The Slippery Slope of Mandatory Quarantine for Healthcare Workers with Exposure to Ebola—Let’s Do the Math

To the Editor—Recently in the United States, attempts have been made to place into quarantine for 21 days asymptomatic healthcare workers with exposure either to patients infected with Ebola virus or to their laboratory specimens. These actions have been taken despite the absence of scientific evidence that asymptomatic persons who may be incubating Ebola virus pose any risk of transmitting the virus to others. The selection of persons for this unwarranted isolation has been seemingly arbitrary, with policies differing from state to state. This procedure is reminiscent of some of the irrational early responses to the HIV epidemic, driven by fear, in which patients with AIDS were kept in strict isolation and were sometimes shunned in the community. ^{1 , 2}

Fortunately, the majority of healthcare workers in the United States who are or who have been providing care or other services for Ebola patients have not been placed into quarantine. But what if some state governors or other authorities decided to actually enforce a policy in which all healthcare workers who have cared for Ebola patients either in West Africa or in the United States were quarantined for 21 days?

Imagine the following scenario. If 10 hospital workers were involved each day with a single patient with Ebola in the United States (a conservative estimate), after 2 consecutive days of care, these individuals would have to be sent into a 21-day quarantine, because the incubation period extends from 2 to 21 days. Of course, as a consequence, other hospital workers would need to take their places. If we assume that the patient with Ebola would be hospitalized for 14 days (also a conservative estimate), then 60 additional hospital workers would eventually be needed to provide care for this 1 patient—a total of 70 healthcare workers. The 70 healthcare workers would eventually spend a total of 1,470 days in quarantine, more than 4 years in total days.

While it makes sense to regularly monitor the temperatures and symptoms of hospital workers with exposure to Ebola, no additional measures are really either necessary or useful. Not only is a policy of mandatory quarantine impractical, it also serves as a disincentive for the very healthcare workers who are needed to care for these sick patients in a manner that will improve their chances of survival while containing the epidemic. In conclusion, mandatory quarantine of asymptomatic healthcare workers who have had exposure to patients infected with Ebola virus simply does not compute.