I agree that HCWs should be treated well, and offered paid time off etc.
I discussed the effect of quarantines on volunteers, as described in this MSF quote:
"The risk of being quarantined for 21 days upon completion of their work has already prompted some people to reduce their length of time in the field. Others will be less inclined to volunteer in the first place. This will present significant operational disruptions at the field level for MSF and other organizations, and lead to an overall shortage of desperately needed health workers, precisely when the Ebola outbreak is as out of control as ever."
This undercuts your earlier statement that quarantines won't affect volunteerism. Even without MSF's hands-on experience, it seems obvious, even tautological, that if someone has 6 weeks leave to treat Ebola patients and 3 weeks have to spent in quarantine, the time spent in-field will decrease. Per WHO, Liberia, a country with 4M people, had ~50 indigenous doctors before the crisis; some have died and many have fled. Most docs in the country are foreign volunteers. It seems reasonably clear that a reduction in the number of volunteer doctors and other HCW could have severe adverse effects on the population and the progress of the pandemic. You should not brush that under the carpet and ignore it.
If quarantines are imposed how do you propose filling in for the reduction in volunteers in Africa that
will follow? This shouldn't be an afterthought; it should be addressed before implementing quarantines that will diminish the supply of volunteers.
Again, I'm sorry where's this "science" showing me that someone's viral load is is zero when they have no subjective sx of ebola and that they don't shed ANY virus? Where's the "science" telling us precisely what those sx are and how to measure them? i.e does nausea before vomiting count, does a belly upset before diarrhea count? When is the moment that precisely someone becomes infectious? No one knows, stop using the word science, science has not answered this question.
I'm not a doctor or expert on this, and I'm not saying this refutes your statement, but it does touch on it (and I do note the "reason to believe" and "often" language):
"Health care professionals treating patients with this illness have learned that transmission arises from contact with bodily fluids of a person who is symptomatic — that is, has a fever, vomiting, diarrhea, and malaise. We have very strong reason to believe that transmission occurs when the viral load in bodily fluids is high, on the order of millions of virions per microliter. This recognition has led to the dictum that an asymptomatic person is not contagious; field experience in West Africa has shown that conclusion to be valid. Therefore, an asymptomatic health care worker returning from treating patients with Ebola, even if he or she were infected, would not be contagious. Furthermore, we now know that fever precedes the contagious stage, allowing workers who are unknowingly infected to identify themselves before they become a threat to their community. This understanding is based on more than clinical observation: the sensitive blood polymerase-chain-reaction (PCR) test for Ebola is often negative on the day when fever or other symptoms begin and only becomes reliably positive 2 to 3 days after symptom onset."
http://www.nejm.org/doi/full/10.1056/NEJMe1413139?query=featured_ebola
First of all, the public has already lost trust and confidence in this government and the CDC's botched response in Dallas based on inaction.
CBS Poll (pub 10-28) says 47% of Americans approve of Obama's handling of the Ebola threat while 41% disapprove.
http://www.cbsnews.com/news/how-do-americans-feel-obama-is-handling-ebola/
WP-ABC poll (pub 10-29) puts the numbers at 49% favorable, 41% unfavorable
http://www.washingtonpost.com/blogs/the-fix/wp/2014/10/29/obamas-ebola-comeback/
The polls show, no surprise, a strong party bias. It would probably be accurate to say Republicans lost trust and confidence in Obama before he took office; Ebola had little to do with it.
There is a reason why those exposed to TB and HIV/AIDs aren't stigmatized because those diseases don't have mortality rates that even come close to approaching Ebola's whopping 50% mortality rate.
I don't disagree with that, but there seems to be some cautious optimism that Ebola will not be nearly as fatal in developed countries as in Africa. To date, only one person treated in the US has died (the Liberian man who was not admitted on his first visit to the Dallas ER), while 7 have recovered and one is still in treatment. Europe's numbers aren't as good but are better than 50%. As I understand it, in each death, the victim did not receive prompt care.
Paul Farmer, the infectious disease expert who runs Partners In Health hospitals in Rwanda and Haiti (and thus knows a
lot about third world medical care) states:
"An Ebola diagnosis need not be a death sentence. Here’s my assertion as an infectious disease specialist: if patients are promptly diagnosed and receive aggressive supportive care—including fluid resuscitation, electrolyte replacement and blood products—the great majority, as many as 90 percent, should survive."
http://www.pih.org/blog/dr.-paul-farmer-an-ebola-diagnosis-need-not-be-a-death-sentence
I am not suggesting that this potential for decreased mortality control the policy response, I'm just throwing it out there.
