Why don't Ebola doctors returning from West Africa quarantine themselves?

'As long as a returned staff member does not experience any symptoms, normal life can proceed,' Doctors Without Borders says

Dr. Craig Spencer. (via Facebook)
Dr. Craig Spencer, a Doctors Without Borders physician who recently returned to the city after treating Ebola patients in West Africa has tested positive for the virus, according to preliminary test results, city officials said Thursday. (via Facebook) (via Facebook)

Why don't all health care workers who treat Ebola patients in West Africa quarantine themselves when they return to the United States?

That's what some Americans are wondering after officials revealed that Craig Spencer — the 33-year-old New York City doctor diagnosed with Ebola on Thursday — rode the subway, visited a Brooklyn bowling alley and took a cab to his Harlem apartment on Wednesday night, hours before he was hospitalized.

Spencer, who was working with Doctors Without Borders treating Ebola patients in Guinea, returned to New York on Oct. 17 and had been monitoring himself for Ebola symptoms since his return.

"We know that he left his apartment," Dr. Mary Travis Bassett, New York City's health commissioner, said on Thursday. "Self-quarantine would have meant he never left his apartment. But he did self-isolate in the sense that he limited his contact with people and saw friends. He did leave his apartment, so I don't want to give the impression that he was in his apartment the entire time. ... (But) he did not have a stage of disease that creates a risk of contagiousness on the subway. We consider it extremely unlikely, the probability being close to nil, that there will be any problem related to his taking the subway system.”

According to Bassett, Spencer had been taking his temperature twice a day. He began feeling sluggish on Tuesday but did not develop a fever until Thursday at 11 a.m., when he discovered he was running a 100.3-degree temperature. Spencer alerted Doctors Without Borders, which in turn alerted New York health officials.

Spencer was transported to Bellevue Hospital Center on Thursday afternoon by a specially trained hazmat unit, and his apartment was sealed off by authorities. He was reportedly in stable condition on Friday afternoon, and doctors said he was able to talk on his cellphone.

The health department’s "team of disease detectives immediately began to actively trace all of the patient’s contacts to identify anyone who may be at potential risk," the city said.

Three people Spencer was in close contact with — his fiancee and two friends — have been quarantined, Bassett said.

Officials at NewYork-Presbyterian Hospital/Columbia University Medical Center, where Spencer is a fellow of international emergency medicine, said he had not been working since his return from West Africa.

But in recent days, Spencer had gone on a three-mile jog and visited the High Line, a public park. He "may have stopped and gone to a restaurant along the way," Bassett said.

In a statement, Doctors Without Borders said it has "specific guidelines and protocols for staff members returning from Ebola assignments" — including staying "within four hours of a hospital with isolation facilities" — for 21 days, the incubation period for Ebola, and that Spencer had followed all of them.

"The individual engaged in regular health monitoring and reported his first symptoms immediately," the group said. "He did not leave his apartment until paramedics transported him safely to Bellevue Hospital in Manhattan, and he posed no public health threat prior to developing symptoms. As long as a patient hasn’t developed symptoms, the risk of contagion is close to zero."

More from the protocols posted on the Doctors Without Borders website:

As long as a returned staff member does not experience any symptoms, normal life can proceed. Family, friends, and neighbors can be assured that a returned staff person who does not present symptoms is not contagious and does not put them at risk. Self-quarantine is neither warranted nor recommended when a person is not displaying Ebola-like symptoms. However, returned staff members are discouraged from returning to work during the 21-day period.  Field assignments are extremely challenging and people need to regain energy.  In addition, people who return to work too quickly could catch a simple bacterial or viral infection (common cold, bronchitis, flu etc.) that may have symptoms similar to Ebola. This can create needless stress and anxiety for the person involved and his/her colleagues. For this reason, [Doctors Without Borders] continues to provide salaries to returned staff for the 21-day period.


Sophie Delaunay, executive director of Doctors Without Borders, defended the guidelines.

“Despite the strict protocols, risk cannot be completely eliminated," she said.

Others have wondered why health officials wait to test the blood of physicians returning from West Africa for Ebola. At a press conference Friday, New York City Health and Hospitals Corporation President Ram Raju said the virus would not show up in their blood until they were exhibiting symptoms, just as this doctor did.

CNN medical correspondent Dr. Alex van Tulleken, who lives near Spencer, said his neighbor did nothing wrong.

"Spencer has followed the protocols, not just the national protocols, but the protocols of the organization that is most expert in the world of dealing with Ebola," van Tulleken said on CNN. "He hasn't broken any rules. He's been very responsible, and I don't think he's got anyone at risk at all."

Van Tulleken added: "The work he was doing in Africa reduces our risk of getting Ebola here. And that is the only way we change our risk. We have a new African country affected. We've got Mali with the first case. That's where we should be concerned about. If you want to panic about Ebola, panic about it in West Africa."

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