Ebola and Public Policy: Weighing the Options

The views expressed are those of the author and do not necessarily reflect the views of ASPA as an organization.

By Stacey Mann and Gretchen Richards
December 9, 2014

Since the first reported case in the United States, the Ebola virus (EBOV) has consumed the attention of medical and public policymakers to address the concerns of the general public. When two health care workers in Dallas contracted the virus after caring for an Ebola patient, the Centers for Disease Control and Prevention (CDC) released updated protocols for personal protection equipment (PPE). Yet, the increased protocols and copious amounts of information provided by the CDC and other health care experts via website, press releases and webinars appear to create more concern and questions than confidence and trust in the containment and treatment of the virus.

Public administrators are navigating through news reports, limited scientific research and expressed concerns and fears from their constituents. Although the CDC reports transmission is through contact only, a 2012 Scientific Reports article researched the possibility of interspecies virus transmission between pigs infected with EBOV and healthy cynomolgus macaques (monkeys). The study indicated aerosols transmission was possible, but further studies on droplet size and the human body’s response to Ebola infection are required.

The study, however, revealed the possibility of EBOV transforming into an airborne-transmitted disease. Likewise, the World Health Organization (WHO) reported “People remain infectious as long as their blood and body fluids, including semen and breast milk, contain the virus. Men who have recovered from the disease can still transmit the virus through their semen for up to 7 weeks after recovery from illness.” The CDC will map contact of individuals recently diagnosed with the disease. But what should be done during the 7 weeks after the individual has been released from treatment?

According to the U.S. Army Institute of Public Health Environment Health Engineering Portfolio Aberdeen Proving Ground, Ebola patients can create approximately 20 35-gallon bags of hazardous waste per day, which leads hospitals nationwide to wonder about safe disposal. However, those questions are going unanswered. In a congressional hearing, Dr. Tom Frieden, director of the CDC, claimed the virus was not “particularly hardy” and could be killed by bleach or a variety of other chemicals.

In addition, a recent AP article reported that Black Book Rankings, a health care research group, found 75 percent of emergency room doctors and 80 percent of infection specialists stated their facilities were not adequately prepared. Furthermore, only 1 percent of survey participants affiliated with acute care hospitals stated more than 10 Ebola cases could be treated at a time.

Elected officials are placed in a conundrum. The legal challenge between individual versus public freedoms are brought before the courts quickly. In the most recent case, the courts swayed toward individual rights of freedom when a returning medical worker fought against quarantine measures, which left public officials perplexed. In a 2009 Public Administration Review article, P. Edward French and Eric S. Raymond addressed the ethical crises public officials would face if an influenza pandemic occurred. In regards to local government pandemic plans, the authors state: “The development of policy with respect to ethics and the implementation of policy in an ethical manner have become increasingly important for government in rebuilding public trust and ensuring that government officials and employees respond to situations in ways that are legally and morally standard.”

The actions of health care workers who carried out their daily routine while in the early stages of infection have heightened the concern of the general public, creating a call to action among governing bodies. The Hippocratic Oath states, “I will prevent the disease whenever I can, for prevention is preferable to cure. I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm.”

C.J. Peters, director for biodefense at the Center for Biodefense and Emerging Infectious Diseases, reflected on his 21-day quarantine after working in a hot zone in the 1970s. He stated the quarantine was not ideal and difficult. However, when individuals work in areas of infection and are at high risk, then workers prepare for possible quarantine, but “these people who do not have highly dangerous exposures do not deserve to be locked up, given what we know or think that we know about Ebola.”

The selfless actions of medical personnel treating patients infected with Ebola are commendable. Before the medical mission trip and during their time in the infected areas, protocols, policies and procedures are reviewed and practiced. Yet, even after leaving infected zones, health care workers are contracting Ebola and in many cases dying. The World Health Organization reported 13,567 confirmed, probable and suspected cases of Ebola virus disease (EVD) in six affected countries and two previously-affected countries up to the end of Oct. 29. Approximately 4, 941 deaths have been reported and 523 health care workers have been infected with EVD, 269 of which were fatal.

Officials are tasked with creating a balance between society and individuals who pose a potential threat to the health and welfare of the public. Perhaps the compromise lies with the medical and research community, which has received additional funding to study Ebola. Exposed health care workers could live in transitional housing where they can be medically monitored and vitals recorded. Meanwhile, the health care workers could document their interactions and experiences with Ebola patients to gain a better understanding of the disease and possible methods of transmission. The health care workers could be compensated through the proceeds received to conduct research. This solution would protect the general public, increase the body of Ebola research knowledge and provide immediate medical care for the population responsible for treating others.

The Ebola virus and medical knowledge increases daily. Yet, many questions remained unanswered. The lessons learned from countries that have been cleared from Ebola, research scientists and front-line medical personnel are crucial in successfully fighting this disease. Medical personnel, public policymakers, elected officials, first responders and civil rights advocates should discuss facts rather than myths, develop an informative campaign to educate society and become united to increase trust and willingness to resolve this global health crisis.

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Author: Stacey Mann, Ph.D. is an assistant professor in the Department of Emergency Management at
Jacksonville State University. She can be reached at [email protected]. Dr. Gretchen Richards is an assistant professor in the Department of Emergency Management at Jacksonville State University.

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