Quick Thoughts on Ebola and Quarantine

As far as I can tell, to date, very few people are panicking about Ebola. Mollie Hemingway of The Federalist and Mark Hemingway of The Weekly Standard have done a pretty good job refuting this media-driven narrative of panic about Ebola. And some of us who would respond "yes" to questions about concern about an Ebola outbreak are worried for the sake of our friends and family members who work in medicine, rather than for ourselves.

(Also, poll respondents may be answering different questions than the ones being asked! But that's a different post.)

However, panic is not an impossibility. I think John McCormack is dead on:

The real Ebola freakout doesn't begin unless/until there's a secondary infection--i.e. not a health care worker treating Ebola patient.
— John McCormack (@McCormackJohn) October 24, 2014

In other words, we don't see panic until some random person catches Ebola on the subway by touching an infected surface and then scratching his/her eye. If that happens, panic and a larger economic impact--in addition to the actual human impact--becomes much more likely.

Moreover, the first secondary infection in the US is likely to be out and about for a longer period of time than our previous Ebola patients, because Ebola isn't going to come up on the medical questionnaires that the patients will be answering. (Have you recently traveled to West Africa? No? Probably the flu.) So, then you could see additional secondary infections off of that first secondary infection.

Let's be clear: thinking about this outcome does not keep me up at night; it is unlikely. But it is not outside of the realm of possibility.

Fortunately, we have a fairly straightforward way to prevent this: mandatory three-week quarantines for potential disease vectors. The most likely disease vectors for Ebola are not regular people from Liberia or Guinea or Sierra Leone. It's the health care workers who are returning home from those countries. These people are doing great work (some would say God's work), and they deserve our respect and gratitude. The likelihood of something very bad happening because we do not compel quarantine is very small, but the cost of doing what it takes to prevent that very bad outcome is so small that to risk the very bad outcome doesn't make sense. The calculation here is fairly straightforward; mandatory quarantines for 21-days are low cost, and their likely effectiveness at preventing secondary infection is extremely high.**

If we're concerned about the unfairness of quarantine, as Sarah Kliff of Vox.com is, we can offer compensation for medical volunteers forced into quarantine. And frankly, it's three weeks out of their lives in 2014, the age of Netflix, tablets, e-Readers, and smartphones. The quarantined people might become stir crazy, but this isn't cruelty, if managed correctly. (We may well want to provide bonuses for doctors traveling to these areas to treat this epidemic, anyway. It strikes me as a worthy expenditure of tax dollars.)

One final note: we are doing a pretty darn good job treating Ebola patients in the US, which has led some experts to suggest that the mortality rate on Ebola with effective treatment would be closer to 10 or 20 percent. But this is very likely because of the quality of medical attention we have been able to provide the handful of patients that we have dealt with. If Ebola becomes more common in the US, the level of attention will drop, and it is likely that the mortality rate will rise. If we're dealing with more than a handful of cases, we can't get every Ebola patient to Emory, Omaha, or the National Institute of Health.

**This sort of cost/benefit calculation is why one can support this sort of prophylaxis against Ebola while rejecting current proposed prophylaxis against global warming.