Tuesday, 28 October 2014

Debate Continues Over Ebola Quarantines

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Debate over the Ebola quarantines in New Jersey rages on, as the nurse who was controversially quarantined in New Jersey heads to her home in Maine.

On Monday, Kaci Hickox — a nurse who was forced to adhere to a mandatory quarantine in New Jersey after returning home from treating Ebola patients in West Africa — left Newark, New Jersey, to return to Fort Kent, Maine. Officials state that she will continue to comply with a 21-day voluntary in-home quarantine instituted by Maine Governor Paul LePage.

A spokeswoman for the Northern Maine Medical Center stated that the facility is prepared to care for an Ebola-infected patient, if necessary.

The Maine Department of Health reported of Hickox,

She will remain subject to New Jersey’s mandatory quarantine while in New Jersey. Health officials in Maine have been notified of her arrangements and will make a determination under their own laws on her treatment when she arrives.

Hickox’s return to Maine follows a long weekend of debate over New Jersey's newly enacted mandatory Ebola quarantine policy.

On Friday, New Jersey Governor Chris Christie, along with New York Governor Andrew Cuomo, announced that they would be forcing a mandatory quarantine on healthcare workers returning from West Africa. The announcement came one day after a New York City doctor, Craig Spencer from Doctors Without Borders, was diagnosed with the Ebola virus. A public debate erupted after it was revealed that Spencer, 33, had traveled widely around the city, using mass transit.

Illinois announced a similar policy on Saturday, with Governor Pat Quinn calling it a “common sense step,” and Virginia has stated it will begin to actively monitor travelers from key West African countries.

Governor Cuomo said, “The steps New York and New Jersey are taking ... will strengthen our safeguards to protect our residents against this disease and help ensure those that may be infected by Ebola are treated with the highest precautions.”

The first person to be impacted by New Jersey’s policy was Kaci Hickox, who, when returning from Sierra Leone, was placed under quarantine by the New Jersey Health Department. Hickox’s quarantine quickly stirred controversy when an article was published in the Dallas Morning News detailing the conditions of her quarantine. “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,” said Hickox, who had access to a computer and cellphone during her quarantine. “I am scared that, like me, they will arrive and see a frenzy of disorganization, fear and, most frightening, quarantine.”

The group Doctors Without Borders asserted that Hickox was treated poorly, being forced to spend the weekend in the unheated isolation tent outside Newark’s University Hospital, dressed in uncomfortable scrubs. The organization added that she was not updated on her status or kept in the loop regarding the isolation process.

Hickox has reportedly hired Norman Siegel, a civil rights attorney who specializes in cases involving the government, to challenge the New Jersey policy.

According to another of Hickox’s lawyers, Steve Hyman, Hickox will remain in seclusion for just the “next day or so” while he meets with Maine health officials. Hyman asserts that Maine should be following the guidelines set by the Centers for Disease Control and Prevention that advise that health workers who treated Ebola patients need only monitoring, not quarantine, unless symptoms are present.

But Governor LePage is defending the quarantine, contending that state officials should be “vigilant” in their efforts to protect the health of the people in his state. "Upon the healthcare workers' return home, we will follow the guidelines set by the U.S. Centers for Disease Control for medical workers who have been in contact with Ebola patients," LePage's statement continued. "Additionally, we will work with the healthcare worker to establish an in-home quarantine protocol to ensure there is no direct contact with other Mainers until the period for potential infection has passed."

LePage’s spokeswoman, Adreienne Bennett, told the Portland Press Herald that the state would take “appropriate action” if Hickox did not comply with the quarantine.

Governors Christie and Cuomo were fiercely criticized by the White House for their quarantine policies. The White House voiced fears that the mandatory quarantines would create "unintended consequences.” Administration officials stated that they are working to create new federal guidelines for returning healthcare workers exposed to Ebola.

Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, voiced concerns that the mandatory quarantines would discourage healthcare workers from volunteering in West African countries. "We do not want to put them in a position where it makes it very, very uncomfortable for them to even volunteer," he told Fox News Sunday.

The criticism from the Obama administration prompted Governor Cuomo to relax New York's guidelines to allow for in-home quarantines where health workers who had contact with Ebola patients would receive twice-daily monitoring if no symptoms were present. Under the revised guidelines, family members would be permitted to visit, and the state would pay for any lost compensation.

Similarly, Christie stated that New Jersey residents who do not have symptoms would be permitted to be quarantined in their home, and non-residents would be transported to their homes when feasible.

However, Christie defended his mandatory quarantine policy, asserting that it is his job to “protect the safety and health” of his citizens.

Connecticut officials followed suit after New York and New Jersey announced their quarantine policies, stating that anyone returning to the state from the West African countries of Sierra Leone, Guinea, or Liberia would face mandatory monitoring of at least 21 days. Additionally, the U.S. Army has enacted a mandatory 21-day quarantine on troops from Ebola hot zones in West Africa. The Joint Chiefs of Staff recommended that other branches of the military do the same.

But while the White House has been outspoken in its criticism of the quarantine policies in New York and New Jersey, it has remained relatively quiet on the military’s quarantine policy. "The Obama administration is going to war with New York and New Jersey, but its own military is recommending the same thing," a senior U.S. official pointed out on Fox News.

White House Press Secretary Josh Earnest stated that Defense Secretary Chuck Hagel is considering the Joint Chiefs’ recommendation, but when he was pressed on the president’s position, Earnest dodged the question. "We will let the Department of Defense make an announcement," he replied.

When asked why U.S. troops were being sent to West Africa if there was not a clear plan for their exit from the Ebola-ridden regions, Earnest responded, "We're going to let science drive that process." 

A recent Economist/YouGov poll shows that the majority of Americans support the quarantine, with more than half of those polled stating they believe the United States should forbid those who have been in Ebola-ravaged countries from entering the United States. Nearly three-quarters of those polled believe everyone coming from those West African countries should be subjected to a quarantine.

But despite fears about the spread of Ebola, some believe that the mandatory quarantines will set a dangerous precedent, violating Americans' civil liberties. The Washington Post writes:

Based on work that we have done on other public health anxieties, such as smallpox and the H1N1 flu, we expect that Ebola anxiety will lead people to seek protection from diseases that may cause harm to them or their family. In seeking protection, we expect that Americans will, at least initially, put their trust in medical experts like the Centers for Disease Control (CDC) to tell them how to stay safe and will support state powers that may lead to quarantine or other civil liberties restrictions for those suspected of exposure.

The Post ultimately concludes that the best hope is that the U.S. health system is worthy of the trust that the American public has placed in it.

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