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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