Sunday, November 2, 2014

Fear versus Science: Kaci Hickox and the Ebola Threat

Maine’s governor, Paul LePage believes that Nurse Kaci Hickox should be quarantined, kept isolated in her home until the gestation period for her possibly coming down with Ebola ends.  That would be 21 days.  Nurse Kaci refuses and vows to fight for her “civil rights.”  Who is right?

Nurse Kaci recently returned from Sierra Leone, West Africa, where she served as an aid worker with Doctors Without Borders, helping to fight the Ebola outbreak there.  That makes her a kind of humanitarian hero.  She risked her own health and wellbeing to save others in a foreign country.  Hats off to her for that!

However, upon her return home to the States, she now balks at what some may call taking reasonable steps to protect the residents of her own country.  Some question, are they really “reasonable” steps?  Others are wondering, is she not concerned for the safety of her own home community?  Legal battles are on the horizon, Maine’s governor versus nurse Kaci.  Is this how it should be?

Hickox arrived in New Jersey on October 24th; there Governor Chris Christie quarantined her for four days.  Apparently she showed signs of a fever, but it was not due to Ebola.  Proving to be asymptomatic in terms of Ebola, Governor Christie eventually released her to travel on to her home state of Maine.  Nurse Kacie criticized Christie for detaining her.

Once she arrived in Maine…, well, by now you know the story.  Nurse Kaci, in an interview says that she is “appalled by these home quarantine policies that have been forced upon me,” asserting that she continues to be in “perfectly good health,” “feels perfectly strong,” and has been “completely symptom free” thus far.

Thus, Nurse Kacie resents and resists the idea of enforced quarantine, virtually being locked-up in her own home until November 10th (which apparently marks the required 21-day period for assuring that she is Ebola free).  Doctors Without Borders sympathizes with her, having put out a statement which “strongly disagrees with blanket forced quarantine for health care workers returning from Ebola affected countries.”

“I’m not going to sit around and be bullied by politicians to stay in my home when I am not a risk to the American public,” she says.  “When someone is asymptomatic, there is no risk for transmitting the infection, so to imprison me in my house for three weeks when you don’t know ahead of time whether I will develop the disease … I’m not willing to stand here and let my civil rights be violated when it’s not science-based.”

She’s got a point.  Rational heads must prevail.  Policies and decisions should be based on solid scientific evidence.  I’ll give her that much.  However, I’d also add that public fears and lack of trust also need serious consideration and respect.  One does not allay another’s fear by in effect saying, “Hold on, you don’t know what you are talking about!  I DO.  So, I’m going to do what I will, regardless of your fears.  Deal with it!”  Did she say that?  No, she did not.  But her attitude and actions come across as much.

Nurse Kaci is resisting her Governor’s civic authority to keep her at home.  Dismissing the Governor’s authority to keep her at home, she plays up her own authority as a scientific medical nurse.  In short, it’s become a power struggle; two different kinds of authorities butting heads, governing authority based on fear versus personal rights based on scientific authority, as Nurse Kaci is inclined to depict it.

Nurse Kaci calls her treatment by the Governor a form of “stigmatization, not based on science or evidence.”  Well, okay.  But even if her treatment is based on reactionary fear that is not based on science, these fears are real and must be addressed as such.  Fearful people require real assurances with cooperative, positive, concrete action, so that those fears are alleviated.

Now, it is safe to say that the average American has a great amount of respect for the voice of science.  Some even treat Science as the new god on the block and scientists as its High Priests.  Nevertheless, the average American also knows that scientists are not perfect.  Miscalculations are made from time to time.  Science and the scientific method are not error free.

So there is a kind of artificial or false dichotomy that gets raised when one quickly pits scientific knowledge and know-how against social public fears.  This is true of any subject where science has a say over against public fears and doubts, be it about fracking, global warming, or the spreading of a life-killing virus, for example.  Bottom line: One does not alleviate fear simply by stating scientific facts and figures to logically prove how silly one’s fears are.

Science is interpretive and requires judgment even educated guesses at times.  All scientists, including doctors and nurses, make mistakes, get things wrong, and make bad judgment calls.  Hence, the need for the scientific community, or in this case the medical community, to develop and sustain public trust and to show some respect for the peoples’ fears each step of the way—no matter how irrational or unscientific those fears may be.

As I understand it, Federal guidelines say that a person in her situation may engage in “non-congregate public activities” like jogging in a park, as long as a 3-foot distance from others is maintained, for example.  That tells me that there can be a middle ground for the Governor of Maine and Nurse Kaci to find. 

The Governor is making a mistake by apparently demanding total isolation of said nurse while the nurse seems to be making the mistake of appearing preoccupied with self.  Both the Governor and Nurse Kaci need to think of what’s best for the public.  For example, Nurse Kaci could allow herself to become a test case to concretely verify and validate what science already knows about the Ebola virus and how it spreads.  She could allow herself to become a case-study by submitting to a bit more restrictive set of rules, so as to eventually confirm that the present Federal guidelines actually work.  By so doing, she could bring more confidence to a frightened public and provide practical reassurances to a doubting and fearful people.  But to do this, both Nurse Kaci and Governor LePage need to work cooperatively.  They must avoid allowing this to become an issue solely about one person’s individual civic rights.

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