Ethical issues in isolating people treated for Ebola

In India a symptom-free man returning from Liberia after being treated for Ebola virus disease (EVD) was recently put into isolation because his semen was still positive for the virus.1 2 Even though blood, saliva, and urine samples gave negative results, he will remain in isolation until his semen also tests negative, which could take as long as three months.3 There is no conclusive evidence of sexual transmission of Ebola virus,4 and WHO does not recommend isolating patients whose blood tests negative for Ebola. Current evidence based practice is to trust and advise such people to abstain from sex for three months or use condoms.5

It could be argued that a risk of sexual transmission exists and one person’s mistake could result in a catastrophic epidemic, especially in a densely populated country like India, where Ebola has never been reported before. But isolating a person in absence of scientific evidence is unscientific, over-precautious, and raises ethical and legal issues regarding violation of individual rights. Indian health authorities have also not adequately communicated the decision making process to the public. The process is obscure and the alternative measures (if any) considered and found insufficient or ineffective were not discussed before restrictive measures were imposed.

During public health emergencies, governments must take appropriate measures to protect their citizens in a transparent and ethical manner. These measures should be guided by science and taken transparently after consultation with various stakeholders in the community and provider and recipient groups so as to balance the interests of the community and the rights of the individual. Decisions should be adequately communicated to the public.