Ebola ‘pariahs’

More than a hundred peacekeeper-volunteers coming from Liberia are now quarantined on Caballo Island, and four others who arrived later are isolated at the AFP Medical Center. The quarantine period is to last for 21 days, which has been shown as the maximum period of incubation for the potentially deadly Ebola virus.

Taking precautions especially with a threat like Ebola is necessary, but doing it beyond what is necessary to the point of paranoia can do more psychological and emotional damage, not only to the quarantined personnel but to the public at large. Overanxiety and panic can really be bad and makes one to actually develop all sorts of imagined medical problems. The mind is so powerful and as one thinks and believes, so one shall be.

Much of the exaggerated paranoia about catching Ebola is brought about by some misinformation on the disease. One can get it only through direct contact with bodily fluids from a symptomatic, infected person. It has not been shown to be transmitted by someone not yet showing any symptom. Ebola is not also transmissible through an airborne route.

For a while, I thought some senators were so serious that they would require acting Health Secretary Janette Garin to wear a protective garment when she appeared at the Senate for the budget hearing just because she and military chief Gen. Gregorio Pio Catapang visited the peacekeepers early last week.

This was obviously an overreaction, the type that would make anyone coming from an Ebola-stricken country or someone who had a casual meeting with these people treated as Ebola pariahs.

Risk classification

Postarrival active monitoring is definitely called for, as an added safeguard for existing exit screening protocols from the affected West African countries. I’m sure we already have in place well-trained personnel at all local airports, rescreening returning travelers and reviewing their “risk classification,” which determines their chance of carrying or incubating the virus.

The Centers for Disease Control and Prevention (CDC) in the United States classifies the returning travelers as “high risk,” “some or moderate risk,” “low (but not zero) risk” and “no risk.”

High-risk travelers are those who had direct contact with: body fluids from a person with symptoms or is confirmed through a needle stick to be sick with Ebola; or splashes to eyes, nose, mouth, or on skin. They may also have touched a dead body while in a country where an Ebola outbreak has been reported, without wearing the recommended personal protective equipment (PPE) or not wearing PPE correctly.

Those at “some or moderate risk” include those who had close contact with a person sick with Ebola such as in a household or a healthcare facility, though they might have worn a PPE. It also includes close contact with a symptomatic Ebola patient in the community without the benefit of a PPE.

The CDC defines “close contact” as being within three feet of the person sick with Ebola “for a long time.”

Low (but not zero) risk includes those who have been in a country with a large Ebola outbreak within the past 21 days, with no known exposure to a sick or symptomatic patient, and had no direct contact with body fluids from a person sick with Ebola. This also includes those who were in the same room with a person sick with Ebola for a brief period of time; had brief direct contact, like shaking hands, with someone sick with Ebola; and those who traveled on an airplane which had a person sick with Ebola.

No risk individuals are those who don’t have any of the criterion in low- to high-risk categories. Contact with a healthy person who had contact with a person sick with Ebola is not a risk factor. Also belonging to this category are those who had contact with someone who showed no symptoms, but eventually developed or got sick with Ebola viral disease.

The determination of the risk classification is important for all returning peacekeepers and healthcare workers, including travelers from Ebola-stricken countries. This should not be “generically” done, but should be individualized for each of the 100 plus peacekeepers who are now on quarantine.

The individual risk classification will decide how best to monitor for symptoms, and what other travel and public activity restrictions should be imposed.

No quarantine required

From the limited medical information we could gather, most, if not all, of the returning peacekeepers could be classified as “no risk” or “low risk.”

Based on the CDC guidelines, those with an exit screening of “no risk” or “low risk” and reconfirmed as such on arrival actually require no quarantine, and need no restrictions on travel or participation in public activities. At most, voluntary home quarantine may be done, and they should also be instructed to check their temperatures twice daily for 21 days. They should be briefed on the signs and symptoms to watch out for. Health personnel from the DOH or other agencies should also contact them by phone, preferably daily, to check on them for any symptom.

When there is a doubt on the classification, it’s safer to “upgrade” them and if they fall on the moderate- to high-risk category, quarantine for 21 days may be imposed.

Our country remains Ebola-free, and with reasonable and rational precautions, we should remain so. Extending the rationality to extremes does not only stigmatize returning peacekeepers and health workers but can unnecessarily make us lose sleep on it—weakening our resistance and making us prone to all sorts of diseases and infections.

Cut short

Personally, I think we should cut short the quarantine period of our returning peacekeepers and just ask them to stay at home for the remaining days of the prescribed 21-day observation period. I’m sure all of them are longing to be with their families already.

Anyway, they’re not also observing the necessary quarantine protocol, which should be done to avoid being within three feet of each other. They’re freely socializing and having parties in the island. I think they’re better off at home than on Caballo Island.

If we believe the experts more than our unfounded fears, allowing them to do such does not constitute any public health risk.