Are new Ebola quarantine rules in U.S. too much?

After deploying more than 700 international staff to treat Ebola patients in West Africa, a Doctors Without Borders doctor has been diagnosed with Ebola after returning home to New York City.

Almost as soon as that news was announced, the debate over whether this amounted to a failure of the existing protocols grew a lot louder.

The group, known by its initials in French, MSF, says Dr. Craig Spencer followed their protocols and "he posed no public health threat prior to developing symptoms."

On Oct. 17, Spencer, 33, returned to the U.S. from Guinea, where he had cared for Ebola patients. On the morning of Oct. 23, he had a fever of 100.3 degrees. Later that day, he tested positive for Ebola and that was confirmed the next day. As of Friday afternoon, authorities said he is in stable condition, in isolation at New York's Bellevue Hospital.

Contact tracing is underway. Spencer's fiancée and two friends – the only people with whom he had extensive contact since returning – are now quarantined. That will continue until 21 days have elapsed since their last contact with Spencer.

Both MSF and the U.S. Centers for Disease Control and Prevention require their returned staff who have treated or been in contact with Ebola patients to check their own temperature twice a day. That will be confirmed by daily phone calls from their local public health department.

Contagiousness low at onset of fever

Temperature monitoring is critical because fever is the first indication of infection.

Before someone carrying the Ebola virus has a fever or other symptoms, they cannot spread the disease. And the disease is only transmitted through contaminated bodily fluids, like blood or vomit.

Tropical disease specialist Dr. Richard Olds says when someone with Ebola first exhibits symptoms, they are not especially contagious. (University of California Riverside)

Even when someone with Ebola first exhibits symptoms, they are not especially contagious, tropical disease specialist Dr. Richard Olds tells CBC News.

When a person develops a viral disease, "in the beginning they have relatively few viral particles in their body or even in their secretions," says Olds, who is dean of the school of medicine at the University of California, Riverside.

As someone becomes ill, the virus is multiplying in their body. After five or six days, they are highly contagious if there is a transfer of bodily fluid. "That's a different situation than the situation when a person is asymptomatic, during the incubation period, and even the situation where the person just developed the fever."

Given the deadliness of the Ebola virus — about 70 per cent of patients do not survive — an abundance of caution from the first sign of fever is the norm. That's how New York City has been responding — with a thorough contact tracing program.

Later on Friday, some states went further. New York and New Jersey declared a 21-day mandatory quarantine for anyone who had contact with Ebola patients in West Africa.

The day before, MSF had stated in a news release that "Self-quarantine is neither warranted nor recommended when a person is not displaying Ebola-like symptoms."

Although he also doesn't call for a mandatory quarantine, Olds says that's "not unreasonable." However, "from a public health danger standpoint, I'm not sure that there is sufficient evidence to suggest" a quarantine is needed. The main reason behind the states' action may be the huge cost of contact tracing, he suggests. "The way people are responding to what are probably pretty trivial exposures could get extremely expensive," he says.

Protocols followed

MSF protocols for their returning health-care workers also require that they "stay within four hours of a hospital with isolation facilities" and immediately contact the MSF if any relevant symptoms develop.

While Spencer is the first MSF worker to develop Ebola after leaving West Africa, 24 of their staff, including three international staff, have contracted Ebola while in West Africa.

Dr. Craig Spencer is in an isolation ward in Manhattan's Bellevue Hospital, a designated Ebola centre. He returned Oct. 17 from Guinea, where he had been caring for Ebola patients. (Craig Spencer/LinkedIn)

Thirteen have died. "In-depth investigations have so far shown that most of the infections occurred outside MSF's medical facilities in the countries," MSF states in a news release.

MSF says they have sent more than 700 international staff to West Africa, with 270 there now. In total, they have 3,000 employees in West Africa.

They say Spencer did everything MSF's protocols call for. As soon as he detected that low-grade fever, "he swiftly notified the MSF office in New York. He did not leave his apartment until paramedics transported him safely to Bellevue Hospital in Manhattan."

MSF guidelines discourage staff from returning to work for 21 days after leaving West Africa and Spencer did not return to his work in international emergency medicine at New York-Presbyterian Hospital and teaching medicine at Columbia University.

MSF staff continue to receive their salaries during the 21-day period.

Contact tracing 'conservative and expensive'

When Thomas Eric Duncan was hospitalized with Ebola in Dallas, extensive contact tracing was carried out and that is happening in New York, too.

New York City health commissioner Dr. Mary Travis Bassett said at a news conference on Friday that Spencer is in stable condition. (Bill Lyons/The Advance/Associated Press)

Members of Duncan's household were quarantined and "no one in his household, including the woman who cared for him every day" contracted Ebola, New York City Health Commissioner Dr. Mary Bassett told a news conference on Friday. And Duncan had symptoms for at least three days before he was hospitalized.

There is also no record of someone contracting Ebola who was a passenger on the same flight as someone who had Ebola symptoms.

Olds says "chasing down everybody is extremely conservative and extremely expensive." He adds that it also "evokes a great deal of concern on the part of the people in the community — and quite frankly adds a bit to the hysteria — and suggests to the population that they're at some significant risk of coming down with Ebola, and I don't think they are, but I understand that that's a reasonable public health response."

He also says it's important to consider that, "probably not since the very early days of AIDS and, historically, probably not since the time of the Black Death in Europe, has there been a better example of true physician and nurse heroes that have stepped up, at some significant risk to themselves, to take care of people."