Federal and state agencies are butting heads over the appropriateness, and effectiveness, of mandatory quarantines for travelers returning from West Africa.
Last week, New York and New Jersey implemented mandatory 21-day quarantines for medical workers returning from those countries hardest hit by the Ebola epidemic. Other states, including Connecticut, Illinois, Virginia and Maryland, have also implemented varying degrees of quarantine requirements.
After receiving criticism from the White House and the public, New York revised its mandatory quarantine policy to allow returning medical workers to remain at home instead.
New York's new quarantine protocols are now aligned with the less stringent recommendations produced by the Centers for Disease Control and Prevention, which call for voluntary home quarantine for those at the highest risk of contracting Ebola. Those deemed to be at a lower risk require daily monitoring but no isolation, per the CDC's suggestions.
New Jersey, however, is not budging. New Jersey Gov. Chris Christie remains adamant about his state's mandatory quarantine policy, saying he will not change it. "We aren't moving an inch," he said on the Today show Tuesday morning. "Governors ultimately have the responsibility to protect people in their borders."
Much of the backlash in New Jersey stemmed from a nurse, Kaci Hickox, who was required to stay in mandatory quarantine upon returning from West Africa with Doctors Without Borders, despite testing negative for the virus. Ms. Hickox claimed being held in mandatory isolation despite not having the virus was a violation of her human rights. She was released to her home in Maine, and a Wall Street Journal report indicates she has agreed to stay in her home and not go into large public spaces. Ms. Hickox's lawyer is not calling this a quarantine, but Maine officials said they will monitor her daily for 21 days after her initial potential exposure, according to the report.
The discussion regarding mandatory quarantines was ignited when it was discovered the New York City physician who was recently diagnosed with Ebola had spent considerable time in public before reporting a fever and gastrointestinal symptoms.
A CNN timeline of his activities upon returning to the United States after volunteering in Guinea indicates he arrived to New York City Oct. 17, started feeling "fatigued" last Tuesday and placed himself in voluntary isolation and reported symptoms last Thursday. Between Tuesday and Thursday, the physician, Craig Spencer, had visited a coffee shop, a restaurant, a bowling alley and rode three subway lines.
Senior officials have expressed concern that the mandatory quarantines would deter people from traveling to West Africa. "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 that they're doing, a couple of things may happen that none of us want to happen," said Thomas Frieden, director of the CDC, such as health workers not disclosing if they have come in contact with Ebola patients.
However, Gov. Andrew Cuomo (D-N.Y.) said the CDC's recommendations are a "minimum policy," adding, "New York…is different than a lot of other places in the country, and I want to make sure that we have the appropriately safe policy, and that's what this is," according to a different Wall Street Journal report.
The newly sprung debate regarding the quarantines is a highly political one: Does the federal government have the authority to implement a nationwide standard or does that power lie in the hands of the states?
White House Press Secretary Josh Earnest said the federalist nature of this country leaves it up to states to decide, according to a Politico report. "We have a federal system in this country in which states are given significant authority for governing their constituents. That is certainly true when it comes to public safety and public health."
Dr. Frieden echoed those thoughts in a media address, saying, "If [states] wish to be more stringent than the CDC recommends, that's within their authority in the system of government we have."
However, legal experts suggest that the federal government does indeed hold this type of power and authority. James Hodge, law professor at Arizona State University in Phoenix, said the CDC has "clear authority" to "systematically engage in quarantine in key situations," according to the Politico report.
According to the CDC's website, the Commerce Clause of the U.S. Constitution indicates the federal government has the authority to isolate and quarantine people for certain communicable diseases. Additionally, the Public Health Service Act, enacted in 1944, authorizes HHS to "make and enforce such regulations as in his judgment are necessary to prevent the introduction, transmission or spread of communicable diseases from…one State or possession into any other State or possession."
More articles on Ebola:
Ebola quarantine controversy: Healthcare professionals weigh in
CDC: What to consider when evaluating a patient for Ebola exposure
Top 10 areas hospitals need extra help in handling Ebola