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A few weeks ago, I told you the different reasons why I believe that quarantine doesn’t work. My main argument boils down to the fact that human beings can think and plan and act when they feel that they are in danger. Being placed in an isolated area (e.g. a tent outside a hospital) and not allowed to see friends and family makes us feel in danger. Being told by the governor of a state in the United States that you are “obviously ill” makes you feel in danger. Seeing incompetence and panic over Ebola everywhere around you makes you feel in danger.
So you try to run.
Nurse Kaci Hickox was taken from the airport in Newark, NJ, to a tent outside a hospital and placed there until further notice because an elected politician said so. She didn’t have a fever. She wasn’t feeling ill. She would test negative for Ebola infection. Yet the government of that state saw it necessary to throw her in a tent with no running toilet. The only thing that saved the day, in my opinion, is that she had a cellphone with her, and she was able to text-message out an exposé of her situation. In that essay, she writes this:
“I arrived at the Newark Liberty International Airport around 1 p.m. on Friday, after a grueling two-day journey from Sierra Leone. I walked up to the immigration official at the airport and was greeted with a big smile and a “hello.”
I told him that I have traveled from Sierra Leone and he replied, a little less enthusiastically: “No problem. They are probably going to ask you a few questions.”
He put on gloves and a mask and called someone. Then he escorted me to the quarantine office a few yards away. I was told to sit down. Everyone that came out of the offices was hurrying from room to room in white protective coveralls, gloves, masks, and a disposable face shield.
One after another, people asked me questions. Some introduced themselves, some didn’t. One man who must have been an immigration officer because he was wearing a weapon belt that I could see protruding from his white coveralls barked questions at me as if I was a criminal.
Two other officials asked about my work in Sierra Leone. One of them was from the Centers for Disease Control and Prevention. They scribbled notes in the margins of their form, a form that appeared to be inadequate for the many details they are collecting.
I was tired, hungry and confused, but I tried to remain calm. My temperature was taken using a forehead scanner and it read a temperature of 98. I was feeling physically healthy but emotionally exhausted.
Three hours passed. No one seemed to be in charge. No one would tell me what was going on or what would happen to me.”
Ms. Hickox has since tested negative for Ebola and is on her way home to Maine, where she faces a lot of hostility from people who don’t know better. She has also retained a lawyer, and there is talk of a lawsuit against the State of New Jersey for her treatment. I don’t blame her. In my opinion, Chris Christie did absolutely everything he could to get this wrong in many, many ways.
Then again, the Governor was acting with whatever information was coming at him as he stumped in Iowa… No, wait. That’s no reason to make so many mistakes. A good leader listens to people who know about things, and everyone worth their weight in salt when it comes to public health has said that quarantines don’t work, and that quarantines will only cause more trouble. Who in the world told him that it was a good idea to institute a 21-day quarantine of anyone coming back from West Africa? If someone did tell him this, that person is probably without a job, just like his staffers who pulled-off the whole “Bridgegate fiasco“.
This whole quarantine business has reminded me about the way we used to treat people with Hansen’s disease (aka “leprosy”). Hansen’s disease is caused by a bacteria closely related to the bacteria that causes tuberculosis. Instead of causing a lung infection like tuberculosis, M. leprae causes a disseminated “granulomatosis”, meaning that your granulocytes (a type of white blood cells) attack the bacteria and destroy everything in sight. That leads to skin lesions externally, and the loss of nerves and growth of granulomas internally. Those skin lesions and nerve damage lead to the loss of appendages. If you’ve ever seen some of the ancient takes on Hansen’s, you’ll see deformed people who are covered up from head to toe and are missing limbs.
A big reason why people with Hansen’s were covered up from head to toe was that people believed that the bacteria that caused it was very infectious from person-to-person. In fact, it is not that contagious, and it is easily treatable with antibiotics. We know that now, though. Back then, it was the ignorance about the causative agent that caused people to be sent off to “Leper Colonies”, usually islands, or forcefully put into quarantines. One of those people was Mr. John Early of North Carolina.
John Early was born in 1874 and served in the US Army from the age of 23 to 32. After his service, John married and moved to back to North Carolina. However, his work caused injuries to his skin, and he decided to quit and seek out a pension from the government based on his service. He traveled in August of 1908 to Washington, DC, alone to seek out that pension. Once there, Mr. Early had a severely swollen face and lesions on his skin. He went to see a doctor. What comes next, you’ll find very, very familiar:
“Remembering that Early had admitted to military service in the Philippines, the doctor, in fear of contagion, retired precipitously. He returned shortly with Dr. William C. Fowler, inspector for contagious diseases in the District of Columbia, who had never seen a true case of leprosy in his life. After a brief look, the two medical men went out, carefully locking the door behind them but soon returning with Dr. Joseph J. Kinyoun, pathologist at Washington University and founder of the U.S. Public Health Service Hygienic Laboratory. After a brief examination, Kinyoun remarked that the case was “strongly suspicious” and took a small cutting of Early’s facial skin to his laboratory. There he reported finding bacilli “corresponding morphologically with those of leprosy.” These findings were speedily endorsed by Dr. William C. Woodward, health officer of the District of Columbia and expert in medical jurisprudence, and Early was immediately removed from the locked room at the doctor’s office and forcibly quarantined in a hastily erected tent down on the marshy bottom adjacent to the eastern branch of the Potomac River.”
Read that one more time and tell me that we are not making the same mistakes more than 100 years later.
From a 2014 perspective, the case of John Early gets more and more ridiculous. Convinced that he had leprosy, Mr. Early and his wife were not allowed to touch each other, talking to each other only from a distance. They were allowed to move into a house that was separated in halves by a wall, and a full-time police officer was hired to make sure that Mr. Early wasn’t touching anyone.
Newspapers at the time took up Mr. Early’s cause, asking if that forced quarantine was really necessary, and if he really was sick. There was mounting evidence that he did not have leprosy or that he could have something else entirely, something not contagious. But the government continued for months to keep him in a strict quarantine.
Dr. Duncan Bulkley, a dermatologist, sent skin samples of Mr. Early’s to prominent physicians, including Dr. William Welch of Johns Hopkins Univeristy fame, and Dr. William Park of the New York City Health Laboratory. Neither Dr. Welch nor Dr. Park were able to find the bacteria that cause Hansen’s in the skin samples. Furthermore, Dr. Bulkley, on direct physical examination, was unable to find signs of nerve damage to the skin or limbs of Mr. Early. In essence, if he had leprosy when he was first quarantined, he didn’t have it now.
Even with that evidence, the DC authorities did not release Mr. Early from quarantine. Instead, they shipped him in a locked vehicle and under guard to New York to be tested further. There, everyone who tested him continued to diagnose him as disease-free. After some “professional” discourse on Mr. Early’s condition, he was finally set free. However, by the time he was allowed to be off quarantine, his reputation was soiled to the point that no one wanted him around, not his neighbors, not his bosses, no one. The only one who stuck by him was his wife, Lottie.
The saga continued when previous skin samples (those collected when Mr. Early first was quarantined) were analyzed again. They were found to have the bacteria, so back to quarantine he went when he showed up in DC to try and collect his pension. Once again, he was sent to New York under lock and key. Once again, he was re-examined and found to be healthy.
“Bulkley publicly labeled Early’s experiences with the Washington, D.c., health officials as “one of the greatest outrages ever officially perpetrated upon an American citizen,” and pointed out that Welch of Hopkins, Park of the New York City Health Department, and Captain Dutcher of the Army Medical Corps totally supported him in his contention that Early was not and never had been tainted with leprosy.”
Read that again and tell me if we’re not making the same mistakes again, a hundred years later.
Mr. Early moved to Washington State with his family, trying to start anew. When he asked for his pension, the government asked that he be examined. When word got out of who he was…
“[His neighbors] indignantly demanded his removal. It was first proposed to enclose one acre of his farm with two rows of barbed wire fences six feet apart, thereby shutting him off from contact with any other person, but even this plan did not satisfy the local citizens.”
Compare that to the hateful things being leveled against returning American aid workers by people like Donald Trump or any of the bozos who think that they’re experts. They are not satisfied with sensible or insensible solutions. They want no one coming out of West Africa, and anyone here to be thrown to the gallows, for lack of a better term.
All of that hassle led to the Earlys separating, with John Early being sent to work at a quarantine station taking care of a sailor with Hansen’s disease. However, Mr. Early escaped and made it all the way back to Washington, DC:
“What is more, on May 17, 1914, he escaped from the quarantine station and was traced to Victoria, British Columbia, were officers lost track of him. Then two weeks later the front pages of newspapers across the country announced that John Early had been discovered as a guest in the exceedingly fashionable Hotel Willard in Washington, D.C., and the other occupants were “thrown into a panic.” He had been staying for the past several days at the same address as Vice President and Mrs. Thomas R. Marshall, numerous senators and representatives, as well as a number of ambassadors. Indeed, a leprosy patient had “tainted” the establishment “frequented by the highest circle of official diplomatic, congressional, and residential Washington life.””
The incompetence of the public health response to Mr. Early — just one man — led to panic. Big surprise.
Mr. Early said this to reporters:
“To demonstrate how easy it is for a leper to mingle in cities, I planned my present trip six months ago. I knew that it is only when a great truth is sent home to the hearts of the people that attention is paid to it. I knew that if I mingled among the well-to-do and the rich and exposed them to contagion that they would arise out of self-protection and further my plan of a national home.”
Indeed, it is not until those in power and with power are affected that things get done the right way.
Days of arguing in Congress on what to do with Mr. Early ended with him being put back into the isolated house he was put in years before. No state would take him because the politicians — not understanding the disease — did not want to be responsible to their constituents for having “a leper” among them. If only they would have taken the opportunity to be leaders and teach their constituents the truth about Mr. Early?
If only Gov. Christie would have taken the opportunity to fully inform the people of New Jersey about Ebola, what it is and what it isn’t? Talk about missed opportunities.
Even when Congress got its act together and created a national home for people with leprosy — a “leprosarium” — Mr. Early’s ordeal was not finished. He suffered from mental health disease due to his treatment. Psychiatrists compared it to the disorders seen in prisoners.
Remember that Ms. Hickox was kept in an isolated tent, away from any form of human interaction, with only her cellphone to connect her to the world. That’s kind of what prison is like… Except that you have cellmates in prison.
Mr. Early died at the leprosarium at the age of 64, a victim of incompetence and ignorance, and, worst of all… Fear.
How many victims will we rack up by the time this is all said and done here in America?
NOTE: I paraphrased and quoted most of the story of Mr. Early from this great article in the International Journal of Leprosy by Philip A. Kalisch. I also recommend “The Colony:The Harrowing True Story of the Exiles of Molokai“. Finally, if you’re a subscriber to Time Magazine, I also recommend this article, “Leper At Large“.
René F. Najera, DrPH
I'm a Doctor of Public Health, having studied at the Johns Hopkins University Bloomberg School of Public Health.
All opinions are my own and in no way represent anyone else or any of the organizations for which I work.
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