Preparing for Ebola

The policy announced yesterday by Gov. Martin O'Malley, health secretary Dr. Joshua M. Sharfstein and the state's major hospitals doesn't call for barring entry to travelers from the affected region, nor does it mandate locking up health care workers in hastily improvised quarantine centers when they return to this country after treating patients there. Instead, the state is planning a measured response to Ebola that, if properly carried out, should effectively contain the threat while quelling public fears surrounding the disease.

The state's response is based on the best available evidence about how Ebola is spread and who is at greatest risk for contracting the illness. Since Ebola can only be transmitted through direct contact with the bodily fluids of an infected person, health care workers known to have treated Ebola patients while not wearing full protective gear face the greatest danger of coming down with the disease themselves. All of the reported cases of Ebola transmission in the U.S. have involved health workers who either were not provided proper protective gear or who had the gear but weren't trained to use it properly.


The state plan calls for those high-risk workers to stay at home for 21 days after their last possible exposure to the virus, the maximum amount of time it takes for symptoms to appear. During that period they must take their temperature four times a day and report any fever, vomiting or diarrhea to health authorities immediately. In addition, they must maintain daily contract with health officials, including in-person visits to assess their condition, and sign an agreement to abide by the terms of their confinement.

On the risk scale just below health workers who come into contact with an infected person's bodily fluids without protection are those who had such contact but were wearing proper protective suits, masks and gloves at the time. They are considered at medium risk, and the state's response calls for restricting their activities, including a ban on taking public transportation or attending large gatherings. They also must clear trips or travel plans with public health authorities beforehand, take their temperature four times a day, stay in daily contact with health officials, including in-person assessments, and sign an agreement to that effect.

At the bottom of the response scale are people considered at low but not zero risk of infection, which would include other travelers from Liberia, Sierra Leone and Guinea, where the epidemic is centered. Those people would be required to take their temperature only twice a day and stay in contact with public health officials.

The state's plan to actively monitor everyone who may be at risk for Ebola is based on individuals' willingness to voluntarily comply with the restrictions imposed by health officials on each of the three risk groups. Should someone under active monitoring disregard the restrictions, officials could issue a public health order to forcibly compel their compliance.

However, no one should be more interested in detecting the first signs of Ebola than those who are known to be at risk. They should have every incentive to comply.

State officials developed this policy in close consultation with Johns Hopkins Hospital, the University of Maryland Medical Center, MedStar Health and the Maryland Hospital Association. As such, it recognizes the importance of protecting health care workers while also avoiding steps that would discourage medical professionals from helping treat the outbreak in Africa.

Some will no doubt continue their calls for travel bans and automatic, mandatory quarantines, but the truth is that the risk of Ebola in this country remains small. The governors of New York, New Jersey and Texas have already had to walk back alarmist rhetoric about the illness that only served to further confuse the public. Governor O'Malley, by contrast, let science dictate the state's response, and he deserves credit for realizing that Ebola is a serious threat to only a relatively small number of people here, and our public health system is quite capable of managing it, despite some initial missteps. Maryland's plan addresses that reality while also recognizing that the only sure-fire way to protect Americans from the outbreak is to eliminate it in Africa.