It’s certainly not impossible to think that California airline workers or healthcare workers could have frontline exposure to carriers of the Ebola virus. While this is principally a public health issue, it could morph into a significant workers’ comp issue.
Thankfully the USA has only seen a handful of Ebola infections, and several of those infected have recovered with intensive treatment.
California does not have direct flights from West African countries, so the level of controversy here has been somewhat lower.
But nationally, even with those limited cases there has been a great deal of confusion and even hysteria.
The Obama Administration and the Governors of New York, New Jersey and Maine have been clashing over what precautions should be instituted.
A nurse, Kaci Hickox, who volunteered in West Africa was quarantined against her will. Hickox proved adept at garnering media attention, and gained widespread public sympathy. This generated a political outcry from politicians , CDC officials , and editorial writers who contend mandatory quarantine was unnecessary and counterproductive.
Yet, it seemed curious that U.S. military are being sent to Italy for quarantine after helping in West Africa but that the Obama Administration did not support quarantine of those returning to the USA who are known to have had direct contact with African Ebola victims.
The contrast between how the government is handling those two scenarios ought to raise plenty of questions.
Meanwhile, the Spencer case shows some of the problems with not quarantining.
Dr. Craig Spencer returned to New York from volunteering in West Africa and took the subways to a Brooklyn bowling alley and Greenwich Village restaurant despite the fact that he was infected. Today the New York Post claims that Dr. Spencer not only did not “self-quarantine” but actually lied to authorities about his activities upon return.
Hopefully Dr. Spencer did not infect anyone and will recover himself, but Spencer’s story is a cautionary tale for those who are blasé about the situation. Even a medical professional did not recognize his symptom onset and self-quarantine.
There is no reason to feed hysteria over Ebola, but it is also not a good time for political correctness. So in this instance it may be that skepticism is the best policy.
On October 29th the California Department of Public Health issued a risk-based quarantine order.
Here is the CDPH press release on the order:
“Health care providers and travelers returning from Ebola affected regions will be individually assessed for exposure risk
While there continue to be no reported or confirmed cases of Ebola in California, State Health Officer and California Department of Public Health (CDPH) Director Dr. Ron Chapman today took action to help prevent any potential spread of the disease in the state by issuing a quarantine order and associated guidelines that require counties to individually assess persons at risk for Ebola and tailor an appropriate level of quarantine as needed. This flexible, case-by-case approach will ensure that local health officers throughout the state prevent spread of the disease, while ensuring that individuals at risk for Ebola are treated fairly and consistently.
Quarantine Order
“Today we’re establishing a statewide, standard protocol requiring some level of quarantine for those at highest risk of contracting and spreading Ebola,” said Dr. Chapman. “This order will protect the health and safety of Californians and support the state’s local health officers’ existing authority to develop protections against disease spread.”
The order, which applies to anyone traveling to California who has 1) traveled to California from an Ebola affected area; and 2) has had contact with someone who has a confirmed case of Ebola, requires those travelers to be quarantined for 21 days. A person traveling to this region that has not come into contact with a person with Ebola will not be subject to quarantine. An Ebola affected area is one determined as an active area by the federal Centers for Disease Control and Prevention (CDC), which currently includes Guinea, Liberia and Sierra Leone.
California Department of Public Health and Local Health Officers Partner
Local County health officers will issue quarantine orders for individuals and establish limitations of quarantine on a case-by-case basis. These limitations will be based on new guidance also released today by CDPH. This “Guidance for the Evaluation and Management of Contacts to Ebola Virus Disease” outlines quarantine limitations that local health officers should take based on the level of Ebola risk to which individuals were exposed. Although quarantine can involve isolation at home, it may be tailored to allow for greater movement of individuals who are deemed to be at lower risk.
“Not everyone who has been to an Ebola affected area should be considered high risk,” Dr. Chapman said. “This order will allow local health officers to determine, for those coming into California, who is most at risk for developing this disease, and to contain any potential spread of infectious disease by responding to those risks appropriately.”
In California, local health officers currently have the authority to order quarantine of people who may have an infectious disease that threatens public health. This order will ensure consistent application across the state of quarantine for high risk individuals in order to control risks from Ebola.
California is home to many health care workers who have selflessly volunteered to help combat the current Ebola epidemic in Guinea, Liberia and Sierra Leone. These individuals are engaged in stemming this epidemic at its source through a range of activities, from direct care of confirmed Ebola patients to health education of the general population. California is also receiving residents returning from travel to these three countries as well as visitors from this region.
“Health care workers who go to Ebola affected countries to treat patients are great humanitarians. They will be treated with respect and dignity when they come home as these important public health actions are taken,” said Dr. Chapman. “We value those who volunteer to help those in need, and appreciate their willingness to serve.”
Here is a link to the CDPH actual order:
http://www.cdph.ca.gov/Documents/Order_%20Ebola10292014.pdf
Risk-based quarantine assessment sounds reasonable, but also rather vague. Since California is not the port of entry for those returning from Africa, California’s policy may be the best we can do for now.
UPDATE:
Today Stanford Dr. Colin Bucks has returned from West Africa and has agreed to be quarantined for 21 days at home in the Bay Area. Thankfully he is not out bowling and eating in trendy restaurants during this critical period. How Bucks returned home and through what port of entry is not currently known.
On October 15, Cal-OSHA issued a statement of guidance on the Ebola virus, detailing infection control and worker protection measures:
http://www.dir.ca.gov/dosh/documents/Cal-OSHA-Guidance-on-Ebola-Virus.pdf
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Julius Young
510.835.8870