Experts Oppose Quarantine for Returning Ebola Care Workers

October 27, 2014

The decision by the governors of New York and New Jersey to quarantine asymptomatic clinicians returning from Ebola care in West Africa has sparked opposition from infectious disease experts, who warn that the move could weaken this nation's campaign to beat the virus.

The Infectious Diseases Society of America and the Association for Professionals in Infection Control and Epidemiology both have issued news releases stating that the prospect of mandatory quarantine could discourage US clinicians from volunteering to treat patients with Ebola in Liberia, Sierra Leone, and Guinea, and from stopping the disease at its source. Both groups stressed that individuals are not contagious unless they have Ebola symptoms, such as fever and diarrhea. Even then, the virus cannot be spread unless there is contact with the infected person's blood or other body fluids.

"It is important to be guided by the scientific evidence," the Association for Professionals in Infection Control and Epidemiology said yesterday in a news release.

In an interview with Medscape Medical News, the chair of the Infectious Diseases Society of America public health committee described the quarantine decision by New York and New Jersey as a "fear-based policy."

"These [Ebola care clinicians] have work-related obligations and family responsibilities," said Jeff Duchin, MD. "They have the right not to have their movement restricted inappropriately. Asymptomatic people can't transmit Ebola."

Quarantine Policy Gets Implemented Immediately

The quarantine debate intensified on October 24, when New York Governor Andrew Cuomo and New Jersey Governor Chris Christie announced that their states would automatically impose a 21-day quarantine on healthcare workers returning from Ebola care assignments in the three West African countries ravaged by the disease. The authority to quarantine extends to all travelers from those countries who have had contact with infected individuals. The two states are implementing this policy at Newark Liberty International Airport and John F. Kennedy International Airport.

The quarantine decision came a day after Craig Spencer, MD, who recently returned from an assignment with Doctors Without Borders in Guinea, tested positive for the Ebola virus after reporting a fever earlier in the day. Dr Spencer was monitoring himself while moving freely about New York City. Doctors Without Borders does not recommend quarantining international healthcare workers coming back from Ebola care in West Africa.

On the very day the new policy was announced, the New Jersey Department of Health quarantined Kaci Hickox, a registered nurse who had flown in from Sierra Leone, where she had treated patients with Ebola under Doctors Without Borders. The state health department initially placed Hickox in a tent inside a New Jersey hospital. After she complained about inhuman treatment, New Jersey officials are allowing her to return to her home in Maine, where she can complete her quarantine.

In a news release, a spokesperson for Christie said that the state's intent all along was to quarantine qualifying New Jersey residents in their homes. "Nonresidents would be transported to their homes if feasible, and if not, quarantined in New Jersey," the spokesperson said.

According to Reuters, the White House has told Christie and Cuomo that it worries about the unintended consequences of mandatory quarantine, such as undermining efforts to vanquish Ebola in West Africa. Cuomo is sticking to his quarantine policy, although yesterday his administration announced that New York residents subject to quarantine would be confined at home, while "other accommodations will be made for out-of-state residents."

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