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 To understand the challenges encountered by ordinary citizens
exposed to Ebola, a team led by researchers at the U.S. Centers for
Disease Control and Prevention reviewed concerns raised by people
monitored as part of an Ebola cluster in Dallas last year.
"If yet-to-be-identified contacts notice that those who come forward
as Ebola contacts are shunned from society and quarantined in their
homes, with no way to provide for themselves and their families,
they will be less likely to come forward," said lead study author
Dr. Charnetta Smith, a CDC epidemic intelligence service officer.
There have been over 23,000 cases of Ebola and more than 9,300
deaths worldwide since the current epidemic began in West Africa,
according to the World Health Organization. Most of the cases have
been in Guinea, Liberia and Sierra Leone.
Last fall, 179 people needed monitoring for Ebola symptoms after
Thomas Eric Duncan, a Liberian national visiting Dallas, became the
first person diagnosed with the Ebola virus in the U.S., according
to the CDC report. He died in an isolation unit inside a Dallas
hospital in October.
Most of the people exposed to the virus in Texas were healthcare
workers, including two who became infected with Ebola after treating
Duncan. But the group also included 20 people in the community and
10 individuals who rode in the same ambulance that transported
Duncan before it was completely cleaned and disinfected, the authors
write in CDC's Morbidity and Mortality Weekly Report.
Duncan's case in Dallas prompted questions about the timeliness of
his care. He initially sought treatment two days before being
admitted to the hospital, but he was sent home with antibiotics.
It also raised questions about the best way to monitor people who
came in contact with Ebola. In Texas, five "community contacts" and
two "ambulance contacts" were formally quarantined, according to
Smith. Another 20 health care workers voluntarily self-quarantined.
The CDC recommends that people exposed to Ebola who don’t have any
symptoms of the virus be monitored for 21 days. During that period,
these individuals may be advised to limit their movements within the
community and avoid public transportation. They may be asked to
remain at home, missing work and school.
As these individuals are asked to disrupt their lives, it’s critical
that public health officials understand how any restrictions on
daily activities may impact their ability to get food, fill
prescriptions and get necessary supplies, Smith told Reuters Health.
In Dallas, the group of people monitored for Ebola symptoms included
eight school-aged children, three non-English speakers, two people
with complex chronic medical conditions and one homeless individual.
Each of these vulnerable populations needed special assistance.
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For example, the children exposed to Ebola missed school. They
needed help getting assignments, books and access to computers. They
also needed support returning to school at the end of the 21-day
monitoring period.
“Physicians from the Dallas County Medical Society volunteered their
time to educate administrators, teachers and parents about Ebola,”
Smith said. “This helped to minimize stigma and ensure that all
students would be welcomed back to their schools.”
Beyond making this type of accommodation, public health officials
also need to recognize that Ebola and other infectious diseases can
disproportionately impact low-income communities where people have
few resources to deal with a quarantine, said Dr. Peter Hotez, dean
of the National School of Tropical Medicine at Baylor College of
Medicine in Houston.
“Whenever you are dealing with an infectious disease issue you are
often dealing with people in the marginalized portions of society,”
said Hotez, who wasn’t involved in the CDC report. “Here in Texas,
where we often find widespread tropical disease outbreaks, it is
almost always the poor and the homeless who are affected.”
Efforts to contain Ebola in Dallas clearly worked because there
wasn’t a single transmission in the community, Hotez said. But a
21-day quarantine might not always make sense, particularly for the
people who would face extreme financial hardship as a result.
“Twenty one days means that there is a 5 percent or less likelihood
that you could still develop Ebola if you don’t have symptoms, but
there is also a case to be made that the risk isn’t as great after
14 to 15 days,” Hotez said. “Twenty one days should be questioned.”
SOURCE: http://1.usa.gov/1zo AJ1D
MMWR, February 13, 2015.
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