospital ward, not in a home.

The thought of an afebrile parent passing Ebola on to a child – as ostensibly can happen 13 percent of the time, “would disturb me. The point of quarantine of is to make sure they [Ebola viruses] are not carried elsewhere. It’s a little bit frustrating. Some of the things that are being done are not completely motivated by safety. For some reason, there’s an imperative to maintain open borders no matter what – to err on the side of total individual freedom rather than on the side of public health,” he said, adding, “If you really want to isolate a disease, then you have to isolate the people who carry it.”

SCIENCE, bitchez.


  1. All that can be done is to announce a quarantine and then let the nurse and her lawyers work to break it, once free she can infect as many people as she wishes then if she gets Ebola you say "I told you so" and then it will be a good thing she has a lawyer.

  2. Point being, if she were a decent and moral person, with principled objections to the quarantine, she'd abide by it while her lawyers fought it in court, not irresponsibly and selfishly go skylarking around the community and daring them to throw a net over her.

    The latter makes me actively hope someone decides to swerve and run her stupid ass over, for the good of humanity, and on general moral principles. We have no shortage of irresponsible twits, and there should be no bag limit.

  3. This behavior from Hickox is part of the "me" in the "I" generation, as in look at me, I'm a hero for what I did in West Africa. Real heros take no applause, do not endanger others, and will sacrifice themselves if necessary, which includes at least confining themselves from others until they know.
    Here's the thing, it's great that she went to West Africa to help people. All of us should have no problem with that. The problem is that she was in direct contact with Ebola victims, not visiting the local company office in the country. So she is at high, even extreme risk to being infected.
    The science says she is not a risk. But who's science, because you can find two reputable scientists who will disagree with each other on the subject, on the transmissive nature, on the incubation parameters. This not to cause a panic because we are in a world of science. But any good scientist or engineer will tell that the science is good until better science supersedes it.
    So what do we do about it? Well does it not make common sense to quarantine or at least "restrict to quarters" a person that has been in direct contact, even if they are currently symptom free. It's really about the fact that we DO NOT KNOW for sure. It's to be safe, it's to keep the general populace from panicking, that's the WE part of society. By the way there are lots of science comments. Well medical science is only one version. How about social science, where people do stupid things because of fear. We're doing quarantine for military staff, because we can, but also those military staff are "sheep dogs", they don't want to take the chance of bringing it home, so I bet they're not bitching and whining.

  4. I bet they are bitching and whining, because I've been them. But they're doing it privately, among themselves, sucking it up, and moving on. And if you or I walked up to them and started bitching, they'd tell us to STFU and butt out, and if one of their own started bellyaching in public, they'd pull him aside for some wall-to-wall counseling, and that'd be the last you ever heard of it.

    But yes, the quarantine is out of caution and prudence, because of how much we don't know, and because other people's lives are at stake.

    The answer to someone doing good deeds isn't to therefore endanger the whole community.