HEALTH

When doctors risk their lives and sacrifice their livelihoods to go to West Africa and provide desperately needed treatment to those suffering from Ebola, what should be their reward upon coming home? Three weeks off, some say—whether they like it or not. (CNN)

Learn more about one of the first Ebola quarantines.

Teachers, scroll all the way down for a short list of key resources in our “Teachers’ Toolkit.”

Discussion Ideas

• The Centers for Disease Control and Prevention says “Isolation and quarantine help protect the public by preventing exposure to people who have or may have a contagious disease.” What is the difference between isolation and quarantine? Are people returning from West Africa being isolated or quarantined?
  • Isolation separates sick people with a contagious disease from people who are not sick.
  • Quarantine separates and restricts the movement of people who were exposed to a contagious disease to see if they become sick.
  • Health-care workers returning from work with Ebola patients in West Africa are sometimes being quarantined. They are not sick, and health-care officials monitor their health to see if they develop symptoms of Ebola. (Read more about Ebola and its symptoms here.)

 

• According to the CDC, the government is only allowed to quarantine people who may have specific diseases: cholera, diphtheria, infectious tuberculosis, plague, smallpox, yellow fever, viral hemorrhagic fevers, severe acute respiratory syndrome (SARS), and some strains of the flu. Why were these diseases chosen? Why not chicken pox, or cancer?
  • The diseases listed are very, very infectious, and very, very dangerous. This means that, without extreme precautions, they are likely to spread from one person to another and cause great harm (possibly death).
  • Chicken pox is a highly infectious disease, but it is usually not very dangerous, and there are effective treatments for people exposed to it. No need for quarantine.
  • Cancer can be very dangerous, but it is not infectious. You can’t “catch” cancer from someone who has it. No need for quarantine.

 

• Ebola is not on the CDC quarantine list. Why are people who may have been exposed to Ebola being quarantined? Our “All About Ebola” blog post might help.
  • Ebola is on the list, actually. It’s a “viral hemorrhagic fever.” Other viral hemorrhagic fevers include the Hantavirus and encephalitis.

 

• The quarantine period imposed in New York and New Jersey is 21 days. Will that probably be effective in identifying people with Ebola?
  • Yes. As far as we know, Ebola symptoms will surface within 21 days of exposure to the disease.

 

• New York and New Jersey have enacted the strictest quarantine procedures in the United States—all health-care workers returning from West Africa will be quarantined for 21 days. New York Gov. Andrew Cuomo has loosened the restrictions somewhat, allowing returnees to be quarantined in their homes instead of hospitals or airports. Still “It’s a home quarantine but it is a mandatory quarantine,” according to the governor. Why are some people, including health-care workers and the White House, criticizing this mandatory quarantine? This CNN article might give you some ideas.
  • The quarantine policy may not be based on science, but on the public perception of the disease. This contributes to ongoing misconceptions about Ebola and how it can be transmitted. Kaci Hickox, a nurse who was quarantined, has spoken out against the policy. “It is not a sound public health decision and well-thought out,” Hickox told CNN. “Many of the experts in the field have come out to agree with me. So I think that we need to stress the fact that we don’t need politicians to make these kinds of decisions. We need public health experts to make these decisions.”
  • Quarantine restricts people’s rights. Using quarantine, the government or other authority has the power to detain or restrict the movement of people against their will. Watch this video to learn more about the rights of quarantined people.
  • Quarantine has been associated with incidents of civil rights violations. In 1900, the city of San Francisco, California, for instance, quarantined the entire neighborhood of Chinatown after a man died of the plague—and the city also closed all Chinatown businesses owned by non-whites. In 1916, during an outbreak of polio, New York City separated children from their families and placed them in quarantine—unless their families were wealthy enough to afford separate rooms and medical care at home.
  • Three weeks is a long quarantine—unpaid time away from work, family, and other responsibilities. Many health-care workers say such a quarantine would discourage others from helping with Ebola treatment in West Africa. “It makes it hard to get health workers in, because they can’t get out,” says the director of the CDC. “If we make it harder to respond to the outbreak in West Africa, it will spread not only in those three countries [in West Africa hit hardest by Ebola] but to other parts of Africa and ultimately increase the risk here” in the United States.

 

• Politicians are in a difficult position. They have to balance the rights of individual citizens—often-heroic health-care workers—and the general public. They also have to balance the complex realities of the disease with public perception. Read through the CNN articles (this one was published first, this second), and this New Yorker article on the “Ebola and the Fiction of Quarantine,” published last summer.
  • If you were the governor of your state, would you impose a quarantine on health-care workers returning from treating Ebola in West Africa? Would the quarantine be at a health-care facility, a temporary facility at the airport, or at the returnees’ home?
  • If you were a doctor or nurse, would you travel to West Africa to help treat the crisis if you know you couldn’t interact with your family, friends, or job for a month after you got home—even if you weren’t sick? Would your answer change if you were allowed to be quarantined in your home, as opposed to a health-care facility?
  • If you worked with someone who recently returned from treating Ebola in West Africa, would you want them quarantined, even if they weren’t sick? Would your answer change if they treated Ebola patients here in the United States, as opposed to overseas?
  • If you lived next door to someone who recently returned from treating Ebola in West Africa, would you want them quarantined, even if they weren’t sick? Would your answer change if they were quarantined at home or at a health-care facility? Would your answer change if they treated Ebola patients here in the United States, as opposed to overseas?

 

• Since the Ebola outbreak, people have been quarantined throughout the affected countries in West Africa, Spain, France, Germany, Norway, England, and the United States. Can you think of any historic instances of quarantine or isolation?
  • Read through this timeline from the good folks at NOVA.
  • Communities throughout Medieval Europe tried to quarantine people who may have had the bubonic plague to prevent the spread of the Black Death. In fact, the word “quarantine” is derived from the Italian phrase “quaranta giorni,” which means “40 days.” People and ships arriving in the city of Venice, Italy, were kept separate on an isolated island (called a lazaret or lazaretto) for 40 days before being allowed to enter the city. Due to a lack of knowledge about the way the plague worked, this “quaranta giorni” didn’t really prevent the disease from impacting the city.
  • Immigrants to Ellis Island who were suspected of having tuberculosis, yellow fever, cholera, or smallpox were quarantined to specific islands (lazarets) in New York Harbor: Blackwell, Ward’s, Swinburne, or Hoffman. Ellis Island itself also had quarantine units. Read more about quarantine “plague houses” for new immigrants here or here.
  • The 24-year quarantine of Mary Mallon—nicknamed “Typhoid Mary”—is perhaps the most famous instance of quarantine in American history. Mallon, a cook, never developed typhoid fever herself, but infected dozens of people. Her refusal to stop work as a cook resulted in her long quarantine on yet another lazaret in New York, North Brother Island. Read more about Typhoid Mary here.
  • The community of Kalaupapa, on the island of Molokai, Hawaii, was a site where people suffering from Hansen’s disease (also known as leprosy) were quarantined and isolated by the Hawaiian government. Forced isolation ended in 1969. Kalaupapa is now a national park.
  • Astronauts traveling to the Moon used a converted Airstream trailer as a “Mobile Quarantine Facility” upon their return to Earth. Coolest quarantine ever, no contest.
  • The entire city of Kinshasa, capital of the Democratic Republic of Congo, was placed under quarantine during an Ebola outbreak in 1995. Read about that quarantine here.
  • In the early 1990s, Cuba isolated all people who tested positive for AIDS. It was the first, drastic stage in an aggressive policy that has actually been extremely successful. Read more about Cuba’s AIDS policy here.

 

TEACHERS’ TOOLKIT

CNN: Should health care workers who treat Ebola in Africa be quarantined?

CNN: Ebola gets political

CDC: About Quarantine and Isolation (includes maps, histories, legal procedures, and travel/shipping guidelines)

Nat Geo Education blog: All About Ebola

Time: #TheBrief: What Are the Rights of People Quarantined for Ebola?

The New Yorker: Ebola and the Fiction of Quarantine

NOVA: A Short History of Quarantine

Nat Geo This Day in Geographic History: 1995: Outbreak of Ebola