Ebola: should returning medics and troops be quarantined?

Quarantined nurse says her rights are being violated but authorities say the public is their priority

LAST UPDATED AT 11:10 ON Thu 30 Oct 2014

A nurse who was put into quarantine after treating Ebola patients in West Africa is threatening to leave and take legal action, arguing that the isolation is a violation of her civil rights and will deter other volunteers from helping fight the disease. 

Kaci Hickox, who returned to the US from Sierra Leone last Friday, was initially placed under precautionary quarantine in hospital in New Jersey. After several days, she was allowed to leave and serve the remainder of her 21-day isolation period at home in Maine.

She has twice tested negative for the Ebola virus and is displaying no symptoms, but state officials say precautionary measures must still be taken as the virus' incubation period can be up to three weeks.

Hickox points out that even if she was infected, she would not be contagious until she started displaying symptoms. She insists that the policy of quarantining health care workers returning from Ebola stricken countries is neither "scientifically nor constitutionally just", and a violation of her civil rights. Now she is threatening to take action.

"If the restrictions placed on me by the state of Maine are not lifted by Thursday morning, I will go to court to fight for my freedom," she told Reuters.

In another interview with the BBC, she said: "I am not going to sit around and be bullied around by politicians and be forced to stay in my home when I am not a risk to the American public."

Hickox also warned that the policy would be a "big deterrent" to health care workers thinking about responding to urgent calls for volunteers in West Africa. "It's already difficult for people to take time out of their lives to go and respond," she said, explaining that an additional three-week confinement could prove too much.

Her case has sparked widespread debate in the US over its quarantine polices, which vary from state to state. A three-week quarantine period for health care workers returning from Sierra Leone, Liberia and Guinea has been imposed in New York, New Jersey and Maine, with California issuing them on a case-by-case basis.

Officials in Maine in New Jersey say the measures are designed to keep the public safe. "[Quarantine] is a reasonable request to ensure – out of an abundance of caution – that we are protecting the people of this state," Mary Mayhew, Maine health commissioner, told CNN.

"While we certainly respect the rights of one individual, we must be vigilant in protecting 1.3 million Mainers, as well as anyone who visits our great state," said the  Republican Governor Paul LePage.

The policy has been condemned by President Obama on several occasions, and he has called on states not to impose their own measures as science does not support the need for quarantines.

He said healthcare workers who have risked their lives to care for patients were "American heroes" who "deserve our gratitude, and they deserve to be treated with dignity and respect".

Obama has, however, authorised the forced quarantine of all military personnel returning from the region – even though many of them have not come into contact with Ebola patients and were in the region building treatment centres. When questioned about the discrepancy in policies by journalists at CNN he said: "We don't expect to have similar rules for our military as we do for civilians."

What is the Ebola virus and what are the symptoms? 

The World Health Organization describes Ebola as a severe acute viral illness. Early symptoms are similar to malaria and include the sudden onset of fever, intense weakness, muscle pain, diarrhoea, vomiting and both internal and external bleeding. There are five known strains of the virus, the one currently spreading across West Africa is known as the Zaire Ebola virus and is one of the most dangerous. Patients who do not survive the disease most often die from blood loss, organ failure or shock.

Where did it come from?

Scientists believe it was initially present in wild animals such as fruit bats or primates living in tropical rainforests in equatorial Africa. The disease spread to humans when they came into contact with the organs, blood or other bodily fluids from infected animals through hunting.

How is it spread?

Ebola can be transmitted through contact with an infected patient's blood or other bodily fluids such as saliva, sweat, breast milk, vomit and semen. This is through direct contact with broken skin or mucous membranes such as those in the mouth, eyes or nose. The disease can also spread through contact with objects contaminated with the fluids such as needles and other medical equipment. Humans are not infectious until they develop symptoms. It can take up to three weeks after infection for symptoms to develop.

Is there a cure?

There is no known cure or vaccine for the virus and the disease kills between 25 and 90 per cent of its victims. The fatality rate of the current strain appears to be roughly 70 per cent, according to the latest WHO figures. The only routine treatment doctors can currently offer is palliative care such as rehydration and pain relief.

However, there are various experimental treatments and vaccines currently in development, most notably the zMapp drug which has been given to several healthcare workers who have contracted the disease. It's effectiveness and long-term safety is yet unknown.

What happens to people who survive the disease?

"There is strong epidemiological evidence that once an individual has resolved an Ebola virus infection, they are immune to that strain," according to Dr Bruce Ribner, director of the infectious disease unit at Emory University Hospital in the US. Doctors believe that the antibodies present in a patient's blood could protect them from that virus, but warn they would still be susceptible to other strains.

Ebola: DEC launches 'unprecedented' appeal

29 October

The Disasters Emergency Committee (DEC) has launched an unprecedented appeal for funds to help stop the "explosive" spread of the Ebola virus in West Africa.

The group, made up of 13 of the UK's leading aid charities, has never before called for public donations for a disease outbreak.

"This appeal is completely unprecedented and that is a sign of just how serious the situation in West Africa has become," said DEC chief executive Saleh Saeed.

In its 50-year history, the committee has made appeals for humanitarian disasters caused by natural disasters and conflicts, but "we have never run an appeal in response to a disease outbreak - until today", he said.

Nearly 5,000 people are known to have died from the disease and more than 10,000 have been infected, but the World Health Organization (WHO) believes the real number could be up to three times higher. It warns that without large-scale intervention, there could be 5,000-10,000 new cases of the virus every week by December.

Saeed told the BBC that donations were urgently needed to help the affected countries and to prevent the outbreak from spreading further, warning that the committee currently faced a shortfall of £69m to carry out their work in West Africa. "This is a race against time," he said.

"Without urgent action to stop the spread of Ebola and to help those affected by the crisis, parts of West Africa face catastrophe within 60 days," Saeed warned.

Funds raised will be used to run treatment centres in the worst affected areas of Sierra Leone, Liberia and Guinea, provide protective clothing and medical supplies for healthcare workers, provide food aid to affected families and protect children who have been orphaned by the disease.

Just £25 will provide three families at risk of the disease with chlorine cleaning kits, while £50 will allow the charities to provide three healthcare volunteers with basic protective clothing.

To make a donation to the DEC Ebola Crisis Appeal visit www.dec.org.uk, call the 24 hour hotline on 0370 60 60 900. You can also donate £5 by texting the word DEC to 70000.

Ebola: 'thousands' more medics needed to fight virus   

28 October

Thousands more volunteers are needed to help combat the Ebola crisis in West Africa, according to the president of the World Bank. 

In an "emotional appeal", Jim Yong Kim said at least 5,000 more healthcare workers were urgently needed in Sierra Leone, Liberia and Guinea, the BBC reports.  

Over 10,000 people have been now been infected with virus, nearly half of whom have died.

"Right now, I'm very much worried about where we will find those health care workers," he said, as most would be too afraid to travel to the region. The World Health Organization (WHO) estimates that at least 443 health workers have contracted the virus and 244 have died.

He said he hoped that they would "understand that when they took their oath to become a health worker it was precisely for moments like this". 

Meanwhile, US authorities have decided to quarantine troops returning from West Africa for 21 days in Italy, while Australia has become the first country to issue a visa ban on the affected countries, angering West African leaders. Critics say both moves will prevent volunteers from travelling to the region to help.

"Western countries are creating mass panic, which is unhelpful in containing a contagious disease like Ebola," Ugandan government spokesman Ofwono Opondo told Reuters.

"If they create mass panic ... this fear will eventually spread beyond ordinary people to health workers  or people who transport the sick and then what will happen? Entire populations will be wiped out."

Ebola: paper tests for the virus in development

27 October

A simple and inexpensive genetic test for Ebola, using discs of paper, has proved effective at detecting two strains of the virus, say scientists at Harvard University.

The technology involves printing sequences of DNA onto paper and freeze-drying them. They can then be stored at room temperature and reactivated by adding water, like "living powdered soup". Once reactivated, the discs will change colour if they come into contact with the virus.

The tests are simple, cost effective and take just 30 minutes to display a result. The technology costs just £13 to produce and as the tests are easy to mass produce, they could end up selling for less than 2p, New Scientist reports.

"The fact you can leave these freeze-dried systems for a year, and they'll still work - that's quite remarkable," Professor Lingchong You, an expert in cellular reprogramming at Duke University, told the BBC.

However, more testing is needed before they can be distributed in West Africa. "Potentially, it's wonderful, but it's one thing to do it in the lab and quite another to manufacture it up to the standards required for it to work in real situations," says Ruth McNerney of the London School of Hygiene and Tropical Medicine.

Currently, testing for Ebola needs to take place in laboratories and is expensive.  One of the main tests for the virus called RT-PCR can cost between £40-£130 per test and results can take up to six hours to develop, according to the New York Times. They are also less than 100 per cent effective and so need to be run twice for each sample.

Over 10,000 people have now been infected with the Ebola virus, almost half of whom have died.

In other developments:
  • The US ambassador to the United Nations, Samantha Power, is currently on a tour of the West Africa and has criticised the global response to the outbreak. "The international response to Ebola needs to be taken to a wholly different scale than it is right now," she said. 
  • Mandatory 21-day quarantines for health care workers returning from West Africa are causing controversy in the US. The procedures were implemented in New York, New Jersey and Illinois but experts warn it could discourage medics from travelling to the region to help. 
  • An American nurse is taking legal action after being quarantined under these measures. The woman, who had been treating patients in Sierra Leone, says said she was made to feel "like a criminal". Here lawyers say her case raises "serious constitutional and civil liberties issues," the BBC reports.

Ebola: New York confirms first case of the virus

24 October

An American doctor who returned from treating patients in West Africa has become the first person in New York to be diagnosed with the Ebola virus.

Craig Spencer had been working with the medical charity Medecins sans Frontieres (MSF) in Guinea and returned to the US last week. He has been placed under quarantine in New York and is receiving treatment.

The 33-year-old doctor, who lives in Harlem, is now the fourth person to have been diagnosed with the disease in the US, along with a Liberian man and two nurses who treated him in Texas.

Spencer's wife and two friends have also been isolated and are being monitored for signs of the disease.

Mayor Bill de Blasio attempted to reassure New Yorkers that the threat of an outbreak in the densely populated city remained low.

"There is no reason for New Yorkers to be alarmed," he said. "Being on the same subway car or living near a person with Ebola does not in itself put someone at risk."

He told the public that Ebola is an "extremely hard" disease to catch as it is only transmitted through contact with an infected persons blood or bodily fluids and not through "casual contact".

He emphasised that New York City has the world's strongest public health system and the world's leading medical experts. Authorities in the city have been preparing for the arrival of the virus "for months", according to the New York Times.

MSF says Spencer complied with protocol, alerting them as soon as he began displaying symptoms on Thursday. "The individual engaged in regular health monitoring and reported this development immediately," it said in a statement.

Meanwhile, Mali has also confirmed its first case of the virus, the [2]BBC reports. A two-year old girl tested positive after returning from Guinea, making Mali the sixth West African country to be affected by the outbreak, although Nigeria and Senegal have since been declared Ebola-free.

More than 4,800 people have now died of the disease, with Liberia, Sierra Leone and Guinea the worst affected. The World Health Organization (WHO) also estimates that at least 443 health workers have contracted the virus, of whom 244 have died.

Ebola: blood serum leads the global race to find a cure 

22 October 

Serum extracted from the blood of Ebola victims who survived the virus could be made available to patients in Liberia in the coming weeks, according to the World Health Organization (WHO). 

The body is fast tracking several experimental drugs and vaccines to be ready by January, according to the BBC.

There is currently no proven Ebola vaccine or cure, but several pharmaceutical companies are racing to develop safe and effective methods of treating and preventing the disease.

What is blood serum and how does it work?

Serum is part of blood plasma and, in this case, is taken from a patient who has recovered from Ebola as it contains essential antibodies that can fight the virus. It has proven effective in earlier outbreaks, but the WHO has previously been hesitant to use it widely until stricter safety controls were introduced. Healthcare workers warn that the blood needs to be screened carefully for diseases such as HIV and the serum only be administered by health care professionals.

When will it be ready?

The serum has already been used to treat infected healthcare workers. Earlier this month, William Pooley, the British nurse who recovered from the virus donated his blood to infected healthcare workers in Texas. The WHO expects the serum to be more widely distributed in Liberia, the country worst affected by the outbreak, "within weeks".

Vaccines

Human trials are currently underway for several different vaccines developed by the large pharmaceutical companies GlaxoSmithKline and NewLink Genetics as well as the US National Institute of Allergy and Infectious Diseases. Scientists hope that patients will react to the small amount of the virus and develop immunity against it.

When will they be ready?

The latest announcement from the WHO suggests that a vaccine could pass safety and efficacy tests as early as January next year. However, just last week, GlaxoSmithKline said their vaccine would not be ready in time for the current outbreak as safety trials would not be completed until the end of 2015.

ZMapp

The experimental drug is made up of a cocktail of antibodies harvested from an infected animal's blood and grown in specially-modified tobacco leaves. It works by stopping the virus from entering and infecting new cells. It has been used to treat dozens of healthcare workers, many of whom have gone on to make a full recovery. However, doctors say it is too early to know whether the drug is effective or safe in the long-term.

When will it be ready?

ZMapp takes a long time to produce even in small quantities and all available doses have now been distributed, according to its manufacturers. Supplies of the drug "will not be sufficient for several months to come" the WHO warned recently.

TKM-Ebola

Developed by a Canadian pharmaceutical company, the drug works by interfering with the virus's genetic code and stopping it from producing disease-causing proteins.

When will it be ready?

Human trials were halted earlier this year over safety concerns, but the company recently announced that the US Food and Drug administration had partially lifted the ban, raising hopes that the drug could be made available in the near future.

Ebola: fresh deployment of UK troops to West Africa

21 October 

Soldiers from the Royal Army Medical Corps have been deployed to Sierra Leone as part of the UK's pledge to help fight the Ebola outbreak.

Nearly 100 medics were joined by International Development Secretary Justine Greening, who is travelling to the region to oversee the UK's training centres. The medics will be working alongside 90 military personnel already stationed in the country.

The deployment forms part of the UK's £125m aid package to help the tackle the disease in West Africa. This includes setting up treatment centres, training healthcare workers and sending around 750 personnel to the region along with the Navy's RFA Argus.

"Halting the disease in West Africa is the most effective way of preventing Ebola infecting people here in the UK," she told ITV news.

"I look forward to seeing for myself how British Army medics and engineers, as well as our humanitarian and health workers, are spearheading the UK's efforts to contain and ultimately defeat Ebola."

The outbreak has killed over 4,500 people, mainly in Sierra Leone, Liberia and Guinea.

Ghana's President John Mahama has said that vital medical supplies are finally beginning to reach the worst affected countries. Aid agencies have criticised major airline carriers such as British Airways for cancelling direct flights to the region as it impedes their ability to deliver essential goods and personnel.

European countries have already pledged £400m in aid to help stem the crisis, but the UK is pressing for that amount to be doubled, the BBC reports.

The BBC's international development correspondent Mark Doyle has said that while the UK's contribution is "significant", it has come "very late", as aid agencies had been warning of a humanitarian crisis since April.

Meanwhile, enhanced screening methods have now been extended to Gatwick Airport. Passengers arriving from West Africa face temperature checks, will need to fill in a questionnaire and will be observed for visible signs of the virus.

The measures are expected to be introduced at Eurostar terminals by the end of the week and at Manchester and Birmingham airports in the coming weeks.

Ebola virus factfile

What is the Ebola virus and what are the symptoms?

The World Health Organisation describes Ebola as "a severe acute viral illness". Early symptoms are similar to malaria and include the sudden onset of fever, intense weakness, muscle pain, diarrhoea, vomiting and both internal and external bleeding. There are five known strains of the virus, the one currently spreading across West Africa is known as the Zaire Ebola virus and is one of the most dangerous. Patients who do not survive the disease most often die from blood loss, organ failure or shock.

Where did it come from?

Scientists believe it was initially present in wild animals such as fruit bats living in tropical rainforests in equatorial Africa. The disease spread to humans when they came into contact with the organs, blood or other bodily fluids from infected animals through hunting.

How is it spread?

Ebola is highly infectious. It can be transmitted through contact with the blood, bodily fluids and organs, including skin, of sufferers or through indirect contact with environments contaminated by the disease. The disease can also have a long incubation period, up to three weeks, which allows it to spread rapidly before diagnosis and quarantine can take place.

 · 

For further concise, balanced comment and analysis on the week's news, try The Week magazine. Subscribe today and get 6 issues completely free.