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US gives safety steps on Ebola

Restrictions omit strict quarantines

New federal guidelines for preventing the spread of Ebola recommend tougher restrictions for those at greatest risk of infection, but stop short of the strict quarantines that several states imposed IN RECENT DAYS.

The measures, announced Monday by the Centers for Disease Control and Prevention, call for escalating restrictions based on the extent of risk. People deemed at highest risk, including those directly exposed to fluids from Ebola patients, are advised to avoid public travel and gatherings even if they have no symptoms, and to have their temperature and health monitored twice daily.

The guidelines aim to standardize monitoring of health care workers and others returning to the United States from Ebola-racked West Africa. The rules emerge in the shadow of controversial 21-day quarantines imposed over the weekend by the governors of New York, New Jersey, and Illinois on medical workers returning from caring for patients with Ebola.

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All three states have since loosened their rules, put in place after a New York doctor, Craig Spencer, ate at a restaurant, rode the subway, and went bowling before he fell ill with Ebola. He is being treated in a Manhattan hospital.

In Massachusetts, Governor Deval Patrick said Monday that he is following the advice of public health officials “who don’t see a need for a response like that” put in place in New York and New Jersey.

Dr. Thomas Frieden, the CDC director, said the new FEDERAL guidelines “add a strong level of protection and a strong level of reassurance.”

“I wish we could get to zero risk in the US. But we will only get to zero risk by stopping it at its source,” Frieden said.

The state-imposed quarantines, he said, risk making pariahs of people fighting the epidemic who are returning from West Africa, and might then be less likely to disclose where they have been. “The risk to us would increase,” he said.

Frieden said that since Oct. 11, 807 people have returned to the United States from one of the countries affected by Ebola, and 46 of them identified themselves as health care workers. Seventy percent flew into New York, Maryland, Pennsylvania, Georgia, New Jersey, and Virginia.

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The updated guidelines underscore tension between some states and the federal government over appropriate requirements for workers returning from Ebola-plagued regions.

Governor Chris Christie of New Jersey on Monday backtracked on a mandatory 21-day quarantine for Kaci Hickox, a nurse from Maine who said she received inhumane treatment Friday when she arrived in Newark from Sierra Leone. She was released Monday.

Late Sunday, Governor Andrew Cuomo of New York relaxed his state’s mandatory quarantine, instead asking health care workers who have treated Ebola patients to remain in their homes for 21 days. Public health workers would make twice-daily visits instead, he said.

Governor Patrick Quinn of Illinois on Monday also clarified a new mandatory home quarantine, insisting it does not apply to medical workers who wear proper gear while treating Ebola patients.

White House press secretary Josh Earnest warned against policies that would discourage health care workers who want to help. “We believe that we can both show them the respect that they have earned while also ensuring that we have protocols in place to protect the American people,” he said.

The West Africa crisis represents a unique staffing challenge because, unlike international disasters such as a hurricane, volunteers involved with treating Ebola require specialized skills.

“The need for health care workers will remain until the outbreak is managed,” said Lisa Hibbert-Simpson, spokeswoman for the United States Agency for International Development.

Public health specialists criticized the quarantines imposed by the three states.

“The highest priority if we want to protect Americans is to contain the epidemics in the three West African countries and prevent it from spreading,” said Dr. Barry Bloom, former dean of the Harvard School of Public Health.

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Dr. Georges C. Benjamin, executive director of the American Public Health Association, said quarantine powers should be used thoughtfully and judiciously.

“By creating an overreaction, they’re doing more to create uncertainty and fear than is necessary that I believe will make their jobs more difficult down the line,” Benjamin said.

George Annas, chairman of the Department of Health Law, Bioethics & Human Rights at Boston University’s School of Public Health, said the governors were not responding to public fear but to their own: “They were nervous that if something happened they wouldn’t be seen as doing everything possible. . . . The public is remarkably calm, and always is.”

Draconian requirements such as quarantines can drive sick people into hiding, which is “the worst thing that can happen,” Annas said.

The new CDC guidelines establish four categories of risk.

“High risk” people are defined as those who had direct contact with the bodily fluids of an Ebola patient, such as being stuck with a needle, having splashes into the eyes, nose, or mouth, or living with and caring for a person with disease symptoms.

Such people should undergo “direct active monitoring,” with a public health official observing individuals taking their temperature once a day and checking on the temperature by phone a second time daily. People being monitored also must report any symptoms. Additionally, they should avoid travel by airplane, ship, or long-distance train or bus, and discuss local public transit with health officials.

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People at “some risk” are those who were within 3 feet of a person with Ebola for a long period of time, or who had direct contact with an infected person while wearing personal protective equipment. Such people also need direct active monitoring, but health officials can establish their travel and activity restrictions based on factors such as how long ago the person had contact with someone infected with Ebola. (Although the incubation period is 21 days, 90 percent of infections occur within the first two weeks.)

Low-risk people include those who traveled in a country with widespread Ebola transmission but had no known exposure. These people should have their health monitored but face no restrictions on travel or activities.

Those at “no risk” have had contact with a person with Ebola before the person showed symptoms or traveled to a country with widespread Ebola more than 21 days ago.

Felice J. Freyer can be reached at felice.freyer@globe.com.