Thoughts on Travel Restrictions To Curb The Spread of Ebola

There is some controversy regarding whether or not the US, the WHO, or some other body should impose travel restrictions, or even an outright ban, to curb the spread of Ebola. In the "nay" column sit:

• CDC chief Thomas Frieden, MD - specialist in public health
• National Geographic correspondent Karen Weintraub
• The Week editorialist Shikha Dalmia, reprinted at Reason.com
• Texas governor Rick Perry

In the "yay" column, we find:

• Yale Trained Epidemiologist, David Dausey, MD
• Louisiana Governer Bobby Jindal
• Entrepreneur Donald Trump
• Conservative Talk Show Host Rush Limbaugh

Surprisingly, the week/reason.com article is the least reasoned on the "nay" side, invoking ad hominem attacks against the GOP for being "dumb," accusing Donald Trump of "threatening" the country with a Presidential run, and implying that because Rick Perry is somehow inferior, his presence in the "nay" column is particularly damning to the rest of the GOP:

(The lone voice of sanity questioning this burgeoning conservative narrative is Texas Gov. Rick Perry, which in itself speaks volumes about the state of the GOP.)

Come on, Reason! You're better than to reprint an article stuffed with ad hominem attacks and invective.

So what should be done? Should an all-out ban be implemented? Is that even possible?

Before I answer this, I want to step back and examine my principles. I consider myself a libertarian - that is, a person who believes in individual liberty and that government should be limited to protecting life and liberty by enforcing the nonaggression principle. The nonaggression principle, simply put, is the notion that aggression is inherently invalid, and therefore force may only be used in a retaliatory manner (defensively, not aggressively.)

So how does that apply here? People clearly have the right to travel. People also clearly do not have the right to expose others to Ebola - doing so is an act of aggression. When Thomas Duncan lied on the form he filled out while leaving Liberia, stating that he had not been exposed to Ebola, even though he knew without a doubt that he had, he was committing an act of aggression upon two continents: Europe and North America. His flight was far enough along during the incubation period that he could very easily have gotten sick during his travel and infected the hundreds of people sharing the airplane with him.

In other words, had the governments in the three countries involved been able to objectively determine that he was ill, they would clearly have been acting within their mandate to protect the populace by isolating him.

The problem is that they couldn't make that determination, and had to rely on screening instead. Screening, as I understand it, involves a questionnaire, which Duncan lied on, and a temperature check, which Duncan passed legitimately. The evidence clearly shows, then, that screening does not work.

What is really needed is an inexpensive, instant test so that screening could be made accurate enough to work. In the real world, though, that technology does not yet exist, so we must look at alternatives.

So what would have prevented Duncan from contaminating North America with Ebola? One possibility is quarantine. Suppose for a moment that, leading up to the airport, individuals had to go through 3 weeks of quarantine. Had this step been in place when Duncan flew out, he would have gotten sick and died in Africa. Meanwhile, foreign care workers, supplies, and the like, would still be able to come on commercial flights. Care workers returning home would also be required to go through this quarantine process.

Another alternative would be to route all flights leaving West Africa through Lajes Field, a US Air Force base in the Azores. People would deplane there, and undergo a 3 week quarantine before heading on to their final destination.

How does this square with the non-aggression principal, though? Does this violate the individual right to travel? It is admittedly difficult to square my desire to shut off travel from West Africa against my desire for universal freedom. Ultimately, it comes to this: allowing the transmission of Ebola is unacceptable, and government's primary job is to protect its citizens' right to life. That protection unfortunately outweighs the rights of people attempting to leave afflicted regions, just as the government had the right to isolate Mary Mallon (commonly known as "Typhoid Mary"), even though she had committed no crime other than to be an asymptomatic carrier of Typhoid. Ultimately, she was a victim of circumstance - confined because she was an unwitting accomplice to a murderous pathogen.

Ebola presents a deadly threat, and there is no quick test to determine if a person is an as-yet asymptomatic carrier. The only effective means to make that determination is through a quarantine process. This process is not permanent; if done properly, it will last no longer than 21 days. There is no reason for the process to be cruel — comfortable accommodations can and should be provided for people put through the ordeal. It is unfortunate that people leaving West Africa would be subjugated to confinement, like Ms Mallon, because they have committed no crime other than to be at risk of carrying Ebola.

Is a quarantine process even possible? For air travel, I believe it is. The US, WHO, and local governments could coordinate their efforts with airlines. For ground and water travel, I'm afraid the answer is most likely "no." The only way it could be made remotely effective would be to bulldoze a clear border around the entire afflicted region, and either man the border to catch people trying to break quarantine, or use autonomous robot guns to do the same. Then there's the logistical nightmare of maintaining a blockade to prevent sea travel. The US is committing 3000-4000 troops, and it doesn't seem likely that such an engagement could clear enough land, even for autonomous robot guns to pick up the slack. Liberia's border alone spans 1,587 kilometers.

Still, by forcing air travel through quarantine, rather than banning travel altogether, perhaps we can get the intended benefit of a total air-travel shutdown without the unintended consequence of making people feel like they're being left to die and resorting to any means necessary to escape.