Charlotte missionary David Writebol and two U.S. doctors who had cared for Ebola patients in Liberia are now living in recreational vehicles on the Mecklenburg County campus of SIM USA, the international mission group that sponsors their work in West Africa.
Writebol, whose wife, Nancy, is being treated for Ebola virus infection in Atlanta, and the two doctors were flown to the United States from Monrovia, Liberia, on Sunday on a private chartered plane that landed at 10:16 p.m. at Charlotte Douglas International Airport.
The three missionaries show no symptoms of Ebola disease, but they are under quarantine by order of the Mecklenburg County Health Department. That means they’ll remain at the RV park, on the 90-acre SIM campus near Carowinds, until enough time has passed to be sure they won’t develop symptoms of Ebola disease.
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“They’re healthy, and they were healthy when they got on the plane in Monrovia,” said Bruce Johnson, president of SIM USA, who visited them Monday morning and found them “amazingly vibrant.”
Johnson said Writebol, 58, who had voluntarily isolated himself in his apartment in Liberia while waiting to come home, looked good. “His health is great. He had good color. There was a sense of relief on his face. I was surprised how well he was doing.”
Each of the missionaries was checked for symptoms before leaving Liberia. And before they were allowed to leave the plane in Charlotte, a Mecklenburg public health nurse dressed in full protective gear, went on board to interview and observe them and take their temperatures. Ebola is not contagious unless a person has symptoms of the infection.
At the RV park, the new arrivals joined two other SIM missionaries and their six children who arrived from Liberia about a week ago. Those earlier arrivals had not had direct contact with Ebola patients. They are not under quarantine, but they are voluntarily living on the RV campus until they have passed the incubation period.
The average incubation period, or time from exposure to onset of illness, is eight to 10 days, but the longest reported incubation period has been 21 days, said Dr. Stephen Keener, medical director of the Mecklenburg health department.
The reason a 21-day quarantine was ordered for the latest group of arriving missionaries was that they had direct contact with Ebola patients, Keener said. Writebol, of course, had contact with his wife, who was diagnosed with Ebola disease July 25.
The two SIM doctors have been treating Ebola patients at Monrovia’s ELWA hospital, which is supported by SIM and Samaritan’s Purse, an international relief agency based in Boone. Johnson said neither of the doctors is from the Charlotte area, but he declined to name them to protect their privacy.
Ebola can only be spread by someone who is already sick and having symptoms, such as fever, diarrhea and nausea. It is not airborne like influenza, but is spread through contact with bodily fluids, such as blood, feces, vomit and urine.
The decision to quarantine Writebol and the two doctors was made last week by Mecklenburg health officials in consultation with officials at the state Division of Public Health and the federal Centers for Disease Control and Prevention in Atlanta. Health officials said SIM representatives contacted them and asked for help in deciding how to get their missionaries home safely.
Keener said the consensus among health officials was that Writebol and the two doctors should be quarantined, or legally restricted from freely moving around in public, until it was certain they wouldn’t develop symptoms. If they do, they would be placed in “isolation,” a more restrictive setting in a hospital for someone who is ill with a contagious disease.
Under state law, if someone fails to comply with a quarantine order, they can be charged with a misdemeanor and face up to two years in prison. SIM’s Johnson said his group wanted the quarantine out of concern for others.
Preparing for the unexpected
Megan Davies, a state medical epidemiologist who participated in discussions about the quarantine, praised SIM for contacting officials early. But she said state and local health departments and the airport hold regular meetings to prepare for such situations “even if something happens unexpectedly. We plan for any communicable disease that could have public health impact. What we did was based on our existing plans.”
A quarantine order “is a spectrum of public health control measures” that can be more or less restrictive depending upon the disease and the person’s exposure, Davies said. “The essential component is that the person stays in close contact with the health department, and there is symptom monitoring.
“Because of public concern, we’ve been extra cautious and have asked returning travelers to stay in a restricted area (so the) public can be assured that people are not moving freely around the Charlotte area.”
She acknowledged that it may be giving contradictory messages to the public because “there isn’t a risk of people who are not actively sick infecting anybody.”
Commercial or charter flight?
Johnson said SIM officials have wanted to “go the extra mile” to protect their Charlotte neighbors. When it came to deciding whether to fly the missionaries on a commercial flight or private plane, Johnson said he chose the latter.
“Jesus gave us two great commands, and one of them was to treat people that you’re around like you would want to be treated,” Johnson said. “I asked the question, how would I want to be treated? Would I want to know that SIM brought two doctors back (from Liberia) along with David Writebol on a commercial aircraft? In the end I went, you know what? I don’t think that’s what my neighbors would want.”
During the quarantine, the missionaries are checking their temperatures four times a day. The quarantine orders will expire at different times, depending on when each missionary was first exposed, Keener said. He said the health department will make an announcement when all three orders have been fulfilled.
At the RV park, Writebol and the two doctors are allowed to move about the grounds and have a limited number of visitors, including Johnson. SIM will prepare their meals. When he visited Monday morning, Johnson said he learned they were practicing the “3-foot rule,” staying about that far away from others, just in case.
Each of the five missionaries is staying in a separate RV, and the six children are staying with their two parents. Johnson said the children told him they’ve been having movie nights and playing games. He said he planned to bring his mountain bike and ride with them on the property’s trails.
When asked if other SIM missionaries would be returning to Charlotte, Johnson said, “This is not an evacuation.” In fact, he said the two doctors who arrived Sunday have told him they plan to return to Liberia at some point. “Frankly, they needed a break,” Johnson said. “They have watched people die from this dreaded disease.”