Smells Like Quarantine Spirit: Governors Push For Stronger Ebola Policies Than The CDC

NEW YORK, NY - SEPTEMBER 15:  New Jersey Governor Chris Christie and New York Governor Andrew Cuomo stand side by side during
NEW YORK, NY - SEPTEMBER 15: New Jersey Governor Chris Christie and New York Governor Andrew Cuomo stand side by side during a press conference after a bi-state meeting on security preparedness for the New York-New Jersey area on Septemeber 15, 2014 in New York. The meeting involved numerous agencies at the state and national level, including the Department of Homeland Security, New Jersey State National Guard, the Port Authority of New York and New Jersey, New York National Guard and Metroplitan Transportation Authority police, amongst others. (Photo by Andrew Burt/Getty Images)

WASHINGTON -- Even as New York and New Jersey fend off criticism that their quarantine measures for health care workers returning from Ebola hot zones are medically unnecessary, a number of other states are moving in the same direction.

Throughout the country, various quarantine policies have been announced over the past few days. There has been no uniformity to the approaches, and several policies were in fact revised soon after being announced, creating a whiplash effect for those closely following the debate. But the overall trend suggests that elected officials from both political parties are more willing to be seen as overreacting to the Ebola crisis in West Africa than to be perceived as playing catch-up.

It also shows the limited faith governors currently have in the federal government's approach.

On Monday, the Centers for Disease Control and Prevention unveiled a set of newly refined guidelines for incoming travelers from the countries in West Africa most ravaged by Ebola. On a call with reporters Monday, CDC Director Tom Frieden recommended "voluntary, at-home isolation" for individuals considered to be at high risk of having Ebola, whom he defined as anyone who has had direct, unprotected exposure to a patient. Under voluntary isolation, individuals will be discouraged from going to work, using public transportation and appearing in public places. As for health care workers returning from West Africa who have not been knowingly exposed to the virus, Frieden encouraged them to thoroughly monitor their own conditions and to coordinate with local health care officials who could provide "direct rapid monitoring."

Frieden said the new protocols would "increase the level of protection of the health and safety of Americans [...] while at the same time recognizing the heroic work that is going on in West Africa."

But even as he made the case that the new guidelines were "based on science," Frieden also appeared to recognize that politics had outpaced the discussion.

Acknowledging that some governors want more stringent conditions than what the CDC recommends, Frieden conceded that "that's within their existing authority."

On Friday, New York Gov. Andrew Cuomo (D) and New Jersey Gov. Chris Christie (R) rolled out aggressive policies requiring quarantines for individuals who have had direct contact with Ebola patients in Liberia, Sierra Leone or Guinea. After federal officials and the medical community slammed the policies as scientifically unnecessary, the governors clarified on Sunday that the 21-day quarantine could be completed at home.

Though New York and New Jersey have received the most press attention, they're not the only states that have done an about-face recently. Illinois, which on Friday implemented a mandatory stay-at-home quarantine policy, clarified on Monday that the policy excludes "medical workers who wore protective clothing," the Chicago Tribune reported. But high-risk medical workers who have had direct contact with the skin or bodily fluids of an Ebola-infected person are still required to stay home in quarantine.

Over the weekend, Florida Gov. Rick Scott (R) signed an executive order saying the state's Department of Health will "quarantine all high-risk travelers from EVD-affected countries in West Africa who are identified as being in Florida for a period of 21 days following last known EVD exposure." (EVD refers to Ebola virus disease.) The order does not specify where people will be quarantined. Unlike the CDC's guidelines, the Florida quarantine is being described as mandatory.

On Monday, Maryland implemented its own new Ebola policy, under which a mandatory quarantine is reserved for individuals with known exposure to the virus. According to a fact sheet distributed to the press, that group includes individuals who have had "a splash of body fluid on exposed skin or a needle-stick injury."

Dr. Joshua M. Sharfstein, secretary of Maryland's Department of Health and Mental Hygiene, told The Huffington Post that such cases usually happen when a patient is medically evacuated from an Ebola hot spot. Health officials would first try to establish an "agreement" with those individuals to stay at home. Absent that, "we will issue an order," Sharfstein said. "This is based on the experience we've had with other infectious disease like tuberculosis."

In Maine, Gov. Paul LePage (R) implemented a quarantine protocol on Monday for nurse Kaci Hickox, who has tested negative for Ebola. Hickox went to her home in Fort Kent, Maine on Monday after being discharged from a tent outside a New Jersey hospital. In a statement, LePage said, "We will work with the health care worker to establish an in-home quarantine protocol to ensure there is no direct contact with other Mainers." LePage spokeswoman Adrienne Bennett told the Associated Press that "if an individual is not compliant, the state is prepared to take appropriate action."

On Monday afternoon, Georgia Gov. Nathan Deal (R) announced a quarantine policy for high-risk individuals. According to a release from Deal's office quoted in The Atlanta Journal-Constitution, travelers who have had direct exposure to an Ebola patient abroad "will be subject to quarantine at a designated facility," and medical personnel who have treated Ebola patients returning to the U.S. must agree to twice-daily check-ins with health officials. "Noncompliance" with these terms "will result in quarantine at a state-designated facility," the release notes.

Not all states have moved to a mandatory policy. Virginia Gov. Terry McAuliffe (D) announced on Monday that the state would be actively monitoring travelers from West Africa, but said quarantine for high-risk patients is voluntary for now.

That some states are going above and beyond the CDC's recommendations certainly hasn't escaped Frieden's notice. On Monday's call, he offered a word of caution about unintended consequences. Quarantines, he argued, would end up discouraging health care workers from going to West Africa in the first place. And should the disease continue to ravage that part of the globe, "the risk to us will increase," he said.

"We will only get to zero risk by stopping it at the source," said Frieden.

UPDATE: 8:20 p.m. -- Add Connecticut to the list of states going beyond the guidelines offered by the CDC for guidance. In a press release Monday night, Gov. Dannel Malloy (D) said state health officials would subject “all such” travelers from Guinea, Liberia and Sierra Leone to “active mandatory monitoring.” That includes daily contacts to obtain temperatures. Moreover, if the state’s public health commission “deems it necessary based on information gathered during the screening process a quarantine will be required.”

As for the guidelines offered by the federal government, Malloy made it clear that he viewed those as a basement, not a ceiling. The first subhead in his press release reads: “Policy More Stringent than CDC Requirements.”



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