Ebola: Some states announce mandatory quarantines…now what?

Posted at 5:17 AM, Oct 27, 2014
and last updated 2014-10-27 05:17:03-04

(CNN) — A weekend of back-and-forth between two governors, the federal government and a nurse about mandatory quarantines left more questions than answers.

At the heart of the debate: Would such quarantines on health workers who just came back from treating Ebola patients in West Africa help prevent the spread of the virus, or would they discourage medical aid workers from helping fight the global crisis.

Here’s what we know about the latest Ebola policies:

Who enacted tougher rules for medical aid workers?

New York, New Jersey and Illinois say anyone returning from having direct contact with Ebola patients in West Africa will have to be quarantined for 21 days. The 21-day period marks the maximum incubation period for Ebola.

Illinois Gov. Pat Quinn’s office said the quarantine would be a “home quarantine.”

“This protective measure is too important to be voluntary,” Quinn said.

When New Jersey Gov. Chris Christie and New York Gov. Andrew Cuomo announced their new policies on Friday, they called for hospitalization or quarantine. But on Sunday night, after debate over the policies heated up, the governors said the quarantines could be carried out at home.

Would home quarantines even work?

Depends on which side you ask.

Neither Christie nor Cuomo explained how a home quarantine would work if family members were also in the home. It’s also unclear how a home quarantine would or could be enforced if the quarantined person chose to leave the house.

On the other hand, the governors say that something had to be done; that asking returning medical workers to voluntarily quarantine themselves hasn’t worked.

Public health experts say there’s plenty of scientific evidence indicating that there’s very little chance that a random person will get Ebola, unless they are in very close contact — close enough to share bodily fluids — with someone who has it.

Still, there’s also a sense that authorities have to do something because of Americans’ fears — rational or not — and belief that the country is better off being safe than sorry.

As Mike Osterholm, an infectious disease epidemiologist at the University of Minnesota, says, “You want to try to eliminate not just real risk, but perceived risk.”

What prompted the policies?

In New Jersey, NBC medical correspondent Dr. Nancy Snyderman violated her confinement to pick up takeout from a restaurant in October.

In New York, city workers scrambled to retrace the steps of a doctor, Craig Spencer, who tested positive last week. He’d been on the subway and to a bowling alley. among other places.

What are the concerns about such quarantines?

The concerns are twofold: One, it could deter doctors and nurses from traveling to West Africa to help rid Ebola; and two, it could greatly impede the livelihoods of health care workers.

“If I lose three weeks on my return and don’t get to do the work I’m supposed to do … means this wouldn’t be workable for me,” said Dr. John Carlson, a pediatric immunologist at Tulane University.

CDC director Dr. Tom Frieden expressed a similar view earlier this month, arguing that stringent travel restrictions might create more problems than they solve.

“It makes it hard to get health workers in, because they can’t get out,” he said. “If we make it harder to respond to the outbreak in West Africa, it will spread not only in those three countries (in West Africa hit hardest by Ebola) but to other parts of Africa and ultimately increase the risk here” in the United States.

Who would pay for the time off?

Cuomo added that if employers don’t pay quarantined workers for the time they are absent while under quarantine, “the government will.”

How has this affected health care workers?

The same day the governors announced their tougher policies Friday, nurse Kaci Hickox arrived at Newark Liberty Airport after spending a month helping treat Ebola patients in Sierra Leone.

She didn’t have any symptoms and has now tested negative for Ebola twice. Nonetheless, the nurse from Kent, Maine, remains holed up inside a quarantine tent at University Hospital in Newark.

“This is an extreme that is really unacceptable, and I feel like my basic human rights have been violated,” Hickox told CNN’s Candy Crowley on “State of the Union” on Sunday.

She slammed Christie for describing her as “obviously ill.”

“First of all, I don’t think he’s a doctor; secondly, he’s never laid eyes on me; and thirdly, I’ve been asymptomatic since I’ve been here,” Hickox said.

New York City Mayor Bill de Blasio supported the nurse.

“This hero was treated with disrespect and was not given a clear direction,” de Blasio said. “We owe her better than that, and all the people who do this work, better than that.”

It’s unclear if Hickox will be given the option of carrying out her quarantine at home, as described the Christie and Cuomo on Sunday night.

Is Hickox’s quarantine unconstitutional?

Lawyer Norman Siegal said he’ll be filing papers in court for Hickox to have a hearing in the coming days. He met with his client through a plastic window.

Siegal said the doctors at the hospital say there’s no medical reason to hold her. The policy Christie enacted is unconstitutional and too broad, he said.

But Christie defended his actions Sunday night.

“I’m sorry if in any way (Siegal) was inconvenienced, but inconvenience that could occur from having folks that are symptomatic and ill out amongst the public is a much, much greater concern of mine,” Christie said. “I hope she recovers quickly.”

Hickox said she has nothing to recover from. Her temperature is normal, and she feels fine.

Who else might amp up Ebola rules?

Florida is starting mandatory monitoring for all travelers returning from West Africa, and Virginia is following suit.

“Virginia will implement an active monitoring program on Monday for all returning passengers from Guinea, Liberia and Sierra Leone, with a special emphasis on returning health care workers,” said Virginia governor spokesman Brian Coy.

Cuomo says he knows some people think he’s overreacting.

“Some people will say we are being too cautious,” the governor said. “I’ll take that criticism.”

Isn’t there a middle ground?

There is.

One possibility is to have those travelers do more than temperature checks.

Dr. Irwin Redlener, director of Columbia University’s National Center for Disaster Preparedness, says one such measure could be checking daily for decreases in white blood cell counts or platelets — which could be, but aren’t necessarily, a sign of an Ebola infection.

And Osterholm thinks there should be stricter controls on what a person who arrives from West Africa does in his or her first three weeks in the United States. For instance, he thinks such a person shouldn’t take public transportation or go to crowded places like bowling alleys, both of which officials say Spencer did before he was symptomatic.