WASHINGTON – The Ebola quarantine controversy has become a chaotic brawl involving politics, science and the law. The rules on quarantining health care workers returning from West Africa are changing almost daily and varying according to geography and political climate.
The Pentagon announced Monday that Army personnel returning to their home base in Italy from Liberia will be held in quarantine for 21 days – even though none have symptoms of Ebola or were exposed to patients infected with the virus.
The military’s policy does not appear to track new guidelines announced Monday by the Centers for Disease Control and Prevention, which called for “high risk” individuals and health care workers without any symptoms to be directly monitored by state and local health authorities.
Nor do the states have to follow the CDC’s recommendations. For example, Georgia’s new rules, announced Monday, are more restrictive in some respects than the ones unveiled the same day in Maryland and Virginia.
Much of the Ebola drama is in New Jersey, where nurse Kaci Hickox, who had been kept under a mandatory quarantine in a tent at a hospital, was released Monday by order of Republican Gov. Chris Christie. He defiantly declared that his aggressive treatment of the nurse, who does not have Ebola, will become the national norm.
But critics of mandatory quarantining of the type imposed in New Jersey say it is an example of politics trumping science because asymptomatic health care workers can’t spread the Ebola virus. The virus spreads only through the bodily fluids of someone who has symptoms, such as fever, vomiting or diarrhea.
“This doesn’t make medical sense,” said Kristi Koenig, spokeswoman for the American College of Emergency Physicians, which represents about 34,000 emergency department doctors across the country.
The issue boiled over after Craig Spencer, a doctor in New York City who had returned from Guinea, tested positive Thursday for the virus after a night on the town, and then Hickox, a nurse who had worked with Doctors Without Borders in a clinic in Sierra Leone, was detained against her will at the Newark airport and then at the hospital. She was on her way to Maine on Monday by a private means that would not expose her to the public, New Jersey officials said.
“I understand she didn’t want to be there. She made that very clear from the beginning. But my obligation is to all the people of New Jersey, and we’re just going to continue to do that,” Christie told reporters Monday.
“That’s a common-sense approach that the federal government wasn’t taking. That we took first in New Jersey and New York. That’s now been adopted by Chicago,” he said. “This will become national policy because it’s smart, tough, common-sense policy.”
Virginia Democratic Gov. Terry McAuliffe and Maryland Gov. Martin O’Malley, also a Democrat, held separate news conferences Monday announcing their plans for Ebola containment. Travelers from Guinea, Liberia and Sierra Leone will be assessed by health workers and asked to agree to a 21-day monitoring protocol.
Higher-risk travelers would be visited at home by health workers and asked to stay there. Individuals refusing to sign the protocol agreement or not following the rules could be involuntarily quarantined, officials said.
Georgia Gov. Nathan Deal, a Republican, on Monday announced a more aggressive Ebola-containment policy. Travelers from West Africa who don’t show symptoms, but who are considered high risk because of “known direct exposure” to Ebola patients, will be subject to quarantine at a designated facility, Deal’s office said.
The White House this weekend pressured New York and New Jersey officials to ease their quarantine rules, and New York complied with a revised policy Sunday. Press secretary Josh Earnest said Monday, “We want to make sure that whatever policies are put in place in this country to protect the American public do not serve as a disincentive to doctors and nurses from this country volunteering to travel to West Africa to treat Ebola patients.”
Hickox “didn’t travel over there because she was getting a big paycheck,” Earnest said. He said work such as hers should be honored and respected, and “I don’t think we do that by making her live in a tent for two or three days.”
An editorial published in the New England Journal of Medicine on Monday called the mandatory quarantines put in place by New York and New Jersey “not scientifically based,” “unfair” and “unwise,” saying the measures would impede much-needed efforts to get aid to Ebola-ravaged areas of West Africa.
“The governors’ action is like driving a carpet tack with a sledgehammer: it gets the job done but overall is more destructive than beneficial,” the editors wrote.
Under the new CDC guidelines, state and local health authorities would directly monitor and observe “high risk” individuals and others with some risk. Depending on the individual circumstance, a person could be prevented from boarding flights, using public transportation, or venturing into public places such as shopping malls and movie theaters. But someone who had contact with an Ebola patient before that patient was showing symptoms – and therefore was not infectious – would not be monitored or face public or travel restrictions.
The CDC also issued new guidance for workers in U.S. hospitals who care for Ebola patients. Even when they follow all recommended guidelines for wearing personal protective gear, they “might not realize they have been exposed,” according to the CDC. Therefore, all health care workers in the nation caring for Ebola patients must also be directly monitored by state and local health authorities.