President Barack Obama defended his administration’s policy against the quarantine of health care workers returning from West Africa in recent remarks. The administration’s position on the issue is that they see no reason to believe that the quarantine of possibly infected workers would translate into meaningful beneficial results. This is in line with interim recommendations issued by the Centers for Disease Control, which are in turn within the guidelines of the World Health Organization. The majority of recognizable health organizations are operating under and disseminating the same recommendations.
The President has also defended his administration’s Ebola policy with the explanation that travel restrictions, in lieu of quarantine, would be similarly effective and more humane. The broader policy means through which a travel restriction would be enforced, and the extent to which it would restrict travel, remain unclear.
In the case of Maine resident Kaci Hickox, at least, restriction indicates a police presence outside of her Fort Kent home. Officers stand ready to follow and monitor her travel in the event of her leaving. Hickox had returned from treating Ebola patients in West Africa on Oct. 24, and had subsequently been placed under quarantine after initially showing fever-like symptoms. Hickox believes that her civil liberties were violated. New Jersey Governor Chris Christie offered for her release last Monday, the explanation that the mandatory quarantine order only pertained to persons appearing to be actively symptomatic. As Maine’s Health Commissioner Mary Mayhew files for an order to keep Hickox effectively quarantined at home, it becomes apparent that there is widespread disorganization, as different levels of government attempt to determine their responses.
According to the best known information on Ebola, the virus has an incubation period that has been observed to range from two to 21 days. As shown on the WHO’s website factsheet, humans are not contagious until the onset of symptoms. The symptoms which present along with the completion of incubation include diarrhea, vomiting, rash. Other symptoms associated with impaired kidney or liver function, and low platelet and white blood cell counts, are detectable in laboratory blood samples. Ebola infection is likely also to be difficult to differentiate from malaria, typhoid, and meningitis until its distinctive bleeding occurs.
The current Ebola outbreak, so far larger than all previous outbreaks combined, is of the Zaire Ebolavirus strain. The Zaire strain was the first identified in 1976, and is one of five known species of Ebolavirus, a genera within the Filoviridae family.
Some of the easily discernible reasons for the unprecedented size of the current outbreak are the increasing population density of the Western African region, and the persistence of impoverished conditions that limit the availability of medical care. However, pathogens such as viruses and bacteria are also capable of undergoing generational mutations which may alter their transmission vectors. While it is currently rare, if at all possible, for Ebola virus to be transmitted through the respiratory route, a report (cited in the sources below) on healthmap.org from 2012 indicated the likely observation of respiratory transmission of Zaire Ebolavirus between piglets and macaques.
The transmission vector responsible for the observations made in Jane Huston’s 2012 report was likely via droplet. There is a key distinction between the three means through which the virus likely travelled. The term “fomite” refers to a contaminated inanimate object that a virus could be capable of surviving long enough to transfer off of, while a “droplet” is similar to “airborne,” though larger droplets are too heavy to remain airborne long or travel far. The research from which the report was based indicated that the droplets were the likely transmission vector because of evidence of infection in the lungs of the primates. So, while there are still no recorded cases of airborne Ebolavirus transmission, there are still reasons to exercise due caution and avoid unnecessary risk of exposure. It may be a defendable consideration the next time that President Obama examines policies toward the containment of Ebola.
By Brian Whittemore
Feature Image courtesy of CDC/ Douglas E. Jordan – Public Domain
Left Inset Image by CDC/ Dr. Frederick A. Murphy – Public Domain