Understanding the U.S. guidelines on Ebola quarantine – Part 2

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    A short time ago, I spoke with Dr. Anthony Fauci of the National Institutes of Health about the guidelines and quarantines.

    Dr. Tony Fauci, thank you very much for joining us.

    These now CDC guidelines recommend a voluntary at-home isolation for health care workers returning from West Africa who are in a so-called high-risk category. How does one determine that these guidelines are strict enough? We have seen there have been already been mistakes.

    DR. ANTHONY FAUCI, Director, National Institute of Allergy and Infectious Diseases: Well, there's really a difference here, Judy.

    And that is what is being matched is the stratification of the risk of the person, according to the risk. So you mentioned high-risk. There are some very clear guidelines now. If a person is high-risk and they have symptoms, this is what you do. If they're high-risk and they don't have symptoms, there is what's called direct active monitoring.

    Namely, a person is monitored not only that they take their temperature and tell someone, but someone actually every day comes and monitors the person with the temperature and an evaluation of symptoms, and that the decision is made based on that exactly what the restrictions.

    But, clearly, if someone is at high risk, they are not going to be able to do the kind of public transportation or what have you, but they will be monitored on a daily basis. What we have injected into the formula is the issue of the clinical judgment of somebody on an interim basis continually monitoring the asymptomatic person.

    The person with symptoms is absolutely no problem. You go ahead and isolate that person until you can prove that they don't have Ebola. But it's the iffy area where somehow doesn't have symptoms. Then they need to be restricted, but they are continually being monitored in an active way.

    And that's something that is new and I think should add a degree of confidence and removal of some of the concern that someone is just going to freely go out and do what they want do when they're in that category.


    But, as I understand it, these new guidelines are recommendation and that it's up to each state to either enact even stricter guidelines or to enact guidelines that are not as strict as this.


    Well, it is highly unlikely, Judy, that there are going to be guidelines that are not as strict as this.

    The CDC is really indeed working very closely with state health authorities and other local health authorities to try and get a coordination to all of this. But it has always been the situation where the CDC sets the base below which you can't go.

    There's always the possibility that some states would want to go even beyond that, but we feel that the recommendations that have been made now by the CDC with their new interim guidelines are based on solid scientific evidence. And it's not going overboard in some respects, but in other respects making sure that the science guides what they do.


    Dr. Fauci, you were pretty clear yesterday in saying you didn't think it was wise, the quarantine restrictions that had been imposed by the governor of New York, the governor of New Jersey. Those restrictions have now been walked back.

    How much pressure came from the federal government, from the Obama administration on these governors to change?


    Well, Judy, I don't think it was pressure.

    I think it was an articulation of the rationale for why we feel that, although we're very sensitive to the concerns of people, we want to make sure that the kinds of things we do are guided by sound scientific evidence. And I think that the dialogue and the discussion back and forth has brought some rethinking on the part of some about how far one should go.

    So instead of having a big basket of quarantine for people, you do it on an evaluation. Certainly, there will be some circumstances where someone is at such a high risk that you would almost have the same functional type of restriction that you would with so-called quarantine.

    But you want to be careful not to throw everyone into that same basket, so that you have stratification and you have clinical judgment that dictates the kind of restriction that you have.


    And these Army rules that were reported today, the fact that the U.S. Army is saying American troops who worked in the Ebola-infected areas of West Africa, they will be quarantined for 21 days in Italy, is that contradicting these other guidelines coming out from the CDC?


    No. No, it really isn't, Judy. It may appear to be contradicting, but it's not, because when you're dealing in the military service, you have commands, you have the disciplines, you have the barracks to do the kind of things that — they come back and they report to their barracks anyway.

    So, really, the military situation is a bit different because of their capability of organization and control of movement of their own troops. That's very different from the civilian population.


    And just finally, are you hearing personally of health care workers who are now rethinking or deciding not to go to West Africa because of these new restrictions?


    Well, Judy, to be honest with you, yes. There are people that are concerned because when they get this feeling that if they go back, there's going to be something that's completely not based on scientific data that they're going to be restricted, they all feel very strongly that if they are at risk to other people, they would want to be restricted.

    That's the point. They would want to be restricted. So I don't think that this idea of giving the kinds of recommendations right now I think is going to fortify them and say, well, at least I know it's not going to just be arbitrary, it's going to be based on science. And I think that would encourage them to continue to go over there.


    Dr. Anthony Fauci, the National Institutes of Health, we thank you.


    Good to be with you.

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