In a time of renewed public fear over terrorism, the Ebola outbreak may seem like a distant memory to many Americans. However, the panic in recent weeks that is driving some politicians to reject refugees mirrors the hysteria that led some states to implement groundless Ebola quarantines that violated fundamental civil liberties. We need to end the cycle of fear-based political grandstanding and instead turn to policymaking based on evidence and resolve.
The 2013–15 Ebola outbreak quickly overwhelmed health systems in West Africa. There was a clear need for international support and many American health professionals stepped up to volunteer their services. However, as the outbreak reached its peak in fall 2014, there were calls to close U.S. borders and quarantine every person traveling from West Africa. Governors in 22 states across the U.S. put policies in place to quarantine health workers returning from Ebola-affected countries. Two members of the Yale community were quarantined in their homes.
Over the past 10 months we worked with our classmates and faculty at the Yale Global Health Justice Partnership as well as colleagues at the American Civil Liberties Union to determine what happened and whether there was a scientific basis for quarantine. We also considered the constitutionality of the quarantines as they were carried out. What we found, published in a report titled “Fear, Politics and Ebola” on Dec. 3, was a shocking disregard for science and the constitutional rights of individuals returning to the U.S. from Ebola-affected countries in West Africa.
It is not easy to become infected with Ebola. To catch the disease requires unprotected close contact with a symptomatic patient or unsafe handling of medical waste from a symptomatic patient. Transmission is most likely to occur later in the course of infection when the patient’s blood and other bodily fluids have high concentrations of the virus.
Ebola did not pose a serious public health risk in the U.S. Nearly four decades of encounters with Ebola in Africa show, and experts agree, that transmission does not occur before symptoms appear. In countries with functioning public health systems, such as the U.S., epidemiologists can (and did) identify anyone returning from Ebola-affected countries and monitor them for the duration of the 21-day incubation period. If symptoms do appear, properly trained and equipped health professionals can safely provide treatment. Epidemiologists can identify and follow up with the new patient’s contacts. The task is difficult but manageable in a country such as the U.S. with considerable public health resources.
Quarantine is not an effective tool to deal with a disease like Ebola. Quarantine is the isolation of someone who may have been exposed to an infectious disease and may be infectious but does not manifest symptoms. It may seem like common sense to impose quarantines “just in case.” But the fact is that Ebola is not transmitted until after symptoms appear, and evidence shows that quarantines ended up doing far more harm than good.
Families returning from West Africa were confined to their homes without access to food. Children were separated from their parents. International relief organizations found it harder to recruit desperately needed volunteers and wasted valuable time and resources supporting their staff and volunteers who were needlessly in quarantine. Children whose families happened to be from West Africa were bullied in schools. Tax dollars were wasted administering and enforcing needless quarantine orders. Mass hysteria over Ebola was validated by public policy.
These policies violated individuals’ constitutional liberties. Under the U.S. Constitution, states may only use quarantines when less restrictive options are not available. However, effective and less restrictive options were available, including actively monitoring patients without restricting their movements. Only one of the 22 states that imposed quarantines allowed for a hearing in front of a neutral decision-maker, a constitutional check meant to protect the rights of the individual. Many states that imposed quarantines did not provide for the basic needs of quarantined individuals, such as providing access to food and child care. Health professionals returning from Ebola-endemic countries deserved our gratitude. Instead they were met with fear and subjected to neglect.
The U.S. state-based Ebola quarantines were unnecessary and counterproductive. The threat Ebola posed to the U.S. population was vastly overstated and the response was overblown. Tragically, these misinformed policy decisions precluded American health professionals from traveling to West Africa during the height of the outbreak, when hundreds of new cases were arising each day.
The stakes are high even though the Ebola crisis is waning. With another humanitarian crisis at our doorstep we again risk succumbing to fear instead of compassion. We need to be steadfast precisely at times like this. Let’s learn from the Ebola crisis and reject the specious narrative that forsaking rights will increase security.
David Gonzalez is a Fox International Fellow with Yale University and El Colegio de México and a 2015 graduate of the Yale School of Forestry & Environmental Studies. Contact him at firstname.lastname@example.org. Emma Roth is a second-year student at the Yale Law School. Contact her at email@example.com.