International healthcare workers, bookmark this NEJM article: Having and Fighting Ebola — Public Health Lessons from a Clinician Turned Patient. It may be anecdotal evidence, but some anecdotes are more persuasive than others. Excerpt:
Back in New York, the suffering I'd seen, combined with exhaustion, made me feel depressed for the first time in my life. I slept long hours and had a hard time connecting with old friends. I became fearful of the incredibly remote possibility that I could become sick and infect my fiancée, the person I love the most.
Touching others and shaking hands — forbidden actions throughout West Africa — still made me uncomfortable. Twice a day, I held my breath in fear when I put a thermometer in my mouth. I did all this worrying well before I ever had a fever or showed any symptoms of Ebola.
The morning of my hospitalization, I woke up knowing something was wrong. I felt different than I had since my return — I was more tired, warm, breathing fast. When I took my temperature and called to report that it was elevated, in some bizarre way I felt almost relieved. Although my worst fear had been realized, having the disease briefly seemed easier than constantly fearing it.
My activities before I was hospitalized were widely reported and highly criticized. People feared riding the subway or going bowling because of me. The whole country soon knew where I like to walk, eat, and unwind. People excoriated me for going out in the city when I was symptomatic, but I hadn't been symptomatic — just sad.
I was labeled a fraud, a hipster, and a hero. The truth is I am none of those things. I'm just someone who answered a call for help and was lucky enough to survive.
I understand the fear that gripped the country after I fell ill, because I felt it on a personal level. People fear the unknown, and fear in measured doses can be therapeutic and inform rational responses, but in excess, it fosters poor decision making that can be harmful.
After my diagnosis, the media and politicians could have educated the public about Ebola. Instead, they spent hours retracing my steps through New York and debating whether Ebola can be transmitted through a bowling ball. Little attention was devoted to the fact that the science of disease transmission and the experience in previous Ebola outbreaks suggested that it was nearly impossible for me to have transmitted the virus before I had a fever.
The media sold hype with flashy headlines — “Ebola: `The ISIS of Biological Agents?'”; “Nurses in safety gear got Ebola, why wouldn't you?”; “Ebola in the air? A nightmare that could happen”1-3 — and fabricated stories about my personal life and the threat I posed to public health, abdicating their responsibility for informing public opinion and influencing public policy.
Meanwhile, politicians, caught up in the election season, took advantage of the panic to try to appear presidential instead of supporting a sound, science-based public health response. The governors of New York and New Jersey, followed by others, enacted strict home quarantine rules without sufficiently considering the unintended side effects.
The threat of quarantine may cause sick people to defer seeking treatment, and both nationals of affected countries and health care responders returning from those countries may alter their travel plans or misreport their exposure to avoid quarantine. Implementing restrictions that don't accord with the recommendations of the Centers for Disease Control and Prevention4 also undermines and erodes confidence in our ability to respond cohesively to public health crises.
At times of threat to our public health, we need one pragmatic response, not 50 viewpoints that shift with the proximity of the next election. Moreover, if the U.S. public policy response undermined efforts to send more volunteers to West Africa, and thus allowed the outbreak to continue longer than it might have, we would all be culpable.
Instead of being welcomed as respected humanitarians, my U.S. colleagues who have returned home from battling Ebola have been treated as pariahs. I believe we send the wrong message by imposing a 21-day waiting period before they can transition from public health hazard to hero. As a society, we recognize the need for some of our best-trained physicians and public health professionals to participate in a potentially fatal mission because failing to stop the epidemic at its source threatens everyone.