CDC Suggests Quarantine-Lite for Some Ebola Clinicians

October 27, 2014

The head of the Centers for Disease Control and Prevention (CDC) today announced recommendations for some US healthcare workers who have battled Ebola in West Africa that stop just short of the outright 21-day quarantine instituted by several states.

For asymptomatic clinicians who had a high risk for exposure to the virus in Sierra Leone, Liberia, or Guinea, perhaps because of a needle stick, "we are recommending voluntary at-home isolation" upon return to the United States, said CDC Director Tom Frieden, MD, MPH, in a news conference today. These clinicians should avoid public transportation, public places such as shopping centers, public gatherings, and outside workplaces. However, the CDC is not necessarily recommending that they should be strictly homebound.

"There are non-congregant activities that could proceed, such as jogging in a park," said Dr Frieden. "If people want to travel, that would have to be done by non-commercial conveyance such as a car and…coordinated with the public health authority."

The decision to restrict the movement of healthcare workers returning from the Ebola front as well as actively monitor them in person for symptoms should be made on a case-by-case basis, he added.

The guidance, aimed at state and local health departments, comes just three days after New Jersey Governor Chris Christie and New York Governor Andrew Cuomo announced mandatory 21-day quarantines of all healthcare workers arriving at two key airports from the three West African countries. The two governors expressed dissatisfaction with the self-monitoring regimen of newly arrived, unquarantined healthcare workers from West Africa that is recommended by many public health experts as well as Doctors Without Borders. Illinois also has joined the quarantine club.

Craig Spencer, MD, who tested positive for Ebola on October 23, had been monitoring his symptoms since his arrival in New York on October 17 after an assignment with Doctors Without Borders in Guinea. Before he reported a low-grade fever earlier on October 23, Dr Spencer had been moving freely around New York City. He had gone bowling on October 22, for example.

Dr Frieden said today that strict quarantines for Ebola fighters such as Dr Spencer could discourage them from volunteering — and ultimately endanger the United States.

"If we do things that make it very difficult for people to come back, if we turn them into pariahs instead of recognizing the heroic work they're doing…they may be less likely to go and stop it at the source in Africa," he said. "If we can't control it there, the risk to us could increase."

Dr Frieden also warned against adopting policies that create the false impression that Ebola can spread as easily as the flu. Only a symptomatic patient, he stressed, can spread the virus.

The new guidelines seem to leave the door open, however, to more stringent measures. They state: "At this time, CDC is not recommending that asymptomatic contacts of [Ebola] patients be quarantined, either in facilities or at home."

More information on the CDC's new interim guidelines are available on the agency Web site.

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