A Stanford physician who recently returned from Liberia has voluntarily gone into quarantine, and the university has announced precautions barring faculty, students and medical professionals who have traveled to areas affected by the Ebola virus from campus for 21 days after they return home.
The campus ban, which Provost John Etchemendy and Dr. Ira Friedman, director of Vaden Health Center, announced in an Oct. 23 message to the Stanford community, preceded a California Department of Public Health order on Oct. 29 requiring California doctors coming from Ebola-stricken areas to be placed in a 21-day quarantine.
Dr. Colin Bucks, clinical assistant professor of surgery in the division of emergency medicine at the Stanford School of Medicine, volunteered for a month treating Ebola patients in Liberia. Bucks, 43, served as a medical coordinator the International Medical Corps. He worked 14-hour days in the jungle of northwest Liberia in a makeshift clinic built out of tin, he told Stanford Medicine, the medical center's online publication.
He was placed in quarantine in his Redwood City home after returning last week, though he has showed no symptoms of the virus, San Mateo County health officials said Wednesday. He is avoiding contact with others but is allowed limited activities outside, such as jogging alone.
County officials said they are reviewing the details of Bucks' quarantine to make sure it complies with the state's order.
Stanford's 21-day ban from the campus does not require a quarantine. The university's protocols state that people must notify the university prior to traveling to Ebola-stricken regions, and travelers must register their trip in Stanford's travel registry at the Office of International Affairs, according to the Stanford Report, the university's news and information service.
Students traveling to an Ebola-affected region must contact the campus health center for an evaluation before returning to campus, and employees must likewise be evaluated, Etchemendy said.
The university has monitored federal warnings about travel to the Ebola-stricken regions since the summer, and it has recalled or cancelled summer academic programs to the region, according to the Stanford Report. Stanford currently prohibits university-related travel to Liberia, Guinea and Sierra Leone due to safety and health care concerns.
"The public health infrastructure in these countries is severely strained as the outbreak grows, and the security situation in these countries is unstable and may worsen," university officials said.
Stanford's School of Medicine does not plan to send an organized medical support team to the West Africa, but it respects that faculty, staff or students may want to undertake personal, voluntary travel to those countries, officials said. But such volunteers may find themselves on their own.
"Stanford's ability to provide medical support or evacuation in the event of illness or exposure will be severely limited, and potentially in the hands of the Centers for Disease Control and Prevention and the U.S. State Department, beyond our control," officials said.
Bucks is one of many health care workers who have traveled to Guinea, Liberia and Sierra Leone to help combat the Ebola epidemic. Bucks told the Stanford Medicine that between 26 and 32 patients died during his month in Liberia, yet nearly as many survived due to the care at the 52-bed clinic, funded by the U.S. Agency for International Development (USAID).
"The real high point is having someone get sick and then get better and rejoin their family. We had children who had been rejected by their families, and then we saw them turn around and have families welcome them back," Bucks, who also serves as the medical director for disaster preparedness at Stanford Health Care, told Stanford Medicine. "I think it's important as caregivers to see the really sad outcomes and say, 'You've got to push harder to find answers and to provide the best support.' But you lose a lot in this one. At best you're saving half of those who are ill."
Most of their care focused on basic medical aid: replacing lost fluids and electrolytes, treating malaria and bacterial infections, controlling symptoms of vomiting and diarrhea, and providing general pain control, he said.
He lauded the local caregivers for their commitment to fighting Ebola, despite the difficult conditions and the fear they faced from fellow villagers. But he said caregivers were vigilant about infection control, wearing head-to-toe protective gear, including goggles and boots.
Because of the intense heat, doctors and nurses spent only about an hour at a time in protective suits, he told Stanford Medicine.
University officials say they are confident in their hospitals' ability to handle a local case of Ebola in the emergency room and isolation units.
"We have and will continue to train our Stanford Medicine staff using state-of-the-art simulations of an Ebola scenario," officials said.
Stanford has developed a website, Stanford Responds to Ebola, which offers updates on the university's response and offers information and links to the Centers for Disease Control and the World Health Organization. The university has also produced a video of Stanford and CDC experts to address the health, governance, security and ethical dimensions of Ebola.
Bucks told Stanford Medicine he is frustrated with governmental policies that discourage much-needed personnel from volunteering to help contain the epidemic in West Africa.
"The notion that the borders can be 'locked down' is ludicrous," he said. "You just have to fight the infection there. And closing the borders to flights sounds productive, but it would have negative consequences. It would spread the disease rather than contain it" by limiting the flow of aid workers and supplies.
"There needs to be a rational policy that facilitates health care workers going to and from the United States," he added. "Policy should help this -- not impede this. You also need an organized response in West Africa. Otherwise, we will be fighting a much bigger battle in the United States and around the globe."