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Mandatory Ebola quarantine is about politics, not public health

The risk to the Australian community from doctors and nurses returning from Ebola-affected countries is minimal. EPA/ARIE KIEVIT

Governments have a duty to protect their citizens but the plan to impose mandatory detention on health-care workers being suggested by some Australian states is excessive and unwarranted.

On Monday, the media reported the Australian government has cancelled all temporary visas from the three worst-affected countries of Guinea, Sierra Leone, and Liberia. In a bizarre world first, this includes humanitarian visas.

So it should not have come as a surprise that on Tuesday The Australian reported that some state health authorities were looking into the possibility of requiring mandatory detention of returning health-care workers if they refuse voluntary home quarantine.

Admittedly, this is not a Commonwealth-led initiative and Australian states are not the first to consider mandatory quarantine. New York, New Jersey and Illinois have hurriedly rush through similar policies in the last few days.

It does, however, contribute to an overall picture of Australia’s response to the Ebola epidemic - one that appears increasingly, and unnecessarily, mean-spirited.

Can we legally quarantine people?

Mandatory quarantine of health-care workers presents a number of ethical challenges, but it’s not without precedent.

The Quarantine Act 1908 allows for people to be quarantined if they’re infected with a quarantinable disease; if an appropriate inspector reasonably suspects they’re infected with such a disease; if they have been in contact with or exposed to infection from people subject to quarantine; or if they have been in a quarantine area within the last 21 days.

So there’s clearly a legal framework for it at the federal level, but does that mean it should be implemented?

During the 2003 SARS outbreak, some of Canada’s success in controlling the spread of the virus was attributed to mandatory quarantine of people suspected of carrying the disease. This notably included health-care workers.

We now know these people not only suffered mental anguish over the separation from their families and loved ones, but the policy also made them feel like pariahs in their own communities. Instead of being praised as the selfless heroes they were, these health-care workers were made to fear walking down their streets or wearing their uniforms.

What is the actual risk?

But governments do have a duty to protect their citizens, so what is the risk to the Australian community from doctors and nurses returning from Ebola-affected countries?

In contrast to SARS, which had an incubation period of just ten days, the Ebola virus can incubate for anywhere between two and 21 days. Unlike SARS, we know exactly what to look for with Ebola. We also have tests for rapid diagnosis.

Most importantly, even when people may have contracted the illness, they’re not infectious until they start displaying symptoms. Having a fever alone is not enough; you have to be producing large amounts of bodily fluids - and therefore very sick - before you can infect others.

What this means is that the current measure of asking health-care workers to self-isolate at home for 21 days and monitor their temperature twice a day is more than adequate to protect the Australian community.

But isolating people based on the possibility that they might be infected, even though they pose zero public health risk, is not just unethical. It ties up resources better spent - and arguably more needed - elsewhere.

Not the time or place for politics

Hysterical responses to health-care workers treating patients infected with Ebola are reminiscent of the initial treatment of AIDS patients and their doctors and nurses.

Yet fortunately, even as New Jersey governor Chris Christie defended the mandatory isolation of Medecins Sans Frontieres nurse Kaci Hickox, stating he had an “obligation … to protect the public health of all people”, federal US health officials strongly condemned the unwarranted measure.

The UN Secretary-General has also joined the fray, criticising enforced quarantine that needlessly penalises doctors and nurses who have willingly put themselves at risk to save others.

Political interference in public health is not helpful as a general rule, but political posturing in these types of events is particularly unhelpful. It breeds unwarranted fear and drowns out more important messages - messages about how Ebola is actually transmitted, the steps needed to contain this outbreak in West Africa, and what Western countries such as Australia and the United States can do to help.

Worse still, it actively discourages health and aid workers from travelling overseas to lend their expertise because they don’t know what political storm they will walk into upon their return.

Politics runs the risk of becoming policy whenever responsibility for public health exists within multiple layers of government. So when it comes to public health decisions, politicians need to rely on the informed opinions of their chief medical advisers.

While hollow debates about misguided measures not based in science take up media space, the increasingly dire situation in West Africa is forgotten.

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