Why a quarantine is the right idea for Ebola

Statements that quarantine of health care workers exposed to Ebola is not supported by medical science are misguided.

It would be true to say that quarantine takes into account the best current medical knowledge, and factors in the vagaries of disease presentation, difficulties with protocols, unpredictable human behavior and the incredible risks involved. Quarantine is not "punishment" — it is the practice of isolating ill, or potentially ill, individuals from others to limit the spread of infection.

Repeatedly it is stated that individuals are not infectious until they are symptomatic. Where are the large-scale data supporting this? At what point is someone deemed symptomatic? There is considerable uncertainty here.

Sources citing the "symptomatic" doctrine invariably cite fever — suggesting that if there is no fever there is no risk.

Elevated temperature is a "sign." It is an objective manifestation of a disease process that can be seen, felt or heard by an examiner (e.g. rash, mass, heart murmur, abnormal reflex, etc.). Feeling "feverish" (hot, chills, fatigue, etc.) is a symptom. Symptoms are sensations perceived by a patient (e.g. pain, nausea, weakness, muscle aches, etc.).

I have many times seen patients for an unrelated problem who are found to have a temperature but do not "feel" feverish or suspect their temperature is elevated (i.e., they are not symptomatic). Also confounding is the fact that disease presentations are variable. Every experienced clinician has seen atypical presentations of disease; it is commonplace.

The clinical upshot of these realities is that it is difficult to identify when symptoms begin, and sometimes symptoms are not present in spite of a sign suggesting illness (e.g. fever and/or infection).

The fact is that we really don't know as much as news releases suggest we do. The biologic and medical manifestations/consequences of disease are not as cut and dried as reports suggest. The art and science of medicine involve consideration of what is not known. Experience warns against the hubris and false assuredness about what are inexact and uniquely individual biologic events (especially considering the limited experience we have with Ebola). Each person reacts differently to illness.

Given the uncertainty of signs and symptoms, the inability to determine the exact moment of infectious potential, the human element and the tragedy of infecting even one person with Ebola, I believe it is reasonable to quarantine those with significant exposure to the disease. Quarantine is supported by sound medical judgment — it differs in that it includes a greater margin of safety than lesser recommendations. This difference in opinions also applies to flight restrictions and quarantine options for West Africa.

The need for health care providers is real and tremendously important. West Africa needs the world's utmost humanitarian, medical and economic support. Though quarantine of risk individuals may make recruitment of medical personnel more difficult, it is not a reason to reject our commitment to protecting others.

My respect for Dr. Anthony Fauci; the Centers for Disease Control and Prevention, and others who have commented on this issue is high. The differences in opinion involve what constitutes an "abundance of caution."