My plea to Maxime Coles
I read with interest your letter on the refusal to accept a mandatory quarantine on health care workers returning from a tour of duty in counties ravaged by Ebola. I suppose that you will agree in accepting this sanction for any symptomatic patients. Many states like NJ, NY, MD are following the authorities of the land and notably the CDC with stricter rules.
I have, like you, many reasons to applaud the devotion of Craig Spencer MD and many other physicians and nurses for reaching victims of Ebola in Guinea and other African countries. Day by day, we understand better the transmission of the disease and a transmission by droplets has been ruled out leaving closed contact with body fluids, the principal way of propagation.
Recently a more responsible physician from NY, returning from his heroic mission was asked to monitor himself but was feeling so great that he started Jogging and visiting his girlfriend until he developed a temperature of 100.3. He looked for care and was placed on a mandatory quarantine. We are learning so much on a disease which is not new to Medicine but which appears to present itself under different clinical aspects.
The American Medical Association, the American Hospital Association and the American Nurses association all are supportive of the CDC guidelines and already have implemented ways in teaching healthcare workers to face Ebola patients with a maximum protection for themselves and others.
I followed the political debates around the country and would not like to be part of the discussions between the CDC, the Federal and State Governments. I believe, on a personal note that a mandatory quarantine is the best way to evaluate a patient suspected to develop possible symptoms of Ebola in a home or a Hospital setting. Unfortunately, I can’t talk for all the AMHE physicians but our infectious disease team think that definitively such a mandatory quarantine should be the only way to deal with such problem in a country like ours, Haiti.
We know well for having been the target of the same government what the 4 H’s theory in HIV and AIDS has inflicted upon millions of Haitians living in the United States. We have a recent example with the Cholera epidemic in Haiti where Soldiers of the United Nations were found to be responsible of a waterborne transmission of a Cholera epidemic. They were never quarantined. This cost us 8.600 lives.
We certainly would not like to impose a strict isolation on others unless necessary.
Maxime Coles MD, FICS, FRCS, FAANOS
Orthopedic Surgeon and Traumatologist
President Central Executive Committee
Association of the Haitian Physicians Abroad