D.C. resident Brett Sedgewick had been to Liberia and flown back to Washington Dulles International Airport before, but when he returned earlier this month the digital printout of his passport scan had a big “X” on it.
The 35-year-old knew this would happen. In fact, a buddy gave him written instructions about how to act when he returned to the U.S. from Ebola’s epicenter in West Africa. One bit of advice: Walk calmly to the airport’s screening area. People would be looking for him, and it’s best not to set anyone on edge.
Mr. Sedgewick spent three weeks in Liberia as an adviser for Global Communities, an aid group aligned with the U.S. Agency for International Development. They play a large role in helping the Liberian government safely bury persons who died of Ebola, although Mr. Sedgewick did not perform burials or come into contact with patients during his tour, which ran from Oct. 19 to Nov. 8.
But while he was gone, the American public’s limited but eyebrow-raising brush with Ebola had sent officials scrambling to set up more monitoring of those coming back from the “hot zone” in Liberia, Sierra Leone and Guinea, including asking them to isolate themselves, take their temperature and regularly report in to health officials.
“It was pretty concerning,” said Mr. Sedgewick, who is married and lives in the Petworth neighborhood of the District. “There was a lot of uncertainty for a long time about what was going to happen to us.”
As Ebola hysteria swirled, D.C. health director Dr. Joxel Garcia had a decision to make. How does the city — a crossroads of diplomatic teams and tourists from around the globe — treat visitors and aid workers returning from West Africa in a reasonable, scientifically sound way, and do it in the face of public fear of a virus that’s killed 5,000 people abroad?
“We said, ‘No, we’re not going to quarantine,’” Dr. Garcia said in an interview at his agency, located several blocks from the Capitol. “We’re going to do voluntary isolation.”
The Ebola headlines started before Mr. Sedgewick departed for West Africa.
U.S. cases begin
Thomas Eric Duncan, a Liberian, had brought Ebola to Dallas in late September and died Oct. 8, infecting two nurses who treated him.
While Mr. Sedgewick was overseas, a New York City doctor had tested positive for Ebola, and straight-talking New Jersey Gov. Chris Christie had placed a Maine nurse in a hospital tent until she no longer exhibited a fever.
The District’s monitoring plan set the city apart from northeast states such as New York and New Jersey, which mandated 21-day quarantine — in most cases at home — for persons who came into contact with Ebola patients in West Africa.
Dr. Garcia said people who did not interact with Ebola patients in West Africa can go about their lives during the monitoring period, but they ask high-risk people who dealt with infected persons to voluntarily isolate themselves. Both camps must report their temperatures to the health department every day for three weeks, the incubation period for Ebola.
In Mr. Sedgewick’s case, airport screeners asked him questions about his exposure to Ebola — he was a “straight no” across the board — checked his temperature with a no-touch instrument and gave him a digital thermometer to take home.
The D.C. Department of Health gave him a call the next morning to explain the next steps.
“They make it clear that this is a partnership,” Mr. Sedgewick said of D.C.
French speakers welcome
Returning health care workers and visitors from West Africa must report their temperature — fever is an initial symptom of Ebola — to the city health department twice a day, typically around 9 a.m. and 4 p.m. Calls go to the agency’s epidemiology office during the day, but there’s always someone on call.
More than 40 people are on the city’s list, although people drop off after 21 days and new people then take their place. Roughly 85 percent of people complied with monitoring rules at first, and the department had to follow up with the others.
“Now, for most people, it’s completely routine,” Dr. Garcia said.
The District is not alone in this endeavor. In New York City, a team mans phone banks to keep tabs on recent travelers from West Africa, and health officials in Georgia said they have monitored nearly 270 since mid-October and had 141 travelers on their list as of Tuesday.
The D.C. monitoring system is even equipped to handle French — the first person to call it tried that out “just to test the system,” Dr. Garcia quipped. Two of the four countries where Ebola is sufficiently widespread to be under any U.S. travel restrictions — Guinea and, to a lesser degree, Mali — are former French colonies where French is still widely spoken.
Mr. Sedgewick is traveling to New Jersey for Thanksgiving, but he will not be subject to more stringent rules. Instead, officials said he can still report to the city’s health office when he leaves the city.
“It’s been a pretty painless process,” Mr. Sedgewick said.
At a global crossroads
Dr. Garcia had expected to be dealing with MERS, a respiratory disease first discovered in Saudi Arabia in 2012.
He’d been eyeing the disease for about a year, fearing its spread because it is airborne. He also keeps an eye on chikungunya, a virus that’s carried by mosquitoes and has affected a large swath of the Americas, and on dengue fever, which the Centers for Disease Control and Prevention refers to as “a leading cause of illness and death in the tropics and subtropics.”
It’s a lot to juggle, but the nation’s capital is unique. Diplomatic teams from across the globe flock to embassies and the World Bank, not to mention global tourists who seek out the White House and other sights.
“We are exposed to any disease from the planet,” said Dr. Garcia, sitting at a conference room with Purell hand sanitizer on the table. “We had, last year, 2 million people travel into D.C. — and I’m not talking about people from Northern Virginia and Maryland.”
But he seems to relish the challenge and says prevention is his chief goal, and is more critical than treating someone diagnosed with the disease.
“If within one week you had 10 cases from here, you guys would have to definitely terminate me immediately,” he said while discussing the city’s stores of protective gear. “Because I failed to do the surveillance that we need to do.”
A misguided stigma
Although D.C. has not dealt with an actual case of Ebola, hysteria has built.
In recent days Dr. Garcia has called attention to the stigmatization of the city’s large African immigrant population, particularly the large contingent from Ethiopia. In some cases, people get in taxis and then hop back out when they read the driver’s name.
Ethiopia is on the eastern side of the African continent, but Ebola is raging thousands of miles to the west.
“If a person doesn’t understand Africa, they assume that Ethiopia is in P.G. County compared to us,” Dr. Garcia said, referring to a Maryland county that borders the District.
His department’s plans for dealing with a suspected case of Ebola are also designed with stigma in mind. A person with symptoms would be transported, without flashing lights or sirens, to one of five D.C. facilities that can handle a patient.
Dr. Garcia said he did not single out one facility because he did not want that one institution to be known as the “Ebola” hospital.
“If you designate an institution,” he said, “that institution is doomed forever.”
Meanwhile, Mr. Sedgewick will not be a marked man for long. He is set to come off the city’s Ebola watch list this weekend as he celebrates the Thanksgiving holiday with family. It’s bittersweet, in that the milestone puts emotional distance between him and the mission in West Africa.
But he said it will be nice to stop sticking a thermometer in his mouth every day.
Plus, he said, “I prefer to be on fewer lists.”