Massachusetts hospitals vary in their policies for staff members returning from relief work in West Africa, an inconsistency highlighted Friday by news that a New York emergency room physician tested positive for Ebola after treating patients in Guinea.
The uneven approaches, health leaders acknowledged, underscore the difficulty in staying ahead of a rapidly changing epidemic that has inspired worldwide travel to West Africa.
While some hospitals said they prohibit any employee who has been to Guinea, Liberia, or Sierra Leone from returning to work for 21 days, the longest potential incubation for the disease, others extend their rules only to medical workers who had direct contact with patients in those countries.
“Our policy is that anyone who travels to a country with active Ebola transmission must stay out of work for 21 days after returning, regardless of what they were doing over there,” said Dr. Thomas Sandora, an infectious disease specialist at Boston Children’s Hospital.
The hospital established work restrictions Sept. 15 that applied only to employees who had cared for Ebola patients, but expanded those restrictions Thursday, in the wake of the news from New York.
Dr. Craig Spencer did not return to work upon his homecoming to New York, but city officials said he rode the subway, took a cab, and went bowling in the past week before he started showing symptoms of Ebola.
The governors of New Jersey and New York announced Friday that they were issuing mandatory quarantines for “any individual who had direct contact with an individual infected with the Ebola virus while in one of the three West African nations . . . including any medical personnel having performed medical services to individuals infected with the Ebola virus.”
In Massachusetts, the state health department, which regulates hospitals and medical workers, has not issued any change to its guidance for those traveling from West Africa.
Department spokeswoman Anne Roach said the agency is following the lead of the US Centers for Disease Control and Prevention, whose guidelines do not distinguish medical workers from other travelers. The CDC recommends that all of those returning from West Africa monitor their health, but does not suggest they stop work or other activities unless they start showing symptoms.
Among Massachusetts hospitals considering policy updates is Boston Medical Center, which had an infectious disease specialist travel to West Africa. It currently prohibits any health worker from tending to patients for 21 days upon their return, but spokeswoman Jennifer Watson said the hospital is “currently reviewing whether to add any additional provisions.”
Hospitals have been constantly evaluating their policies, training, and guidelines in preparation for the possibility an Ebola patient could arrive in Massachusetts, but several said the appearance of the case in New York has not sparked any changes.
“I think the risk this individual has spread Ebola to others is very low,” said Dr. Deborah Yokoe, hospital epidemiologist and medical director of the infection control department at Brigham and Women’s Hospital. “We’ve been working on increasing the vigilance even before this New York physician was identified as having Ebola.”
Since September, Partners HealthCare, the parent company of the Brigham and Massachusetts General Hospital, has had a policy mandating that health care workers involved in direct care of patients in Ebola-stricken countries stay away from work for 21 days.
Dr. Stephen Calderwood, the infectious disease division chief at Mass. General, said that such workers must register with the hospital’s occupational health service and call or e-mail their temperature twice a day. Workers who develop symptoms would be transported to the hospital with full personal protective equipment. He noted that the hospital’s work rules do not require people to stay inside their homes, as long as they are not symptomatic.
“As a health care facility and an employer, the question to us is, may they return to work?” Calderwood said. “What they do at home is outside our jurisdiction. It is a public health decision.”
At Tufts Medical Center, employees returning from West Africa are required to be cleared by the employee health department before returning to work.
“We currently are working closely with our Travel Clinic to define the process for evaluating any employees returning from West Africa before they are cleared to return to work,” spokesman Jeremy Lechan said in a statement.