Monday, November 10, 2014

Ebola Update: Canadian aid agencies fear new guidelines

Health alerts regarding people who may have traveled to particular West African countries are posted in the lobby of Bellevue Hospital, Friday, Oct. 24, 2014, in New York. Mark Lennihan/The Canadian Press 
Steve Rennie
The Canadian Press
Canada’s aid community is buzzing with speculation that the federal government may be poised to escalate its measures aimed at otherwise healthy people who had contact with Ebola patients overseas.

Aid agencies are cautioning against anything that would discourage people from travelling to Ebola-stricken West African countries, where medical personnel and expertise are desperately needed to help contain and treat the deadly virus.

No announcement has been made, but multiple sources have told The Canadian Press that the government has been giving serious thought to adopting guidelines similar to those announced by the U.S. Centers for Disease Control and Prevention.

At this week’s annual meeting of the Canadian Network for Maternal, Newborn and Child Health, the rumour mill was churning that Ottawa is considering putting additional measures in place.

Precisely what those measures entail remains unclear. Talk at the meeting ranged from mandatory quarantines similar to those adopted by some U.S. states to a more modest regimen of monitoring — with the possibility of further restrictions on people’s movement — in line with the CDC’s guidelines.

“These are the best and the brightest minds in Canada on how to get on top of this, how to train effectively, how to do community mobilization on prevention,” Plan Canada head Rosemary McCarney said in an interview.

“Any number of them said, ‘I would like to go, but I can’t be locked in a quarantine that will take me through Christmas … and I would be worried if our government decided that one of its response measures was to enforce a quarantine on people returning who may not have had any contact with Ebola.'”

The minister’s office has yet to comment on any new measures.

So far, all travellers returning to Canada from the three affected West African countries — Guinea, Sierra Leone and Liberia — have been referred to a quarantine officer from the Public Health Agency of Canada who checks them at the airport for fever and determines if any more steps need to be taken.

In the U.S., the CDC has established a tiered system that treats people differently based on how likely it is that they have been exposed to Ebola.

Anyone who has been to a country with a widespread Ebola outbreak and has treated a patient while wearing the proper protective gear, but who shows no signs of illness themselves, is considered to be at “some risk.” Most health workers who have been to an Ebola-stricken country likely fall into that category.

The CDC recommends “direct active monitoring” in such cases. That essentially means a public health official visits once a day to take the person’s temperature and check them for any Ebola-like symptoms. The person may also have to check in by telephone at another point in the same day.

Public health authorities can also go even further and restrict a person’s movement by ordering them to keep off public transit, avoid crowds and stay home from work.

Epidemiologists, contact tracers, airport screeners and laboratory workers are among those who would be in the “low (but non-zero) risk” category. The CDC does not recommend movement restrictions in such cases, but it does require people to check in daily by phone to report their temperature and any symptoms.

A growing number of U.S. states have gone even further and are now enforcing mandatory quarantines on travellers who have had any contact with Ebola patients in West Africa.

Politics is almost surely at play. A recent poll by NBC News and the Wall Street Journal suggested more than seven in 10 Americans support mandatory quarantines for health workers who have treated Ebola patients in West Africa, even if they have no symptoms.

U.S. President Barack Obama has chided those states with mandatory Ebola quarantines, saying the move discourages American health workers from helping in West Africa. Others, including UN Secretary General Ban Ki-moon and aid groups, have also weighed in against mandatory quarantines.

“I disagree with the premise (of) quarantine of health workers who are asymptomatic upon return,” Ontario Health Minister Eric Hoskins said recently.

“I don’t believe that that’s good science and I think it actually discourages health-care workers from going to West Africa, which is how we’re going to solve this epidemic.”

McCarney said such measures would slow recruiting.

“If we can’t effectively get people into the field quickly and know that they can return (to normal activities) when they need to, then we’re going to slow the response.”

Canada has already put a temporary stop to processing visa applications for residents and nationals of countries with “widespread and persistent-intense transmission” of the Ebola virus — a decision that put the government at odds with the World Health Organization. Work on permanent residence applications for people from the affected countries has also been suspended.

By emphasizing that the suspension only applies to countries with widespread transmission, Canada managed to neatly sidestep a potential diplomatic row with the U.S., which still has at least one active Ebola case within its borders.

The Centers for Disease Control diagnosed the first case of Ebola in the U.S. on Sept. 30. The patient died Oct. 8. So far, there have been no confirmed Ebola cases in Canada.

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