From His Kitchen “Prison,” Ebola Non-Victim Blasts Governor’s “Maddening Overreaction”

FacebookRyan Boyko sat by an open rear window late Thursday afternoon, inches from the East Rock backyard he may not enter, continuing by laptop to try to help Liberia contain the Ebola epidemic.

Boyko, a Yale public-health doctoral student, would rather have left the house. But he has been ordered quarantined by the administration of Gov. Dannel P. Malloy after officials feared he had contracted Ebola. So he endured another involuntary day Tuesday in what he described as a prison cell—his East Rock apartment.

It turned out Boyko didn’t have Ebola. He just had some diarrhea (“antibiotic-associated diarrhea,” according to the hospital) and a slight fever that went away. But he remains, in his view, a prisoner of misguided public policy.

As his “imprisonment” nears an end, Boyko has decided to go public with his outrage over how politicians are, in his view, overreacting to the crisis by quarantining people who pose no public-health risk.

“It’s frustrating,” he told the Independent in a conversation through the rear first-floor window. He sat inches away in front of an open laptop on his kitchen table and spoke through a window grill in order to comply with a mandatory order that he not have physical contact with people. Across the street an officer sat in a cruiser in a church parking lot, part of an around-the-clock police vigil. The phone rang continually during the interview, including one of the twice-daily calls he receives from New Haven’s public health department to confirm he still has no fever. (He asked not to have his photo taken at the house, fearing a parade of reporters showing up later.)

“What we really need to do is debate how to solve the epidemic in West Africa and prevent future epidemics,” Boyko said. “It’s maddening to hear this overreaction. We’re responding with fear. There’s no scientific justification to quarantine returning health-care workers.” The quarantines just dissuade more volunteers from traveling to West Africa to help contain the disease, he argued.

Boyko, who is 30 years old, is at Yale studying the epidemiology of microbial disease. He was part of a group invited to Monrovia, Liberia, “to help them with their contact-tracing system” to keep track of people who have had contact with Ebola patients.

Boyko arrived on Sept. 18. He worked out of a Ministry of Health and Social Welfare office, helping to build an IT system for data analysis. He worked on an Android app for use by community leaders in Monrovian neighborhoods, so they could transmit information each day on the number of people sick, people who died, people who return, and orphans who need services.

“I built the dashboard that the Ministry of Health could use to ID” people, he said. It was a meaningful trip for an idealistic student who seeks “to do applied work that helps people in need.”

He did not deal directly with Ebola patients in Liberia. At one point, he said, he was sitting at a table with colleagues when an NBC cameraman stopped by. He had no contact with the cameraman, who subsequently developed Ebola symptoms. Boyko said he did contact the Centers for Disease Control to report having seen the cameraman before he developed symptoms; he was told he was not in danger of having contracted the illness.

He flew home to the U.S. on Oct. 10. At first he was told to check in daily with a Yale Health Plan physician and report his temperature. “I thought that was fine,” he said. “I thought I could keep track of it myself. But it was reasonable.”

Then, four days later, on a Wednesday evening, Boyko informed the physician that he had a slight fever, in the “mid-99s.” Boyko also had some diarrhea, but it had now passed. The doctor asked him to take his temperature again: It had risen to 100.2.

Boyko said he knew that he didn’t have Ebola, that his symptoms weren’t consistent with the disease and that he hadn’t been in contact with the bodily fluids of anyone who had the disease. He also knew he was about to be sucked into the frenzy in the U.S. over the disease.

“Obviously there [was] a little tiny worry in the back of my head,” he said. But he was more “embarrassed” than scared—and concerned about the impact on his family. He called his mother in St. Louis to say “I was going to the hospital. It was going to be on the news. And I didn’t have Ebola.”

A police escort arrived to accompany his trip to Yale-New Haven Hospital. The officers “had masks and gloves. They stayed far away from me.” An American Medical Response ambulance worker in a full protective suit “came in and help me get into a suit.”

He spent the first six hours in an isolation room in the emergency wing. Then he was transferred to an isolation room in the intensive care unit.

“They were very nice and professional,” Boyko said of the hospital staff. “All of them quickly decided that they didn’t think I had Ebola either.”

Outside the hospital, a media frenzy began. The governor rushed to the city. By day’s end, tests confirmed that Boyko did not have Ebola. But just to be safe, Malloy ordered him quarantined at home until 21 days had passed since leaving Liberia. The same order was given to another Yale student who’d been helping out in West Africa.

That student, confined to her home in Wooster Square, has not wished to be publicly identified. Boyko made a decision this week that he should speak out. A mutual friend connected him with Rachel Maddow, and he Skyped in to her MSNBC show Monday night, for the first time publicly identifying himself as the quarantined student. On the show he blasted governors for quarantining people like himself who pose no public risk. The Maddow segment was entitled “Fear-Driven Governors Make Ebola Policy Mess.”

Meanwhile, Boyko Tuesday was working at his kitchen table on a statement along with ACT UP activists calling for “a more sensible policy that is applicable nationwide.”

“There’s this patchwork of guidelines that’s ever-shifting, ever-changing,” driven by politics and hysteria rather than science or the public good, he said.

He was also communicating with people from Monrovia, continuing work remotely on the contact-tracing system.

He is not allowed visitors. He can’t go to work.  He can’t go out to exercise.

As Boyko spoke in East Rock, the governor whose public-health commissioner ordered his quarantine happened to be in New Haven’s Fair Haven neighborhood campaigning for reelection. Gov. Malloy was asked about Boyko’s criticism.

“He voluntarily put himself in quarantine,” Malloy responded. “The 21-day period is not over. What should we have done differently? Put people in close contact with someone who has Ebola?”

Told of Malloy’s remarks, Boyko emailed the Independent a copy of the quarantine order.

“It says right on it, if I disobey the quarantine, it’s up to a $1,000 fine and one year in jail per each infraction. That was handed to me while I was still in the hospital. It’s voluntary the same way that paying for things that you’re taking out of the store is voluntary. I don’t know how else to respond to that. I have a police officer in a police car outside of my house right now. I have signed orders that tell me if I break quarantine I can face up to a year in jail.”

Plus, he added, “I’m asymptomatic. I had negative blood tests for Ebola.”

“I agree with the governor that if somebody has symptomatic Ebola, they should be isolated in the hospital and not allowed to have contact with the public,” he added. “I agree to that extent.”

Meanwhile, Boyko prepared, along with his colleagues, for their release from quarantine on Thursday.

“We’re planning a Halloween/get-out-of-jail party,” he said.

Aliyya Swaby contributed reporting for this story.

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posted by: romby on October 28, 2014  7:31pm

I don’t know if quarantining this particular man is really that ridiculous. Certainly it is frustrating for him but that doesn’t mean its the wrong move. Society makes all sorts of public health decisions that quash individual rights for the greater good of the society (vaccines, mandatory Tb treatment, pasteurization of milk, lead paint abatement).

Facts are: he had fever, he had unexplained diarrhea (antibiotic-associated diarrhea is not really a diagnosis but a diagnosis of exclusion), he’d been in Liberia and he’d had contact with someone who developed Ebola. Perhaps that contact wasn’t physical but nobody’s recollection is perfect. Given the high mortality rate and infectivity of the virus quarantine at home seems like a good decision.

posted by: HewNaven on October 28, 2014  7:42pm

My biggest fear is that the sphere of public health field work is filled with altruistic people like Boyko who’s work is largely unappreciated and unnoticed. Politicians should thank them as easily as they have quarantined them.

posted by: robn on October 28, 2014  10:02pm

In Sept 1918, against the wishes of some concerned public health officials who knew that Spanish Flu was spreading amongst returning soldiers, Philadelphia officials held a parade. A few days later there were 700 new cases. A year later, 675,000 Americans were dead from the flu and possibly 50 million worldwide. That was only a 10% mortality rate, compared with Ebolas 70%.

Maybe a bit of over-cautiousness is OK.

posted by: Xavier on October 29, 2014  7:39am

Bien dicho- well said robn!

Science has been wrong before. I do not understand why Mr. Boko can not see this rather minor inconvenience of a cautionary quarantine as part of his sacrifice to help the people of Western African and assure your neighbors?

Considering the tragedy unfolding in the continent and even the slightest chance of contaminating people in this country- I think Mr. Boko’s complaints are unwarranted.

posted by: connecticutcontrarian on October 29, 2014  7:51am

Ideals are great and I applaud everyone who is willing to put their lives at risk in order to help people in need. Indeed that is the calling and vocation of those in the public health field. However, I’m not convinced that his indignation is particularly righteous.

Why has Boykin had a change of heart. Initially it was reported that he and the other student would voluntarily self-quarantine upon their return. Then the story changed so that the university said there was no need to do so. After presenting with symptoms and being rushed to the hospital, Boykin now has an issue complying with a quarantine policy. It appears that he’s been able to use his experience to garner significant media attention. Perhaps he should use that platform to promote greater awareness of ebola and the need to intervene in West Africa rather than critiquing quarantine policies designed to protect the public.

posted by: Wooster Squared on October 29, 2014  7:55am

Have to agree with the other commentors here. Given the incredibly high mortality rate and the fact that we don’t have a lot experience dealing with ebola in this country, a 21 day quarantine is a reasonable measure.

When evaluating risk it’s important to look at both the possibility of a bad outcome and the severity. In this case, even though the probability of a bad outcome (epidemic) is very very low, the potential severity should an epidemic occur is positively catastrophic.

I’m sorry Mr. Boyko was inconvenienced, but as robn stated, there are cases where it’s appropriate to be a little over-cautious and this is one of those cases. The only real overreaction I see here is Mr. Boyko’s.

posted by: DrJay on October 29, 2014  9:00am

Fear has replaced reason in dealing with this disease. There is no scientific basis for locking someone up who is not ill. This is superstition- using a magic ritual to avert a feared outcome. Come on people- let’s be rational.
I also wonder why this can be done without judicial review. When a person is committed to a mental institution by 2 physicians, that patient is entitled to a hearing before a judge within 72 hours to see if he should be held longer. Why aren’t these quarantine prisoners given a hearing to examine the evidence in their particular case? Is it because there isn’t any evidence?

posted by: cedarhillresident! on October 29, 2014  9:06am

I to am going to agree with everyone. And
most that have posted here are pretty liberal minded folks. Why even talk the chance? And as stated, Boyko agreed with this point of view only a few weeks back.

I think we are all grateful for the work that our meds, troops and techs are doing over there. They are hero’s in my eyes.

And I know it is a lot to ask these hero’s to stay put for 21 day when coming back to help calm the fears of John Q. public. But is it really??
We know the facts, we know how it is spread, we also know that it can change. So lets just take the extra step.

posted by: robn on October 29, 2014  9:40am

Lets face it. Being at home for a month with a puppy doesn’t suck.

posted by: Hill Resident on October 29, 2014  11:24am

If you are a healthcare worker, shouldn’t your primary concern be the health and welfare of others? If he was certain he did not have the virus then why did he go to the hospital when he came down with a fever? Because “there [was] a little tiny worry in the back of my head,” he said. The state has him in quarantine for the same ‘tiny worry’ about the safety of hundreds of thousands as opposed to the inconvenience of one!

posted by: Esbey on October 29, 2014  7:02pm

What you are all missing is that YOU CAN’T INFECT SOMEONE WITH EBOLA UNTIL YOU HAVE ACTIVE SYMPTOMS, and only then via contact with bodily fluids.

Science is not wrong about this. Everyone infected in the US got the disease from contact with the actual bodily fluids of some very, very sick person.  As in, they were in contact with the vomit, blood or feces of a very sick Ebola victim.  If folks returning from affected areas take their temp twice a day and go to the hospital at the first sign of a temperature (as this guy did), then no one else can be infected, it is not possible.  It was fine to release him from the hospital as soon as it was clear that he did not have Ebola.  Because, you know, he does not have Ebola and therefore he cannot give you Ebola.

Quarantines are much more dangerous than the alternative.  They will discourage our hero-doctors and hero-nurses from traveling to fight the disease at its source (or at least to cut their trips short by 21 days).  We are not safe until the disease is eliminated at its source. 

In the end, most health experts agree that these quarantines help Ebola to spread.  You not at all likely to get Ebola in any circumstance.  But you are more likely to get it from an unknown ordinary person who had contact with someone could not get treatment in West Africa (because of a lack of doctors) than from a medical professional who is monitoring their own temp.  By locking health pros up, you increase your personal chances of getting the disease.  On the other hand, if you let the health professionals eliminate the disease overseas, then you are 100% safe. 

So, if you like Ebola, support these quarantines.  And by the way, medical experts agree with me, not you.  Hysteria should not trump truth.

posted by: parejkoj on October 29, 2014  8:25pm

What Esbey said.

We understand the transmission mechanism of Ebola very well. Quarantine only makes sense for those who are actively presenting symptoms.

posted by: Xavier on October 29, 2014  11:12pm

Sorry Esbey, you can talk about “transmission mechanism” and active symptoms, but you can not convince that a quarantine is not prudent.

Public health heroes will understand it is not just what they do in Africa is important, it is also assuring the safety of the public and health care workers here as well.

Prudence is not hysteria. If anything, you and Mr Boyko are creating the panic.

posted by: robn on October 30, 2014  6:19am

Three points in support of over cautiousness (which is not hysteria)

There are too many variables in life to guarantee 100% that someone hasn’t been exposed to a disease running rampant in a third world country with third world infrastructure.

The “known transmission mechanism” rebuttle only works if the person in question is omniscient about their context and if they are truthful in their intentions (neither can be guaranteed.)

If a healthcare worker is willing to risk their life battling a disease then a 21 quarantine (however over cautious it seems) is a small sacrifice in comparison.

posted by: cedarhillresident! on October 30, 2014  7:39am

Esbey
Thanks for your comment. But I think unless you have been living under a rock, we know all about how it is transmitted.

But we also know that virus’s can change. How ever slight the chance of it actually happening.
We also know that how ever slight the chance you can be contagious with out knowing it. Even if it is one day.

I agree with robn when he said that I think most health care workers that do head over there should at the least have a small understanding of having an abundance of caution. 21 days is not that long.

Boyko seemed to have that we he elected to do it even after being told he did not have to.

People say will the flu kills more people than ebola. Ya I get that. But the chance of death is .05% every 100,000. Ebola is 70% chance.
Not a chance worth taken. Simple quarantine can prevent that till we get it under control.

posted by: Esbey on October 30, 2014  9:26am

—You can say that 21 days of house arrest won’t discourage professionals from traveling to fight the disease, but you aren’t responsible for recruiting those professionals, Doctors Without Borders is.

—Therefore, your preferred strategy of “over-caution” in fact is a strategy of reckless surrender to hysteria.  It endangers us, it endangers me, all on the basis of “feelings are more important than facts and expertise.” This is the opposite of caution.

—The death rate from Ebola in the US is not 70%, we are not living in Liberia. It remains true that more Americans have been married to Kim Kardashian than have died from Ebola in the US.  Scientists say that the virus cannot change its fundamental form of transmission any more than dogs will quickly mutate to have wings and fly. 

—How come it is OK that the Bellevue hospital workers who are treating the “Ebola doctor” in NYC take the subway home every night?  Whereas this Yale student who had no contact with a symptomatic Ebola victim is held under house arrest?  Simple answer:  Africa!  OMG!

—How come the doctors who treat horrible, deadly antibiotic resistant bacterial infections are not placed under quarantine?  Because we are bored with that, it’s not on CNN and Fox, no one is whipping up hysteria.  From the NYT September 2013: “Federal health officials reported Monday that at least two million Americans fall ill from antibiotic-resistant bacteria every year and that at least 23,000 die from those infections.”  Yawn, a risk we can live with.

posted by: HewNaven on October 30, 2014  11:08am

Esbey,

Thank you for that dose of reality to counteract all the ignorance and hysteria on this comment thread.

posted by: robn on October 30, 2014  11:14am

ESBEY,

Your premise is that 21 days of quarantine will discourage professionals from traveling to fight the disease. It seems unlikely to me that a people willing to spend months risking their own lives to help others would not be willing to end that trip with a 21 day quarantine.

Airborne transmission is a distraction from the fact that bodily fluids like saliva, mucus, vomit, feces, sweat, tears, breast milk, urine and semen all can carry the virus and those fluids can sit on surfaces, harboring the virus for quite some time. In other words, if someone who is just beginning to present symptoms is taking the public transportation, covers a cough and then touches a safety rail or seat leaving mucous, that mucous could infect every other person who comes into contact with that mucous. However unlikely you find this scenario, its possible. 21 days of quarantine is a small price to pay in addition to overseas service.

posted by: William Kurtz on October 30, 2014  11:37am

It’s amusing to me how usually progressively-minded people can decry how politicians deny the science of climate change, evolution, and all sorts of other matters and then fall prey to the same irrational disregard for the facts when it comes to Ebola.

“Just to be safe” and, “if there’s even the slightest chance” are among the scariest phrases in the English language, long used to justify any and all sorts of governmental excess. I’m surprised to see so many ardently defending it.

It’s fair to say, “we’re afraid, no matter what the science says, and we want our political leaders to hold our hands and tell us the monster won’t get us” but it’s intellectually dishonest to claim that these quarantine procedures are having any impact on public health.

A lot of police overtime is going into this . . . isn’t there some way to blame the all-powerful suburban unions?

posted by: William Kurtz on October 30, 2014  11:38am

Esbey—I’m confused. Are you calling for a quarantine of Kim Kardashian?

posted by: cedarhillresident! on October 30, 2014  11:54am

Esbey

you keep using the word hysteria? What hysteria? Most here seem to be informed. And have rational points. And I think most Americans are being rational about this. They are staying informed. And know the facts.

And please when I said 70% you knew I meant in Africa. Give me a break.

and DUDE!
“Whereas this Yale student who had no contact with a symptomatic Ebola victim is held under house arrest?”

Again they requested it in the begining…now he wants out…why because he wants to sue?

Please.

You know what if you can not understand the general public concern for safety fine. Not gonna win with ya.

I stand by the fact that 21 days is not much to ask.

posted by: robn on October 30, 2014  12:14pm

Kim Kardashian Quarrantine

WK FTW!

posted by: Esbey on October 30, 2014  12:33pm

A quarantine of Kim Kardashian?  Public health experts might get behind that one!

@Robn—the fact that 21 days of house arrest will discourage health professionals from traveling to fight the disease is not “my premise,” it is the conclusion of those who are doing the traveling and recruitment. 

From Doctors Without Borders, October 29, 2014:

“Doctors Without Borders/Médecins Sans Frontières (MSF) strongly disagrees with blanket forced quarantine for health care workers returning from Ebola affected countries.  Such a measure is not based upon established medical science ... Quarantine will only undermine efforts to curb the epidemic at its source in West Africa, as MSF announced on October 27.”

From that 10/27 statement:

“MSF is concerned that excessive strictures could deter would-be field staff from going to West Africa, for fear not of what they will encounter when they get there, but what they will encounter on their return. This will undermine the effort to combat and control the outbreak in West Africa, where it is doing the most damage, and thereby, as noted below, undermine the effort to keep people everywhere safe.”

posted by: Esbey on October 30, 2014  12:40pm

For those interested, more from Doctors Without Borders, 10/27, on the “devastating consequences” of everyone’s favorite policy:

“International MSF staff members commit to burdensome four-to-six week assignments in the Ebola-affected countries. The risk of being quarantined for 21 days upon completion of their work has already prompted some people to reduce their length of time in the field. Others will be less inclined to volunteer in the first place. This will present significant operational disruptions at the field level for MSF and other organizations, and lead to an overall shortage of desperately needed health workers, precisely when the Ebola outbreak is as out of control as ever.

As it is, MSF draws on a small pool of people with highly specific skill sets required in an Ebola setting. Further restricting access to that group of aid workers could have devastating consequences ....

Enhanced restrictions on returned aid workers in the United States could lead to similar measures being adopted in other countries, leading to an even greater impact on the ability to fight the outbreak in West Africa.

“We need to be guided by science and not political agendas,” said Dr. Joanne Liu, international president of MSF. “The best way to reduce the risk of Ebola spreading outside West Africa is to fight it there. Policies that undermine this course of action, or deter skilled personnel from offering their help, are short-sighted. We need to look beyond our own borders to stem this epidemic.”

posted by: robn on October 30, 2014  1:02pm

#1
Its a lie to say that quarantines are not based upon medical science. Unless every person coming in on a plane landing from Liberia is RT-PCR tested upon landing, there’s no guarantee that they haven’t been in contact with and infected by virus laden fluids (from an airport worker, another passenger, crew, or Liberian ground crew).

#2
MSF claims that return quarantines “could” deter volunteers but they have no empirical evidence proving that. What ARE their volunteer numbers? What are they comparing them to? If there’s no comparison, how do they know that the rate of volunteerism is being affected by return quarantines and not just fear of Ebola infection? That’s lack of science.

posted by: William Kurtz on October 31, 2014  7:51am

“Its a lie to say that quarantines are not based upon medical science”

No, it’s not. It’s what the actual medical scientists say. The politicians and less well-informed members of the public, misunderstanding or disregarding what the medical science experts say, say otherwise. Again, it’s fine to do this but let’s just talk about it honestly. These quarantines, as enacted, are having no impact on public health. Again, it’s fine to say we want our political leaders to disregard the opinions of the acknowledged experts and enact extreme measures ‘just to be safe’, but let’s not delude ourselves into thinking it’s necessarily sensible policy.

posted by: robn on October 31, 2014  9:03pm

WK

What MSF is saying is that quarantines hurt their recruitment of volunteers. Not that there is zero risk of an Ebola infected person flying back to the U.S.

posted by: newhaveres on November 3, 2014  8:46am

Thank you Esbey for being a voice of reason in this thread. When it comes to Ebola, the quarantine of sick individuals is an absolute necessity. The quarantine of healthy returning volunteers is not only illogical, but also counterproductive to the fight against this deadly disease.