Safe at Home? Letting Ebola-Stricken Americans Return

Safe at Home? Letting Ebola-Stricken
Americans Return
Sarah A. Lister, Specialist in Public Health and Epidemiology (slister@crs.loc.gov, 7-
7320)
August 5, 2014 (IN10126)
In early August 2014 two American healthcare workers who contracted Ebola virus infections while
working to stem an outbreak in West Africa returned to the United States to continue receiving
medical care here. Ebola infection is highly deadly and there is no approved specific treatment.
Although the patients were to be transported and cared for under strict isolation protocols, some have
voiced concern about Ebola infection being brought to the United States for the first time intentionally.
Ebola infection is one of several communicable
Figure 1. Ebola Virus Particle
diseases for which aliens are generally barred from
entry into the United States. Although U.S. citizens
are entitled to certain constitutional protections
related to the right to travel and reenter the United
States, these rights may be balanced against the
government's interest in preventing the spread of a
dangerous communicable disease. In any
event, U.S. practice has been to isolate and/or
quarantine arriving U.S. citizens who have been

infected with or exposed to a dangerous
communicable disease, rather than barring their
Source: Colorized transmission electron
entry into the country outright (though
micrograph from Centers for Disease Control circumstances could conceivably arise where this
and Prevention, Public Health Image Library, practice would be altered).
image #10816, http://phil.cdc.gov.
Isolation or Quarantine?
Isolation is used to separate ill persons who have a communicable
disease from others. It is often carried out in a healthcare setting.
Quarantine is used to separate and restrict the movement of well
persons who may have been exposed to a communicable disease to see
if they become ill. It is often carried out at home.
Ebola infection has a high mortality rate, often killing more than half of those who are
infected. Supportive treatment such as intravenous hydration lowers the death rate somewhat. The
two infected American healthcare workers who returned to the United States are reported to have
received an experimental antibody treatment for the disease. The U.S. National Institutes of Health
(NIH) plans to begin clinical trials on a candidate vaccine in the fall of 2014.
Figure 2. Healthcare Workers in
Personal Protective Equipment

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Transmission of Ebola infection requires direct
Source: Centers for Disease Control and
contact with body fluids; it cannot generally be
Prevention,
spread through airborne or casual contact.
http://www.cdc.gov/vhf/ebola/exposure/index.html. Spread of infection in affected West African
nations was facilitated by certaindietary and
cultural practices that are not generally observed in the United States. Community spread in the
United States would be unlikely. However, healthcare workers are at considerable risk when caring for
ill patients.
The course of Ebola infections is generally well understood. The incubation period is up to 15 days
after a potential exposure. If an exposed person, such as a healthcare worker who sustains a
needlestick injury while caring for an Ebola patient, does not develop symptoms within that time, he
or she is not likely to do so. The disease is not communicable until symptoms appear. Those surviving
infection may remain contagious for several months after infection, when symptoms are no longer
present, but they can be tested for persistent infection in order to quarantine themselves from others.
Using this information, public health officials can craft appropriate isolation and quarantine protocols
for patients and those exposed to them. Enforcing isolation and quarantine protocols, if necessary, is
generally a matter of state law. U.S. hospital isolation capacity has expanded since the anthrax
attacks of 2001, partly as a result of federal Hospital Preparedness Program grants to all 50 states,
the District of Columbia, and the U.S. territories.
Diseases like Ebola could enter the United States through an infected traveler at any time. In response
to the outbreak in West Africa, CDC has taken two actions that it has used before in similar situations.
First, it has advised healthcare providers in the United States to be vigilant for possible symptoms of
Ebola infection in recent travelers to affected countries. Second, it has issued a Level 3 Travel
Warning to travelers from the United States, urging against nonessential travel to Liberia, Guinea, and
Sierra Leone. The warning provides information about protective practices for those (such as aid
workers) who must travel to these countries while the Ebola outbreak is ongoing. United States health
authorities continue to work with World Health Organization (WHO) and other nations to monitor the
outbreak and share information, as is expected now of all parties to WHO's International Health
Regulations (IHR). The IHR provide a means for coordinated international tracking of and response to
infectious diseases in an ever more mobile world.

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