Thank you, Kaci Hickox.
You did the world a service in traveling to Sierra Leone to care for Ebola patients. Then you did your country a service in standing up for rationality.
It might have been easier to go along with the unnecessary quarantine. After all, as New Jersey Gov. Chris Christie (R) observed with his usual sensitivity when Hickox was being detained in his state, “She was inside the hospital in a climate-controlled area with access to her cellphone, access to the Internet and takeout food from the best restaurants in Newark.”
Instead, Hickox made a brave, and useful, stink — and, as her bike ride watched round the world demonstrates, continues to do so.
“I am not going to sit around and be bullied by politicians and forced to stay in my home when I am not a risk to the American public,” Hickox told NBC’s “Today” show on Wednesday. “I do understand that [Ebola] has created a lot of fear, but we still have to make policies based on evidence.”
Tell that to Christie and his partner in hysteria, Maine Gov. Paul LePage (R). Hickox’s “behavior is really riling a lot of people up,” LePage warned after the bike ride. “We’re trying to protect her, but she’s not acting as smart as she probably should.”
He should talk.
People are understandably concerned about Ebola. Politicians are understandably responding to those concerns. But they also owe the public the duty to combat fear with facts and to tailor the public health response to the scientific evidence.
Which is, as you probably already know, this: Ebola is a deadly virus, but also an oddly cooperative one. You cannot catch Ebola until the infected person is symptomatic. Even then, becoming infected requires direct contact with bodily fluids. For proof, look at the fact that none of the relatives of the one person who has died of Ebola in the United States, Thomas Eric Duncan, caught the disease, despite living in close quarters with him.
Indeed, politicians’ fear of Ebola is more contagious than the disease. The most recent outbreak came in Louisiana, which is about to host the American Society of Tropical Medicine and Hygiene. The state Department of Health and Hospitals has told attendees who have recently been to Sierra Leone, Guinea or Liberia that they will be quarantined if they come.
Certainly, there is a hierarchy of risk. Travelers from countries with Ebola outbreaks present more risk than others. Travelers from those countries who have cared for Ebola patients even while using protective equipment present greater risk.
And the greatest risk comes from those who have been in direct contact with Ebola patients without proper protection. The Centers for Disease Control and Prevention recognized this spectrum in its new guidelines for monitoring those with potential exposure.
But the current state of quarantine law presents a twofold problem. The first is that questions of quarantine have traditionally been in the realm of state and local power. In the absence of federal legislation, the CDC can only make helpful suggestions, not enforce rules.
Yet leaving this issue up to states makes little sense in a modern, global world. Christie’s wrongheaded Ebola policy doesn’t just affect the citizens of New Jersey; it affects all of us, because of the ripple effect on the willingness of aid workers to take the risk of traveling to Africa to fight the disease.
Second, and compounding the first problem, courts have given governments broad latitude to impose quarantines. “A community has the right to protect itself against an epidemic of disease which threatens the safety of its members,” Justice John Marshall Harlan wrote in a 1905 case upholding compulsory smallpox vaccination.
Still, Harlan acknowledged that such a power “might go so far beyond what was reasonably required for the safety of the public” as to “compel” court intervention.
In an age of modern medicine, those limits haven’t been tested. Hickox is changing that. On Friday, a Maine judge rejected the state’s request that she be ordered to stay out of public places and remain three feet from other people; instead, she will be closely monitored for signs of illness.
Judge Charles LaVerdiere observed that “people are acting out of fear and that this fear is not entirely rational.” Still, he cautioned Hickox that her behavior should take into account “the real fear that exists,” however irrational.
Wise words. If only our politicians did more to calm those fears — and less to stoke them.
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