Nurse criticizes Ebola quarantine, raising concern

VERENA DOBNIK, Associated Press

NEW YORK (AP) — The nurse who was quarantined at a New Jersey hospital because she had contact with Ebola patients in West Africa criticized the way her case has been handled, raising concerns from humanitarian and human rights groups over unclear policies for the newly launched quarantine program.

Kaci Hickox, the first traveler quarantined under Ebola watches in New Jersey and New York, wrote the first-person account for the Dallas Morning News, which was posted on the paper’s website Saturday. Her preliminary tests for Ebola came back negative. Hickox is a nurse with degrees from the Unniversity of Texas at Arlington.  

New York Gov. Andrew Cuomo and New Jersey Gov. Chris Christie on Friday imposed a mandatory quarantine of 21 days — the incubation period of the deadly virus — on travelers who have had contact with Ebola patients in the countries ravaged by Ebola — Liberia, Guinea and Sierra Leone. A similar measure was announced in Illinois, where officials say such travelers could be quarantined at home.

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The hazy details of how such quarantines will be handled are drawing sharp criticism as infectious disease experts say enforcement logistics are up in the air. Health officials in all three states with quarantine policies did not return messages from The Associated Press seeking details about enforcement.

Cuomo on Saturday acknowledged that the policy might be hard to enforce, according to the New York Daily News.

The governor said officials had never considered whether people refusing to go along with the order could face prosecution or arrest, adding “It’s nothing that we’ve discussed, no,” the newspaper said.

In her essay, Hickox described being stopped at Newark Liberty International and questioned over several hours after touching down Friday. She said none of those who questioned her would explain what was going on or what would happen to her.

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Hickox is a nurse who had been working with Doctors Without Borders in Sierra Leone. Officials said she was taken to a hospital after developing a fever, but Hickox said she was merely flushed because she was upset by the process.

Doctors Without Borders executive director Sophie Delaunay complained Saturday about the “notable lack of clarity” from state officials about the quarantine policies, and an American Civil Liberties Union official in New Jersey said the state must provide more information on how it determined that mandatory quarantines were necessary.

“Coercive measures like mandatory quarantine of people exhibiting no symptoms of Ebola and when not medically necessary raise serious constitutional concerns about the state abusing its powers,” said Udi Ofer, executive director of the ACLU of New Jersey.

Doctors Without Borders said Hickox has not been issued an order of quarantine specifying how long she must be isolated and is being kept in an unheated tent. It urged the “fair and reasonable treatment” of health workers fighting the Ebola outbreak.

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“We are attempting to clarify the details of the protocols with each state’s departments of health to gain a full understanding of their requirements and implications,” Delaunay said in a statement.

Christie, campaigning Saturday in Iowa for a fellow Republican, said he sympathizes for Hickox but said he has to do what he can to ensure public health safety.

“My heart goes out to her,” the governor said, while also noting that state and local health officials would make sure quarantine rules are enforced. He said the New Jersey State Police will not be involved.

Health officials said preliminary tests for Ebola came back negative for Hickox but Newark University Hospital would not say if she would be released for the balance of the quarantine period or remain in the hospital.

In the very early stages of Ebola, patients may still test negative because the virus has not yet reached detectable levels in the blood. The U.S. Centers for Disease Control and Prevention says it may take up to three days after the onset of symptoms for the virus to reach detectable levels in some patients, prompting repeat testing in some cases.

Hickox’s mother, Karen Hickox, said Saturday her daughter probably wasn’t expecting to be quarantined upon her return to the United States, but is dealing with it.

“I spoke with her (Friday and Saturday),” she said. “She was more frustrated (Friday) but there were some tears (Saturday) … If you knew her, she’s a very compassionate person but she doesn’t usually get emotional.”

The quarantine measures were announced after a New York physician, Craig Spencer, working for Doctors Without Borders returned from Guinea was admitted to Manhattan’s Bellevue Hospital Center earlier this week to be treated for Ebola.

A senior White House official said Saturday that how to treat health care workers returning from the affected West African countries continues to be discussed at meetings on Ebola as the administration continues to take a “careful look” at its policies.

Dr. Irwin Redlener, a Columbia University professor and director of the New York-based National Center for Disaster Preparedness, said the logistics of the states’ new quarantine policy are “a problem.”

“The challenge now is how you translate this quarantine plan to operational protocol,” Redlener said.

He warned that quarantines might discourage doctors and nurses from going to West Africa to help, an issue raised by aid groups and Dr. Rick Sacra, one of the American health care workers successfully treated for Ebola contracted while he worked in Liberia.

“Until Ebola is under control in Africa, we’re never going to see the end of such cases coming to the United States,” Redlener said.


Associated Press writers Darlene Superville in Washington, D.C., Jonathan Lemire in New York, Jill Colvin in Clive, Iowa and Bruce Shipkowski in Trenton, New Jersey, contributed to this story.


U.S. regions differ on quarantines for medical workers coming from West Africa

By Spencer S. Hsu and Nia-Malika Henderson (c) 2014, The Washington Post.

WASHINGTON — One day after governors in New York, New Jersey and Illinois imposed a mandatory 21-day quarantine on medical workers returning from Ebola-stricken countries in West Africa, public health officials in Maryland, Virginia and the District of Columbia did not follow suit Saturday, intensifying a national debate over how to prevent the spread of the disease.

That debate sharpened Saturday as the first person affected by the quarantine requirement in New York and New Jersey — a nurse who tested negative for the Ebola virus but remained under quarantine after landing Friday at Newark Liberty International Airport — authored an angry first-person account in the Dallas Morning News about how she was forcibly transported by an eight-police car caravan to the hospital.

“I am scared about how health-care workers will be treated at airports when they declare that they have been fighting Ebola in West Africa,” wrote the nurse, Kaci Hickox, who volunteered with Doctors Without Borders. “I wondered what I had done wrong. . . . I had tried to help when much of the world has looked on and done nothing.”

The differing views between regions highlight challenges confronting federal and state politicians as well as health officials as they race to keep up with fast-changing circumstances and competing political, scientific and legal demands, experts said.

Lawrence Gostin, a global health professor at Georgetown University Law School and an adviser to the World Health Organization, said quarantining medical workers might sound reassuring, but it is an overreaction that if widely adapted “will come back to haunt us.”

“The more we make it difficult for health workers to stem the epidemic in Sierra Leone, Guinea and Liberia, the more at risk we are,” Gostin said. “Because in the modern global world, you’re not going to be able to put those three countries in cellophane wrap. People will travel to other parts of the world and come in through different countries.”

Critics of current federal monitoring rules say they are too lax, allowing people with potential exposure to Ebola to endanger others. Others say self-monitoring eliminates almost any chance of transmission because Ebola typically is contagious only after symptoms emerge.

Privately, some legal authorities and hospital industry representatives say that logically, if authorities impose a quarantine requirement on health workers who treat Ebola patients abroad, they should impose it on health workers who treat infected patients in the United States, a potentially disruptive step for hospitals that might also be unconstitutional.

For now, states are trying to coordinate their responses while awaiting promised guidelines from the U.S. Centers for Disease Control and Prevention, which announced Wednesday that it would begin requiring tighter health monitoring of all inbound airline travelers at five U.S. airports from any of the three West African nations hardest hit in by Ebola.

The pending guidelines — which are supposed to be implemented Monday in six states surrounding New York’s John F. Kennedy, New Jersey’s Newark, Washington Dulles, Atlanta’s Hartfield-Jackson and Chicago’s O’Hare international airports — are expected to require travelers without symptoms to take their temperatures regularly and report to state and local health departments.

However, New York emergency physician Craig Spencer was confirmed to have the Ebola virus on Thursday night. On Saturday, the city’s health department said Spencer has gastrointestinal symptoms and was “awake and communicating.”

On Friday, New York Gov. Andrew Cuomo and New Jersey Gov. Chris Christie mandated a 21-day quarantine for health workers, and Illinois Gov. Pat Quinn ordered a 21-day home quarantine for “high-risk individuals,” including medical personnel in direct contact with Ebola-infected individuals. “This protective measure is too important to be voluntary,” Quinn said.

By contrast, local health authorities in Washington on Friday began implementing a more aggressive voluntary isolation procedure, notifying all licensed health-care providers returning from Ebola-affected regions to isolate themselves for 21 days, including from public places such as mass transit, grocery stores and bowling alleys, and to limit physical contact with spouses or others.

“Based on the science that we know related to Ebola, we are not going to be calling for a quarantine,” Garcia said.

Health officials are working on developing a consistent approach for the area around the nation’s capital. Joxel Garcia, director of the D.C. Department of Health, said that a mandatory quarantine was not scientifically justified and could have a chilling effect on the medical personnel, many of them volunteers, needed to treat Ebola patients at home and overseas.

Officials in Virginia and Maryland also said they were coordinating their stances, stopping short for now of mandatory quarantines.

“We are working on having a consistent approach here in our national capital region. . . . We haven’t finalized those decisions,” said David Trump, chief deputy commissioner of the Virginia Department of Health.

“We, along with others, are looking at whether there are additional steps we need to take,” said Joshua Sharfstein, secretary of health and mental hygiene in Maryland. “This has been a fluid process. When you’re in a situation like this, you want to learn from what is happening elsewhere.”

On Friday, CDC spokeswoman Barbara Reynolds said, “CDC sets the baseline recommended standards, but state and local officials have the prerogative to tighten the regimen as they see fit.” She added, “When it comes to the federal standards set by the CDC, we will consider any measures that we believe have the potential to make the American people safer.”

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Washington Post staff writers Lena Sun, Lori Aratani and DeNeen Brown contributed to this report.