DOH should review Ebola quarantine procedure

I received quite a number of reactions both for and against my comments last week, wherein I suggested that our Department of Health (DOH) appears to be overenthusiastically applying the quarantine guidelines to our returning military peacekeepers and overseas Filipino workers (OFWs). I probably didn’t explain myself too well, so let me just try to put things in better perspective.

What we need is a science-based, individually calibrated and really essential set of precautionary measures with real-world practicability and are implementable even if we have hundreds or possibly more than a thousand returning OFWs from Liberia, Guinea and Sierra Leone. And we can remain confident that with these individualized precautionary measures, we can still optimally reduce the threat of Ebola to public health.

As they say, different strokes for different folks. We may need a shotgun to ward off a tiger that’s about to attack us, but we don’t need a shotgun to kill a small mouse that’s crossing our path. We can’t routinely quarantine all returning peacekeepers, travelers and OFWs from Ebola-stricken West African countries. One size does not fit all. Our intervention must be calibrated based on individual risk.

That’s why returning travelers from Liberia, Sierra Leone and Guinea are either classified as high risk, moderate risk, low risk, or zero risk on exit screening before they’re allowed to board the plane. Only low- and zero-risk travelers are allowed to travel. As an added precautionary measure, this is revalidated on arrival at our airports or seaports.

I’m sure we have trained personnel (not necessarily doctors) doing the temperature checks and primary screening at our airports and seaports; and if warranted or when in doubt, travelers who may pose some risk are referred to a more rigid secondary screening which is usually done by trained medical personnel.

High- or moderate-risk individuals should undergo the 21-day quarantine. Low- or zero-risk returning travelers, which, I reiterate, consist practically all of these prescreened travelers from the three countries, do not need to be quarantined and should just be advised to check their temperatures twice daily for 21 days. Our health personnel should check on them by phone daily; and for some with uncertain risk, for which the 21-day home quarantine has been prescribed, unannounced visits may be made during the home quarantine to ensure strict compliance.

Info kit about EVD

On arrival, they should also be given a kit containing communication materials on all the basic, necessary information about Ebola virus disease (EVD) emphasizing the necessary precautionary measures to protect others especially their families. I’m sure no returning OFWs would want to cause harm to their loved ones.

For better perspective, based on recent statistics (which admittedly can change quickly like a moving target), the risk among those who live or temporarily reside in the Ebola-stricken countries to catch the infection is one in 1,196; while the risk of dying from EVD is one in 3,380. That means that to detect one potential carrier of the virus, we need to quarantine 1,196 individuals, some of whom may be significantly traumatized by the measure, or may develop other psychological issues, like depression, that can have long-term consequences.

This does not factor in the expenses and use of other resources for the quarantine. In the first place, do we have enough facilities, should a big number of the more than 10,000 OFWs from the affected West African countries return this holiday season? I don’t think we have. And how do we think these balikbayans would feel when they come home to spend the holiday season with their respective families, only to find out on arrival that they would be compelled to spend their first three weeks in an inadequately prepared quarantine facility? If they’re on a month-long vacation leave, they would only have a few days left to spend with their families. Some of them may have to spend Christmas and New Year while on quarantine.

So, our health officials may be unwittingly infringing on the civil rights of our returning OFWs and other travelers. I fully agree that public safety is of paramount concern, something which can justify violating the civil rights of, say, a few hundred Filipinos. But our precautionary measures must be consistent with available scientific data and the results of a proper and thoroughly done screening. If we say a peacekeeper or an OFW is classified as “zero risk,” why subject him or her to quarantine? There’s a disconnect between what we say and what we practice. It may be acceptable to stretch it a bit to provide an extra comfort zone, like holding them for a day or two to rigidly screen them to make sure we don’t miss anything, but imposing a blanket 21-day quarantine for all returning OFWs and travelers from Liberia, Guinea and Sierra Leone is bordering on paranoia.

Precautionary measures

We have an opportunity now, while the number of arriving OFWs is still manageable, to practice the appropriate precautionary measures, so our health personnel can determine the compliance rate of home-based daily self-monitoring and reporting, and institute the proper control measures for strict compliance. As said earlier, this may include unannounced visits at their homes to check on travelers who may be at an uncertain risk for EVD. The few high- and moderate-risk travelers are the ones who should be quarantined, preferably in a hospital facility.

If it’s any reassurance, Thomas Eric Duncan, the Liberian who was the first patient diagnosed with EVD in the United States, eight days after arrival in Dallas, Texas, had presumably close contact with his family for eight days, with a full-blown clinical expression of EVD during the last four days prior to his hospital admission; but none of the family members got the infection. Two nurses, who attended to him during the advanced stage, caught the virus but fortunately survived and had fully recovered.

So the risk to the family and the public of OFWs showing no signs and symptoms of EVD, and classified and reconfirmed to be low and zero risk is practically zero. We should just focus and allocate our meager resources and available quarantine facilities to those classified as high and moderate or some risk. If the exit screening had been done properly, we don’t expect to see them, but it’s also possible that a few of them might have been missed in the exit screening because of the big volume of departing passengers in the affected countries. There will be only a few of these high- or moderate-risk returning travelers, and if our screening at our ports is risk-oriented, our health personnel will be better equipped to spot them immediately when they arrive at our ports.

A zealous passion for public health safety is good, but a rational, individualized, calibrated and risk-oriented approach is more cost-effective than a one-size-fits-all strategy.