COMMENTARY

We Need to Bend Privacy Rules to Stop the Ebola Outbreak

Arthur L. Caplan, PhD

Disclosures

October 24, 2014

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Had Enough of Ebola?

I'm Art Caplan and I'm at the Division of Medical Ethics at the New York University (NYU) Langone Medical Center in New York City.

Ebola—heard enough about it yet? I suspect you are going to continue to hear more about it and you are going to hear more about it from me, but let's take a different angle on this. Rather than all the issues about who is infectious and how this situation in Dallas occurred, where somebody infected two nurses and wasn't detected as an Ebola candidate during his first visit to the hospital, let's ask a different set of questions.

What are the top ethical issues that Ebola raises? I'm going to give you mine, and maybe a few words about what to do about them. The first one that I still believe our politicians in the United States aren't focused on is stopping the epidemic. We get into a lot of debates about travel bans and who can come here, and checking passports and taking temperatures, some of which don't seem to make any sense. Taking temperatures is not cost-effective in any way; travel bans are pretty difficult to enforce, given the way the air traffic world is connected; and so far the only person who has been infected by somebody who traveled here was the case in Dallas. It's not like we're seeing infections all over the place as people come in from West Africa. Another way to put it is, if you are healthy enough to travel, you are probably healthy enough not to be infecting people during the time you are on an airplane.

The Real Moral Challenge

But put all of that to the side. The real moral challenge is, how are we going to stop the epidemic in West Africa? If we don't stop it, we are going to be arguing about travel bans and temperature-taking for the next 3 years. We have to get a handle on the Ebola epidemic. Countries like Nigeria and Senegal have done so with assistance, isolation, quarantine, and supplies. We need more resources on the ground in the poor countries in West Africa that are suffering from the epidemic—Guinea, Liberia, and Sierra Leone. They don't have beds anymore; too many people are dying at home. That is a sure route to infection. The dead bodies are there, and families are taking care of their loved ones. They don't have any protective gear. That has to be stopped. If we don't get a handle on that situation, we are going to be arguing here about how to manage Ebola for a long, long time.

The number-one moral priority to me is, what are we going to do to stop the epidemic over there? How can we get more resources over there? How can we get more beds, more quarantine, more isolation, and more education?

Bending Privacy

The next big moral issue for me is privacy. That has been a tough one. We are all committed to privacy in the United States, but just as we use quarantine, isolation, and restricting liberty to deal with the disease, sometimes we have to bend privacy. I don't think we need the names of those who become infected, but we sure need to know how a nurse taking care of a patient became infected. Was the equipment faulty? Did they get exposed by not taking off protective gear properly? What is going on? We need to hear where people have been if they have Ebola so that people who are worried that they might have been exposed don't panic. We have had some school closures because somebody said, "I think my cousin sat next to somebody else who sat next to somebody else who might have had Ebola on a flight that went to a different city and then they came and visited us."

These kinds of panic opportunities are huge. We need transparency to say, "Look, you can do a lot of things with a person who has Ebola but isn't showing any symptoms, and as long as you don't exchange bodily fluids with them or get close enough for them to spit on you, you are not going to get this disease." We could use some bending of the privacy rules—more information about where people have been, what steps have been taken to care for them—than we normally expect in the average care of a patient, to calm people and to have more antidotes to panic.

Overdoing Ebola Readiness

The last moral issue (and I'll put it very simply) is, should every hospital be made Ebola-ready? Is it the case that every clinic and every hospital should be ready to deal with an Ebola patient? That seems to me to have been the strategy in the United States, and it is not one that I agree with at all. Every hospital, nursing home, healthcare facility, and group practice needs to know what to do if an Ebola patient shows up, but to say that you have to be able to put on the moon suit and quarantine and isolate makes no sense at all.

We don't need that many places to treat Ebola patients because there aren't going to be that many Ebola patients. We are never going to have an epidemic here. We are going to have the occasional Ebola patient. They can be managed at specialized centers in Atlanta or Nebraska. There are many hospitals in every city that might be able to handle an Ebola patient. In New York, where I am, Bellevue (the NYU affiliate hospital) can easily handle an Ebola patient. But you don't have to pretend that every Veteran's hospital, pediatric hospital, and group practice is going to have moon suits and training and know how to manage somebody on site. We need to identify patients and train people to transport these patients safely to other facilities where they practice and train, and where they have the right equipment and know what to do. Making everybody Ebola-prepared means knowing where to send the patient but caring for these patients in specialized units.

Those would be my top Ebola recommendations from the ethics point of view.

Every physician needs to be alert to another fact: Flu season is coming. A lot of patients are going to come in, having heard that aches, pains, and fever are symptoms of Ebola. They are going to freak out. They are going to run to the emergency department. We have to tell them, "No, it's more likely the flu, and right now the best thing to do is get a flu shot. Don't be part of that crowd that is showing up and overwhelming the emergency department, screaming that you must have Ebola."

I'm Art Caplan, at the NYU Langone Medical Center.

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