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Showdown over Ebola: Will Quarantines of Healthcare Workers Harm the Fight Against Epidemic?

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A debate is intensifying in the United States over quarantining healthcare workers who return from West Africa but do not show signs of Ebola. On Wednesday, Maine’s governor said that he would seek legal authority to enforce a 21-day home quarantine on Kaci Hickox, a nurse who has tested negative for Ebola after treating patients in Sierra Leone. Hickox made national headlines when she publicly criticized New Jersey Gov. Chris Christie for quarantining her in a tent outside the hospital. Hickox said she would challenge Maine’s restrictions just as she did in New Jersey. “I completely understand that the state’s purpose is to protect the state of Maine,” Hickox said last night. “I have worked in public health for many years, and that has always been my purpose, as well, but we have to make decisions on science, and I am completely healthy.” To discuss the debate, we speak to Lawrence Gostin, professor and faculty director at the O’Neill Institute for National and Global Health Law at Georgetown University. He is also the director of the World Health Organization Collaborating Center on Public Health Law.

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Video squareStoryOct 27, 2014Back from West Africa, a U.S. Nurse Says Quarantining Medical Workers Threatens Ebola Response
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This is a rush transcript. Copy may not be in its final form.

NERMEEN SHAIKH: The World Health Organization says Liberia, the country worst hit by an Ebola epidemic, may be seeing a decline in the spread of the virus. While the number of burials and new admissions has fallen in Liberia, World Health Organization Assistant Director-General Dr. Bruce Aylward said the international community must continue to step up its response to the virus that’s killed around 5,000 people in West Africa.

DR. BRUCE AYLWARD: It would be a huge mistake for anybody to think, “Oh, great, we’re getting in front of this virus, we can scale back on some of the investments planned.” I mean, you know, these are wily viruses. They’re waiting for you to make that kind of a mistake. And as you’ve seen in places, you know, in Guinea, you’ve seen in Guéckédou, this thing will go on for a very, very long time at lower rates of transmission. So, you’ve got to exploit those opportunities as they arise, step up your game. And if anything, this should be really a sign that, look, make those investments because this can be turned around, this virus can be stopped eventually, but it’s going to take a very, very aggressive program of work to capitalize on those opportunities.

NERMEEN SHAIKH: Dr. Bruce Aylward, assistant director-general of the World Health Organization. This comes as a debate intensifies in the United States over quarantining healthcare workers who return from West Africa but don’t show signs of Ebola. On Wednesday, Maine’s governor said that he would seek legal authority to enforce a 21-day home quarantine on Kaci Hickox, a nurse who has tested negative for Ebola after treating patients in Sierra Leone. Hickox made national headlines when she publicly criticized New Jersey Governor Chris Christie for quarantining her in a tent outside the hospital. Hickox said she would challenge Maine’s restrictions, just as she did in New Jersey. Last night, Hickox spoke outside her boyfriend’s home in Maine.

KACI HICKOX: I completely understand that the state’s purpose is to protect the state of Maine. I have worked in public health for many years, and that has always been my purpose, as well. But we have to make decisions on science. And I am completely healthy. You know, you could hug me, you could shake my hand. There is no way that I would give you Ebola. If I develop symptoms—and there’s even some evidence that, you know, in the beginning periods there’s not enough virus in your blood, that you’re shedding virus. It’s, you know, still not perfect science, because we don’t know everything we need to know about Ebola, because it’s a rare enough disease. But, you know, I don’t want to hurt anyone in the public, but I don’t think this is an acceptable line to be drawn.

AMY GOODMAN: As Hickox spoke on her boyfriend’s doorstep, he had his arm around her the whole time. Maine Health and Human Services Commissioner Mary Mayhew said the state is filing a court order to keep Kaci Hickox isolated at home until November 10th.

MARY MAYHEW: We will make it mandatory. It is certainly in everyone’s best interest to just cooperate and work with us to minimize contact. It is very difficult, outside of that voluntary agreement to stay at home, to monitor someone who may come into contact with many individuals, that if that individual then becomes symptomatic, we will have to work with every single one of those individuals to quarantine those individuals.

AMY GOODMAN: On Wednesday, President Obama held an event at the White House to honor American doctors, nurses and healthcare workers returning from West Africa.

PRESIDENT BARACK OBAMA: Like our military men and women deploying to West Africa, they do this for no other reason than their own sense of duty, their sense of purpose, their sense of serving a cause greater than themselves. So we need to call them what they are, which is American heroes. They deserve our gratitude. And they deserve to be treated with dignity and with respect.

AMY GOODMAN: To talk more about the debate over quarantining healthcare workers, we’re joined by Lawrence Gostin, university professor and faculty director at the O’Neill Institute for National and Global Health Law at Georgetown University, also the director of the World Health Organization Collaborating Center on Public Health Law.

You’re one of the leading experts, Dr. Gostin, on the issue of quarantine. This showdown is only getting hotter in this country, and it’s not just about this one crusading nurse, Kaci Hickox. But can you talk about what it is she’s saying, why she objected to being held in the hospital in New Jersey, and then went home to Maine and was told she had to stay there, why she feels she shouldn’t be there for 21 days?

LAWRENCE GOSTIN: Well, I really don’t think she should be there for 21 days. I, like her, believe—and I’ve spent my entire life defending the public’s health. And if I actually thought that she or any of the other health workers coming from the region were a risk to the public, I would support a quarantine. But the Supreme Court has said that if you confine somebody who has committed no crime, it’s, quote, “a massive deprivation of liberty.” It’s not a trivial thing. We have to make sure that we balance civil liberties with public health. In this case, all the public health experts are telling us that it’s unnecessary—the CDC, the World Health Organization. There’s no organization that I know of that believes it’s right to quarantine for three weeks somebody that really is, as President Obama said, is a hero. They’ve sacrificed. They’ve done things that most of us wouldn’t do. They’ve put themselves at risk, gone in a compassionate way. And I do think we need to treat them better than we are. This is self-defeating. We think that we’re actually decreasing our risk by quarantining her, but actually we’re increasing it, because if we impede people from going to the region, then the epidemic there will spin out of control, and that is where our risk lies.

NERMEEN SHAIKH: Well, I want to turn to comments made by NBC cameraman and Ebola survivor Ashoka Mukpo. He was asked about the mandatory quarantine being imposed on Kaci Hickox. He also talked about Dr. Craig Spencer, who’s being treated for Ebola in New York. He was speaking on CNN. Let’s just go to a clip.

ASHOKA MUKPO: She’s earned a right to, you know, have a sense of her own safety and her own risk factor to others. And I don’t think that Dr. Spencer endangered anyone. My feeling is—and, you know, again, I’m not an expert, this is just my own view on the exposure that I’ve had to Ebola—is I think that Governor Christie is playing politics right now. It seems to me that it’s an effort to, you know, work with public opinion rather than listen to the advice of the experts. And I just think that it’s counterproductive. You know, these are people who have gone and endangered their lives to work with people who have very limited resources and are dying in relatively large numbers. So, to make it more difficult and to treat them as if they’re a potential problem as opposed to a public asset, I just think it’s a shame, and I don’t think it’s the right way to act.

NERMEEN SHAIKH: That was Ebola survivor Ashoka Mukpo speaking on CNN. So, Lawrence Gostin, can you explain why it is people are so fearful? They’ve have been so critical, many people, of Kaci and of Dr. Craig Spencer, for what they claim was endangering the lives of the public. Could you explain why that’s not really been the case?

LAWRENCE GOSTIN: You know, it really isn’t the case. We know from science and epidemiology that if a person is completely symptom-free, if they haven’t had any known exposure, with their skin or anything else, they have no temperature, and if the health department would proactively monitor them—I’m all in favor of that—then if they want to get in their car, or if they want to have a walk on the street, they’re endangering no one at all. And as I say, from a matter of law, the doctrine of quarantine requires that you have an individual assessment of significant risk. And it doesn’t exist here. The CDC itself does not put her in a category that would warrant quarantine. They have guided the states in that way. They’ve asked the states to behave in a way that comports with science. And unfortunately, we’re coming up to elections. Politicians are wanting to follow the polls. They’re basing their decisions on fear rather than science. And while sometimes that might be an OK thing to do, not if you’re depriving somebody of liberty, and not if you’re really making a situation in West Africa worse than it is.

AMY GOODMAN: Maine Governor LePage is one of the most conservative governors in the country. And his Health and Human Services secretary spoke yesterday. What they didn’t explain, they have police outside of the home where Kaci is staying. They have not directly said what they’re going to do to her if she goes outside. But if they’re saying she’s contagious, right—the New Jersey governor, Christie, said she’s “obviously ill,” which was obviously wrong—

LAWRENCE GOSTIN: Clearly wrong.

AMY GOODMAN: Are they going to be wearing moon suits and tackle her? They will not explain what they’re going to do to her.

LAWRENCE GOSTIN: No, and in fact, unless they’ve actually issued a formal quarantine order under the state’s public health law, the police actually have no authority over her. She has committed no crime. There has been no assessment that she actually, from a scientific point of view, poses any risk to anyone. I don’t see that they’ve got any authority. Now, if they get a court order, they’re going to have to convince a judge that their decision is based upon rationality and science. And I don’t see how they can do that when the entire scientific community disagrees. And they’re just—they’re fanning the fear in the public. The public are wondering, “Why are we getting all these confusing messages?” The president’s saying one thing, the governor’s saying another thing, the WHO and CDC have their own position.

AMY GOODMAN: Well, there—

LAWRENCE GOSTIN: We have to have a consistent position.

AMY GOODMAN: Dr. Gostin, there are mixed messages.

NERMEEN SHAIKH: On Wednesday, Defense Secretary Chuck Hagel announced that all U.S. troops returning from the Ebola zone in West Africa must spend 21 days in quarantine. Let’s go to a clip.

DEFENSE SECRETARY CHUCK HAGEL: What I signed this morning was a memorandum to the chairman of the Joint Chiefs of Staff in response to the memorandum of recommendation I received from the chairman and the chiefs yesterday to go forward with a policy of essentially 21-day incubation for our men and women who would be returning from West Africa.

NERMEEN SHAIKH: That was Defense Secretary Chuck Hagel speaking on Wednesday. So, Larry Gostin, can you explain the discrepancy in policy? Because on the one hand, the Obama administration seems to be saying that quarantine is not required for health workers, and now we have Chuck Hagel, the defense secretary, saying, but for the military, it is. And presumably healthcare workers are in much closer proximity to those suffering from Ebola in West Africa.

LAWRENCE GOSTIN: I mean it’s a complete contradiction in terms. I was very proud of the United States for sending military troops into West Africa. I actually wish that the military troops could provide direct patient care. But President Obama ruled that out because he didn’t want them to be exposed to any risk—for political reasons. I can understand that. But now, when they’ve not had any patient contact—they may have had no exposure whatsoever—and then come back, and every single one of them will be quarantined 21 days, it defies rationality. Why would you want to do that?

The other thing is, is that we have people coming and going to West Africa all the time. We have U.N. diplomats, high-level American officials, high-level World Bank officials, that will be coming to and from New York City and other places. Do we intend to quarantine them all?

AMY GOODMAN: I mean, the U.S. ambassador—

LAWRENCE GOSTIN: We have no consistent—

AMY GOODMAN: —to the United Nations, Samantha Power, just went to all three nations that are hardest hit.

LAWRENCE GOSTIN: Absolutely.

AMY GOODMAN: She said she’ll abide by the law. But this goes even beyond Ebola. I wanted to turn to Steve Hyman, an attorney for the nurse, Kaci Hickox.

STEVEN HYMAN: There’s no basis to arrest her. There’s no basis to detain her. And such action would be illegal and unconstitutional. And we would seek to protect Kaci’s rights as an American citizen under the Constitution. The fact is, she seems to be doing well. She’s now certainly better than she was when she was in the isolation tent, courtesy of Governor Christie, in New Jersey. She is feeling fine—hopefully, she stays that way—and is monitoring herself, as required by the protocols, and is staying in touch with the Maine public health officials. There is no legal basis under Maine law or under the U.S. Constitution to restrain her because she went to Africa to help people get better.

AMY GOODMAN: And this is what else Kaci Hickox’s attorney, Steve Hyman, had to say.

STEVEN HYMAN: In the AIDS crisis, they were trying to do the same thing. People were supposed to be isolated because of AIDS and the fear that ran through the community. And that proved to be totally wrong. And people were subjected to the same thing that’s happening to Kaci by this hysteria that somehow there’s contagion, because of some myth as to how it’s transmitted.

AMY GOODMAN: That’s Steve Hyman, an attorney for Kaci Hickox. And I wanted to ask you, Dr. Lawrence Gostin—I was just watching a Mount Sinai Hospital doctor, infectious disease doctor, today on television, who was responding to the question, you know, more than 80 percent of Americans want people quarantined, so how do you deal with that? And he said, you know, if you had asked them if they wanted Ryan White, the boy who had AIDS—

LAWRENCE GOSTIN: Yeah.

AMY GOODMAN: —if you wanted him quarantined, not to go to school, they would have said the same thing. That doesn’t make it right. How do you deal with this, Dr. Gostin?

LAWRENCE GOSTIN: Well, I mean, I think you need to deal with it with clear information. I mean, we didn’t, in the end, quarantine people with AIDS, thank goodness, but we did harass them, discriminate against them. Ryan White, a poor little young boy who had HIV infection, was embarrassed, kick out of school. These are not humane, compassionate ways of dealing with things. Unfortunately, you know, epidemics, particularly fearful ones, bring the worst out in society and civilization and humanity. But we need to find the better parts of ourselves and treat human beings with compassion, and only restrict them if it’s absolutely necessary for the public welfare. And in this case, it clearly is not.

NERMEEN SHAIKH: Well, on Wednesday, representatives of the Centers for Disease Control joined health officials from 31 other countries from the Americas in Cuba for a conference on Ebola. The meeting was convened by ALBA, a regional alliance of Latin American and Caribbean countries. This is Cuban Health Minister Roberto Morales.

DR. ROBERTO MORALES OJEDA: [translated] We hope that this meeting creates a concerted course of action to continue perfecting our national plans, that it ratifies the commitment we have to the most vulnerable people as an expression of the principles of solidarity, genuine cooperation and integration between our countries.

NERMEEN SHAIKH: The U.S. presence in Cuba is the latest show of cooperation between the two countries on the Ebola crisis. This is Nelson Arboleda of the CDC.

DR. NELSON ARBOLEDA: [translated] I think that this is an international emergency and that we must all work together and cooperate in this effort.

NERMEEN SHAIKH: So, Larry Gostin, according to the World Health Organization, Cuba is by far the largest provider of doctors and healthcare workers to West Africa in dealing with this Ebola crisis. So could you talk about what you think the U.S. ought to be doing more to deal with the crisis there in West Africa?

LAWRENCE GOSTIN: Yeah, well, before I do that, I mean, one—when I just had said that epidemics bring out the worst in us, but here’s a case of where epidemics can bring out the best in us, where it can bring us together, which shouldn’t be a Democrat-Republican issue. It shouldn’t be a Cuba-American issue. It’s a global issue for all of mankind and humankind.

What America needs to do is really ramp up the response in West Africa. We need to be training a reserve work core of experienced doctors and nurses, putting them into the region, supporting them, treating them with respect. And we need to be providing money. And more than anything, we need to mobilize the international community. At least the U.S. has troops there. There are a lot of countries that don’t. I’m really astounded at the delay and the lack of attention that’s been given to what is really one of the worst crises I’ve seen since the AIDS epidemic.

AMY GOODMAN: MSF, Médecins Sans Frontières, Doctors Without Borders, is really suffering now. They’re saying that—

LAWRENCE GOSTIN: They are.

AMY GOODMAN: —because of this controversy over the quarantining of healthy people, that it means that they are getting less recruits, fewer doctors, nurses, health workers offering to go abroad. President Obama almost had tears in his eyes yesterday as he surrounded himself—I think the visual was more important than anything he said, being very close to hugging people who had been in West Africa. What is your—what is the single most important thing you feel needs to happen right now as the U.S. focuses on this debate over local quarantine? What’s brought Liberia’s infection rate down?

LAWRENCE GOSTIN: Well, you know, first, we have to stop being so insular and just thinking about ourselves and our own—we have a few very isolated cases. In West Africa, they will have tens of thousands, maybe even hundreds of thousands, of people with Ebola. So we’ve got to put it in perspective. And we have to really all come together, as Americans and as an international community, and put our focus in West Africa. You know, if we don’t, and for some reason it jumps to another populous city like Delhi or Beijing, then we could have a global catastrophe, something that would really come back to haunt us. So, this is in our self-interest, but more than that, it’s in our shared humanity, that we really need to focus our attention, resources, human resources and engineering to really build up hospitals, doctors and public health systems. And we have to learn from this lesson. We have to learn what to do in the future. And what that is, is to build the health systems up in low- and middle-income countries so that these things don’t spin out of control.

AMY GOODMAN: Lawrence Gostin, we want to thank you for being with us, university professor, faculty director of the O’Neill Institute for National and Global Health Law at Georgetown University—

LAWRENCE GOSTIN: Thanks for having me.

AMY GOODMAN: —also director of the World Health Organization Collaborating Center on Public Health Law. Thank you. This is Democracy Now! When we come back, we’re going to be looking at the Red Cross, not around the issue of Ebola today, but it’s the second anniversary of Superstorm Sandy. “Where were they?” people asked all over the East Coast. We’ll look at their own internal documents to find out why they were not present. Stay with us.

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