Accepted monitoring or endured quarantine? Ebola contacts' perceptions in Senegal

Abstract

During the 2014-2016 West Africa Ebola epidemic, transmission chains were controlled through contact tracing, i.e., identification and follow-up of people exposed to Ebola cases. WHO recommendations for daily check-ups of physical symptoms with social distancing for 21 days were unevenly applied and sometimes interpreted as quarantine. Criticisms arose regarding the use of coercion and questioned contact tracing on ethical grounds. This article aims to analyze contact cases' perceptions and acceptance of contact monitoring at the field level. In Senegal, an imported case of Ebola virus disease in September 2014 resulted in placing 74 contact cases in home containment with daily visits by volunteers. An ethnographic study based on in-depth interviews with all stakeholders performed in September-October 2014 showed four main perceptions of monitoring: a biosecurity preventive measure, suspension of professional activity, stigma attached to Ebola, and a social obligation. Contacts demonstrated diverse attitudes. Initially, most contacts agreed to comply because they feared being infected. They adhered to the national Ebola response measures and appreciated the empathy shown by volunteers. Later, acceptance was improved by the provision of moral, economic, and social support, and by the final lack of any new contamination. But it was limited by the socio-economic impact on fulfilling basic needs, the fear of being infected, how contacts' family members interpreted monitoring, conflation of contacts as Ebola cases, and challenging the rationale for containment. Acceptance was also related to individual aspects, such as the professional status of women and health workers who had been exposed, and contextual aspects, such as the media's role in the social production of stigma. Ethnographic results show that, even when contacts adhere rather than comply to containment through coercion, contact monitoring raises several ethical issues. These insights should contribute to the ethics debate about individual rights versus crisis public health measures.

Keywords: Africa; Contact tracing; Ebola; Ethics; Quarantine; Senegal; Social distancing.