ONE feature of the tragic case of Thomas Eric Duncan, the first traveler known to have carried the Ebola virus into the United States, rankles me as a physician: Even if every system in place to identify suspected carriers had been working perfectly, he may have still set off a mini-epidemic in Dallas.
Mr. Duncan, recall, was screened before his flight and found to have a normal temperature. Asked specifically about exposures, he denied any contact with the ill. On Sept. 25, when he first presented to the emergency room with a fever, he was discharged. He returned three days later with fulminant infection. But the fact remains that even if Mr. Duncan had been identified and isolated on the first visit, it may have been too late. He had probably been exuding the virus for days. The news that a nurse who helped treat Mr. Duncan has now tested positive for the disease, evidently because of a breach of safety protocols, adds to the picture of disorder.
In the wake of the Duncan case, three strategies to contain the entry and spread of Ebola in the United States have been proposed. The first suggests drastic restrictions on travel from Ebola-affected nations. The second involves screening travelers from Ebola-affected areas with a thermometer, which the federal government is beginning to do at selected airports. The third proposes the isolation of all suspected symptomatic patients and monitoring or quarantining everyone who came into contact with them.
Yet all these strategies have crucial flaws. In the absence of any established anti-viral treatment, we may need to rethink the concept of quarantine itself.
“Quarantine” sounds like a medieval concept because it is. Invented in the mid-1300s to stop the bubonic plague, the word derives from the Italian for “40 days,” the time used to isolate potential carriers. Although the practice of quarantine has been reformed over the centuries, pitfalls remain. They are especially evident during this epidemic.
An indiscriminate ban on travel would make it impossible for aid workers to reach the most widely affected areas, obviously deepening the medical and humanitarian crisis. It would also encourage subversion: Travelers might pass through other countries, confounding efforts to track their origin.
Screening travelers from affected areas using questionnaires and temperature may prove effective, but here, too, there are profound weaknesses. Low-grade fevers can easily be concealed with antipyretics like Tylenol. More important, by the time an Ebola carrier has a fever, he or she is already in an infectious phase and may have exposed many others to the virus.
Isolating symptomatic patients is certainly effective, but it will not work as a proactive strategy of containment. By that point, a carrier may have already infected dozens of people. Even when surveillance is well deployed, the collateral costs associated with it are forbidding. Between July 31 and mid-September, New York City’s health department received 57 calls reporting suspected infections based on fevers. Of these, only six merited further testing. Three cases were caused by malaria and one by anaplasmosis; two were of unknown causes. Ebola was not found in any of the cases.
There is a fourth strategy, although it will need to be evaluated and deployed carefully. Since the 1990s, novel methods have allowed doctors to detect viruses in the pre-symptomatic phase of an infection, often with remarkable sensitivity and precision. One of these involves the polymerase chain reaction, or P.C.R., a chemical reaction that amplifies pieces of a virus’s genes floating in blood by more than a millionfold, which is what makes early, pre-symptomatic infections identifiable. The technique is not particularly cumbersome: As an oncologist working with blood cancers, I have been using variants of it to detect subclinical infections in patients for nearly a decade.
A 2000 study in The Lancet illustrates the power of this approach. Twenty-four “asymptomatic” individuals exposed to Ebola were tested using P.C.R. Eleven of the exposed patients eventually developed the infection. Seven of the 11 tested positive for the P.C.R. assay; none of the other 13 did. In 2004, virologists at the Centers for Disease Control and Prevention further refined this method to increase its sensitivity. The test now requires only a teaspoon of blood. The sample is transported, on ice, to a centralized lab. Results are back in a few hours.
Technologies like this allow us to imagine a new form of quarantine. Rather than relying on primitive instruments, indiscriminate profiling or questionnaires, we should consider running a pilot program to test asymptomatic travelers using sensitive P.C.R.-based techniques. Obviously, such technologies are expensive, but the cost is not prohibitive. A typical P.C.R. reaction, including labor, costs between $60 and $200 (we have already spent 100 times more disposing of the contaminated sheets from the home Mr. Duncan stayed in). Since the test takes about a third of the time of a trans-Atlantic flight, the flight would become the quarantine.
Huge logistical questions would need to be solved. Where would such a screening test be administered — before departure from West Africa, or upon landing? Could we imagine a walking quarantine in which travelers were granted provisional entry, but recalled if they tested positive? What infection precautions would need to be in place for such testing? What forms of consent would be required? Who would bear the costs? Who exactly would be tested?
Despite these questions, we should develop a pilot program, perhaps targeting the worst-hit regions of the epidemic. Currently, immigrants to the United States are screened with blood tests and chest X-rays to detect preclinical tuberculosis. Testing nonimmigrant travelers is obviously a much larger endeavor, but a targeted program is worth the effort.
One major issue with this kind of rapid-testing quarantine is the phenomenon of false positives. But P.C.R.-based testing for Ebola has a low false-positive rate (three per 1,000), and its accuracy could be further improved by focusing on patients who come from particular geographic regions or by using more refined questionnaires. The second problem is false negatives: missing actual carriers of the infection. And yet, at four false negatives per 1,000, the detection rate might be sufficient to keep Ebola from becoming epidemic in the United States. Even the presence of such a testing and tracking system would act as a deterrent to those who wish to evade detection.
A rapid-testing quarantine would be expensive, but a pilot program might teach us much more about how to move forward. It certainly does not solve the civil liberties questions of quarantining, but it makes them vastly more palatable.
Ebola is an ingenious virus. To fight it, we need to be just as ingenious.
ahntkd99
carahall
andrewbecharaa
athenapup4
bane1900
bestbaker123
bmdpiano
comp0327
compclass8
cynicalwordsmith22
doglover441
drippydoughnut
drpaleontology
gcatt310
givemeclouttokens
hershey515
iamsleepy01
imagination4421
influenza123
jackso23
Jayv23
kraemercali
lazybear8
lelebxby
lg102015
lovericeandnoodles
lucbe219
morra2024
mpsj13
roses0102
Sub2MigzFilms
smellycat23
tenere84
thefrontbottom
voxpopuli75
whosyourcookie22
yankeefan25
Newspaperlessness 
Paragraph 1 Unfair
This paragraph says the opposite of what the author says within the article.
Paragraph 2 Fair and Accurate
Paragraph 3 Inaccurate
Some of the words are put out as stronger than other words. This means that it shows the authors point but still exaggerates it.
LikeLike
Summary 1– Unfair
The author of this paragraph deliberately attributes Mukherjee to statements that were neither made or implied in the article. He uses only his own opinions to support his claims and makes unjust claims that have no contextual support.
Summary 2– Fair and Accurate
Summary 3– Inaccurate
The author confuses the meaning of “quarantine,” faltering the rest of the analysis.
LikeLike
Summary 1–Unfair
This summary claims that the author refutes all options but his own. While in the article the author just states that there are more efficient and effective ways to test for ebola.
Summary 2–Fair and Accurate
No comments required.
Summary 3– Inaccurate
This summary attributes things to the author that he did not say like “Mukherjee’s “fourth strategy” for a new quarantine method is the greatest medical innovation since the Middle Ages.” When the author said nothing that was even close to what was stated in the quotes.
LikeLike
Summary 1-Unfair
The author of this paragraph makes claims that are completely unfair. “Mukherjee is clearly proud of the PCR strategy his industry has developed” is an unfair claim because he did not develop this strategy.
Summary 2-Inaccurate
The author of this paragraph inaccurately supports his paragraph with information that is not true. The article never said that more money was spent on Mr. Duncan’s screening than would be spent on this new type of screening. It stated that more than 100 times the cost of this new type of screening had already been spent on the discarding of Mr. Duncan’s sheets.
Summary 3–Fair and Accurate
No comments required.
LikeLike
Summary 1 – Unfair
Summary 1 uses what Mukherjee wrote in his article and twists it to make it sound completely incorrect. It attributes opinions to him for the sake of arguing against them, even if those may not be his opinions.
Summary 2 – Fair and Accurate
Summary 3 – Inaccurate
This summary uses the article to give Mukherjee thoughts that he may not have come up with.
LikeLike
Summary 1– inaccurate
The author states that suggests that “every effort to quarantine, other than his own supposedly innovative new version, is so fraught with objections it can’t possibly work”, which is inaccurate. Mukherjee clearly states that there are “flaws”, and never says that those first three different ways of quarantine can’t work.
Summary 2– Unfair
The author states that the Mukherjee said that PCR “cost that is much lower than what we’ve spent on Mr. Duncan’s screening,” when he said “its a cost that is much lower than what we’ve spent on Mr. Duncan’s screening”
Summary 3– Fiar and accurate
LikeLike
Summary 1- Unfair
I feel as if the author has unfairly summarized the words of Mukherjee to fit his own needs. “Mukherjee is clearly proud of the PCR strategy his industry has developed…” is the one sentence that really gets me, because it was doctors who also came up with the other methods to prevent the spread of Ebola.
Summary 2- Inaccurate
Even when the author is agreeing with Mukherjee misquotes can still make the summary inaccurate. “Allows doctors to detect viruses in the pre-symptomatic phase . . . with remarkable . . . precision,” takes what Mukherjee states in the original article and butchers it.
Summary 3- Fair and Accurate
No comments required.
LikeLike
Summary 1– Unfair
First of all, saying that Mukherjee cant get anything right is a huge assumption because he is in a fact a professor of medicine at Columbia and a long-time doctor. This paragraph assumes that every refutation he had was about the quarantine, when in fact he was also commenting on how the virus was entering the country also. The author of this passage throws away several of Mukherjee’s ideas because they are not specifically about quarantine.
Summary 2– Fair and Accurate
No comments.
Summary 3– Inaccurate
Calling this the greatest medical innovation is a big assumption to make. The author does agree with the claims made by Mukherjee but expands them into long winded descriptions, adding more detail than Mukherjee originally used. He says that they would be quarantined on the plane when in fact, he said that they would simply be called back if they tested positive.
LikeLike
Summary 1- Unfair
The claim is made that Siddhartha Mukherjee says, “Every effort to quarantine is so fraught with objections it can’t possibly work.” This is never stated in the article. Mukherjee only suggests that the strategies have crucial flaws.
Summary 2- Inaccurate
He claims that quarantine has changed, but the concept has basically stayed the same since the medieval times. Also, it is not being proven how Siddhartha Mukherjee does not answer his own questions.
Summary 3- Fair and Accurate
No Comment Needed
LikeLike
Summary 2 – fair and accurate
no comments
Summary 1- unfair
This summary expresses how quarantining will not work and be ineffective as a whole. The original article expresses that it is a process to stop the spread of ebola, but it can be done with cooperation of the public. He says “efforts to isolate dangerous pathogens are weak,” but many efforts are being made and the ways to detect ebola are improving.
Summary 3- inaccurate
“the fourth strategy is the greatest medical renovation…” it has not worked yet because many do not show symptoms until post arrival. By then, the disease has already spread and quarantining the airplane would be ineffective because everyone would have exited already. Also, you cannot quarantine hundreds of people in an airplane for the amount of time needed. (21 days?!) The length of an international flight will not stop the disease from spreading on the plane. When the plane lands more people will become infected.
LikeLike
Summary 1- Unfair and inaccurate
The summary says that Mukherjee thinks that all other approaches are wrong.
Summary 2- Inaccurate
No where in the original did Mukherjee say that the newer screening would be cheapest.
Summary 3- Unfair
No where in the original did Mukherjee say there will be less than 100 people on the quarantined airplane. He also didn’t say anything about home quarantines for 21 hours.
LikeLike
Summary One– Inaccurate
The summary says Mukherjee is proud of PCR strategy which is an opinion he might have but his writing did not state that.
also this isn’t something Mukherjee sugests
“suggests that every effort to quarantine, other than his own supposedly innovative new version, is so fraught with objections it can’t possibly work.”
Summary Two– Accurate and Fair
Summary Three– Unfair
“but the three methods most commonly used will all fail us against Ebola,”
these methods will still be helpful but have flaws to say that they will fail us is not true.
LikeLike
Summary 1 – Unfair
This summary starts off by saying that Mukherjee can’t get anything right. It goes on to say that each strategy is “fraught with objections it can’t possibly work.” And that Mukherjee’s objections to the methods that have been proven ineffective, are weak.
Summary 2 – Inaccurate
Mukherjee does not say that the “fourth strategy” is quarantine. The fourth strategy is a technique called PCR. This summary also claims that Mukherjee maintains that “nonimmigrant travelers are not significantly different from immigrants to the US.”
Summary 3 – Fair and Accurate
No comments required.
LikeLike
Summary 1- Unfair
This summary makes accusations against the author that the author never had a position on himself. The claims that an indiscriminate travel ban would make it easier for medical teams to get to problem areas is blatantly ignorant. Indiscriminate in this article means regardless of who you are, you aren’t getting on a flight. The writer of this summary debunks the articles arguments with out even providing reasons why they aren’t acceptable. He continuously discredits the author and puts words in the authors mouth.
Summary 2- Inaccurate
This summary shows small misunderstandings towards the end of the summary. When the summary claims the it would be inexpensive, that is exactly the opposite of what the author claims. The author claims the most effective tests could get expensive, but would be well worth the cost because it could stop the epidemic from spreading faster in the United States. The summary also claims the author didn’t answer his questions, which was actually purposefully done because the author says “Despite these questions, we should develop a pilot program, perhaps targeting the worst-hit regions of the epidemic.”
Summary 3- Fair and Accurate
LikeLike
Summary 1 — Unfair
In addition to sounding like an outright personal attack on Mukherjee, this summary offers a point of view that is not at al what Mukherjee is trying to say. At no point in the original article does Mukherjee suggest that all passengers and crew be detained because they were exposed “en route” to a destination. The solution Mukherjee is proposing would catch and Ebola carrier before they are symptomatic and infectious. Therefore, complete quarantine of an entire flight is a completely preposterous conclusion to draw as anyone in the infectious stages of Ebola would have noticable symptoms and not be allowed anywhere near the plane to begin with.
Summary 2 — Fair and Accurate
No Comments Required
Summary 3 — Inaccurate
This summary stays true to the original ideas of Mukherjee with a few misconceptions. First, Mukherjee was meaning to imply that quarantine was a medieval solution that has not changed much since the method was first introduced. Therefore, saying that Mukherjee states that quarantine is medieval but has evolved over the centuries is not completely inaccurate but inaccurate in the most important part of Mukherjee’s argument; quarantine is an ineffective and primitive solution to a sophisticated problem. Later in the summary, it is suggested that, “Mukherjee correctly compares those complaints to the whining of prospective US immigrants who object to chest X-rays to screen for tuberculosis.” Nowhere in the original article does Mukherjee actually talk about the immigrants that have to take the chest X-rays, he simply states that this is a method that is in use today that provides proof that Ebola blood tests, while a much larger undertaking, are certainly possible for people travelling out of infectious areas.
LikeLike
Summary 1–Unfair
The author of Summary 1 states many opinions of Dr. Mukherjee and his work. The author’s opinions about Mukherjee question: If the doctor himself knew about the statements made about him would he refute that the author stated the points Mukherjee was trying to get across? One of the questionable statements includes:
“Mukherjee is clearly proud of the PCR strategy his industry has developed, perhaps so proud that he sees this useful enhancement to an ancient technique as a brand-new solution.”
How could the author of the summary tell how Mukherjee feels, about any given thing, as fact?
Summary 2–Inaccurate
The author of this summary presents many quotes from the original text, then uses them to point to non-truths that were not present in the original article. An example of this is the statement:
“This “fourth strategy” of quarantine, says Mukherjee, “allows doctors to detect viruses in the pre-symptomatic phase . . . with remarkable . . . precision” and at a cost that is much lower than what we’ve spent on Mr. Duncan’s screening.”
If we recall the original article, Mukherjee states that the fourth strategy was significantly cheaper than the cost it took to dispose of the contaminated sheets in Thomas Duncan’s contaminated home.
Summary 3–Fair and Accurate
No Comments Required.
LikeLike
Summary 1- Unfair
The author of this summary is completely unfair towards the work of Mukherjee. He states multiple ideas that Mukherjee didn’t even relatively offer to the reader. Such as calling the restriction of travel to countries high in Ebola as. “patently ridiculous.” Totally going against Mukherjee’s views because Mukherjee states the travel restriction would restrict the travel of the disease from being spread throughout the world.
Summary 2- Inaccurate
The author of this summary is utterly inaccurate. Stating that Mukherjee, “offers a completely new approach to an ancient technique for halting the spread of deadly disease.” This author is talking about quarantining people that test positive for Ebola. But that isn’t what Mukherjee is offering as a new approach. He is offering a blood test called, PCR,that is effective within only and error 3 out of 1,000. I don’t understand where the author of this summary came to this conclusion but it is inaccurate.
Summary 3- Fair and Accurate
No comments required.
LikeLike
Summary 1– Unfair
The authors response is very opinionated, leaving little to no room for discussion. The writer goes straight for the jugular even in the first sentence. Resistance to believe anything Siddhartha Mukherje claims to be helpful.
Summary 2 — Fair and accurate
Summary 3 — Inaccurate
As stated in the example, the use if the word “quarantine” is exaggerated to a point where it is meaningless. Some of his claims are a little to forward, ” “fourth strategy” for a new quarantine method is the greatest medical innovation since the Middle Ages,” for example.
LikeLike
Summary 1-unfair
It completely downgrades Dr. Mukherjee’s article. It denotes the complete opposite of what was said in the article.
Summary 2-inaccurate
The fourth strategy is merely a theory/concept It hasn’t been put into play yet, so there is no way to say that it’s the best idea
Summary 3-fair
No comments required
LikeLike
summary 1-unfair and inaccurate
The writer gives the impression that Dr. Mukherjee doesn’t give credit to other methods and says that none of them are capable of getting the job done.
LikeLike
Paragraph 1 Unfair and inaccurate
This paragraph claims that the author refutes all other methods other than his own full proof method. The paragraph not only claims that the archaic methods of quarantine are still effective but claims that they are proven and gives no context to support such a claim.
Paragraph 2 Inaccurate
The problem with this paragraph is that it is using inaccuracy’s to support the author. It was never said that the cost of this new type of screening would be cheaper than the screening Duncan went through, it mearly said the screening is cheaper than having to dispose of an infected patients contaminated belongings. Paragraph 2 also states that the screening of blood of nonimmigrant travelers wouldn’t be a problem, a serious misquote of what the author actually stated
Paragraph 3 Unfair
This paragraph completely takes the authors statements out of context to support his own claims about whining US immigrants and his radical idea of quarantining entire plans before deemed safe to land.
LikeLike