Jeffrey M. Drazen M.D. - Harvard University professor and editor-in-chief of the New England Journal of Medicine - joins several of his colleagues in offering the deceptive editorial "Ebola and Quarantine" [1]. I'll briefly quote the editorial and then describe how it's misleading. The full list of authors of the editorial is at [2].

First, here's part of what they say:

[...you aren't contagious for Ebola unless you're symptomatic...]

A cynic would say that all these “facts” are derived from observation and that it pays to be 100% safe and to isolate anyone with a remote chance of carrying the virus. What harm can that approach do besides inconveniencing a few health care workers? We strongly disagree. Hundreds of years of experience show that to stop an epidemic of this type requires controlling it at its source. Médecins sans Frontières, the World Health Organization, the U.S. Agency for International Development (USAID), and many other organizations say we need tens of thousands of additional volunteers to control the epidemic. We are far short of that goal, so the need for workers on the ground is great. These responsible, skilled health care workers who are risking their lives to help others are also helping by stemming the epidemic at its source. If we add barriers making it harder for volunteers to return to their community, we are hurting ourselves.

In the end, the calculus is simple, and we think the governors have it wrong. The health care workers returning from West Africa have been helping others and helping to end the epidemic that has killed thousands of people and scared millions. At this point the public does need assurances that returning workers will have their temperatures and health status monitored according to a set, documented protocol. In the unlikely event that they become febrile, they can follow the example of Craig Spencer, the physician from New York who alerted public health officials of his fever. As we continue to learn more about this virus, its transmission, and associated illness, we must continue to revisit our approach to its control and treatment. We should be guided by the science and not the tremendous fear that this virus evokes.

We should be honoring, not quarantining, health care workers who put their lives at risk not only to save people suffering from Ebola virus disease in West Africa but also to help achieve source control, bringing the world closer to stopping the spread of this killer epidemic.

The authors are offering a false choice. We could both honor and quarantine those health care workers. We honored the astronauts who went to the moon, but we also put them in quarantine for three weeks. See [3] for how they were both quarantined and honored.

The question becomes, are these authors not smart enough to realize they're offering a false choice, or do they realize what they're doing and they're intentionally trying to deceive? Based on their credentials, I think the second option is much more likely.

The calculus isn't as simple as they present. In the end, Craig Spencer caused damage by his actions: the locations he went had to be decontaminated, no doubt many who came into contact with him are worried they might have caught the same disease, and so on. If he did pass Ebola on to someone else in New York City, then all that person's contacts and comings and goings will need to be reviewed and who knows what will need to be decontaminated then. People being people, there's going to be fear about a disease that causes you to bleed out. So, if you think of fear as a public health issue, then the calculus is hardly simple.

The authors seem to be supporting some form of voluntary quarantine, which conflicts with their opposition to "barriers [that make] it harder for volunteers to return to their community". Like Craig Spencer's wild ride through New York City? See the map at [4]. Is that what the authors want to make easier? Either they support voluntary quarantine or they don't. If they do, how is quarantining oneself in one's abode fundamentally different from doing it in some sort of government facility? If they don't, then who thinks they wouldn't necessarily be exposing others to risk? If a nurse returns from Liberia and immediately goes back to work but does develop Ebola, how much damage could she do to the U.S. patients she has contact with before she realizes she has a high fever? How much damage did Amber Vinson do with her flight (something approved by the CDC)? Why should hundreds of those who had contact with returned health care workers be forced into their own voluntary quarantines and companies be forced to decontaminate airplanes, apartments, and bowling alleys just to avoid inconveniencing a few health care workers?

Our priority should not be the convenience of health care workers, it should be the health and economy of the U.S. population.

On the topic of incentives, the authors are also being deceptive. The U.S. could easily give U.S. health care workers who go to Africa a reasonable payment for both their time there and their time in quarantine. Let's say the 1,000 U.S. health care workers went to Africa and each spent two months in Africa and one month in quarantine (preferably outside the U.S. but at least in a secure facility). Let's say we gave them an average of $10,000 (based on home zip code and profession) per month. That's just $30 million. In U.S. terms that's a very small amount that we can easily afford and that Congress (outside of a few) wouldn't have any problems disbursing. The CDC probably could spend that out of some sort of general fund. We can make their time in quarantine as easy as possible, with all the communication and recreational facilities they need. It will definitely be more luxurious than living in backwoods Africa. So, those health care workers get their bills paid (and probably some left over), they get to do a great public service, they get a little vacation on the way back, and they don't endanger the rest of us and spread fear inside the U.S. when it isn't necessary. We'd honor them, but we'd also make sure that they can't unwittingly do harm to us.

Please ask yourself: why didn't the seven top authors even consider a plan like that? It would solve the problems they claim to care about and it could easily be started in a short time frame. It would also be better than spreading fear inside the U.S. and all the other costs associated with the situation.

Can you trust the seven top authors when they offer a false choice and don't mention other alternatives?

Want to do something about this? Look up those who tweet approvingly to @NEJM - especially about this editorial - and make the points above to them.

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[1] nejm . org/doi/full/10.1056/NEJMe1413139
[2] The authors: Jeffrey M. Drazen, M.D., Rupa Kanapathipillai, M.B., B.S., M.P.H., D.T.M.&H., Edward W. Campion, M.D., Eric J. Rubin, M.D., Ph.D., Scott M. Hammer, M.D., Stephen Morrissey, Ph.D., and Lindsey R. Baden, M.D.
[3] hq.nasa . gov/pao/History/SP-4214/ch9-7.html
[4] mashable . com/2014/10/24/nyc-ebola-patient-map/