having contact with patients having Ebola during their (usually volunteer) tour of duty in West Africa with MSF or other organization. Illinois is the only other state with a mandatory quarantine requirement for returning health care workers with known exposure to those suffering from this often-lethal virus.
This new policy of mandatory quarantine led to the isolation of Kaci Hickox, a nurse from Maine who had spent time with MSF in Liberia. She was released from this and went home to Maine after just a few days. Ms. Hickox was vocal about her treatment, saying she was treated like a criminal, and has threatened legal action against her confinement.
The controversy over mandatory state imposed quarantines, and strict travel bans to and from the countries most affected by this disease. Public health decisions are being are made for political reasons and not necessarily based on sound science. It is unlikely that this will be resolved to everyone’s satisfaction any time soon.
Despite the public outcry and sometimes hysteria that has occurred in the European Union (most notably Spain) and the US, of more significance is the spread of the virus in West Africa. In the three most affected countries of Guinea, Liberia, and Sierra Leone, the number of cases exceeds ten thousand, with perhaps about 5,000 dead. The actual number of cases and deaths is likely under-reported due to lack of effective communication in outlying areas of the countries involved and the stigma of the illness leading many to hide and avoid treatment.
As in other epidemics of this country, mostly in Eastern Africa and Congo River Basin, there has been much local resistance to treatment, fearing through myth and superstition and misinformation having contact with Western health care workers This has led to violent confrontation, with an episode in Guinea of Western health care workers being killed.
At the present time, Guinea, Sierra Leone and Liberia are the most affected countries. Nigeria had 8 deaths during the summer, but is now considered free of Ebola. Senegal is also considered free of Ebola though there were a few cases in the summer.
This past week, Ebola was reported in Mali. A two-year-old girl, who subsequently died, traveled by bus for several hundred miles to Bamako, the capital, from interior Mali, after having been in Guinea, where she likely contracted the disease. There are efforts to contact and closely observe up to several hundred people who may have been in contact with this girl on her long bus-trip through Mali to Bamako when she was supposedly symptomatic with bleeding from the nose. Mauritania reportedly closed its border with Mali.
The continued spread of this illness in West Africa is more significant on a global scale of controlling this outbreak than the arguments about quarantine in the US or Europe.
This viral disease that occurred only in Africa since first identified in 1976 is now considered a global threat with many humanitarian, economic, social, and geopolitical implications. It is imperative that Western countries work towards bringing this epidemic under control in the areas most affected, primarily in West Africa.
The whole world needs to be vigilant in response to isolated cases that could occur anywhere due to international travel. However, the main focus should be bringing the epidemic under control in Africa. Despite strong calls for more international assistance by UN Secretary General Ban Ki-Moon, President Obama, the WHO, MSF, and governmental officials from the most affected countries, the response of the international community has thus far been woefully inadequate.