As federal and state authorities continue to disagree over Ebola quarantine protocols for travelers returning to the United States from West Africa and for healthcare workers exposed to the disease inside U.S. borders, certain states have implemented controversial quarantine protocols that are gaining the attention of the public.
The Centers for Disease Control and Prevention updated its guidelines for healthcare workers returning to the U.S. from West Africa, which are markedly less strict than the quarantine protocols of the states that have devised their own rules. According to the Wall Street Journal, the CDC's guidelines recommend that people at high risk of developing Ebola voluntarily isolate themselves from others for 21 days. These individuals would also be banned from flying and would undergo 'direct active monitoring' by a public health worker who would check their temperature twice a day and keep an eye out for potential symptoms.
The following list describes Ebola quarantine protocols for individual states that have implemented guidelines that deviate from the CDC's recommendation.
New York's Governor Andrew Cuomo (D) issued new guidelines for a three-week mandatory home quarantine that will affect travelers returning to New York from West Africa, according to a recent Bloomberg report.
Gov. Cuomo's initial announcement of mandatory hospital quarantine for healthcare workers returning to New York from Ebola-stricken countries was redacted after receiving pressure and criticism from the White House, medical experts and the public, deciding on mandatory home quarantines instead.
The New York guidelines require anyone who was in the presence of an infected person to be quarantined, even if they were wearing protective gear, according to the report.
New Jersey Governor Chris Christie (R) made similar amendments to his state's quarantine guidelines, according to a recent article in the New York Times. After Gov. Cuomo announced changes to quarantine guidelines in New York, Gov. Christie announced new protocols in which New Jersey residents not displaying symptoms would also be allowed to be quarantined in their homes.
Gov. Christie's initial Ebola quarantine protocol, which required healthcare workers returning from West Africa to be quarantined in hospitals, faced fierce resistance from the White House and medical experts for being too strict and for possibly discouraging healthcare workers from offering aid in the West African countries stricken by the disease, according to the NYT article.
Kaci Hickox, the first nurse to return to New Jersey after working with Doctors Without Borders in Sierra Leone, was quarantined in a hospital tent for three days before she was allowed to return to her home in Maine. Ms. Hickox's opposition of her quarantine conditions made her an example of government overreach to many, though Mr. Christie was unapologetic about her situation, defending he was doing what he thought would keep New Jersey safe from the potential spread of the disease, according to the article.
Maine's Governor Paul LePage (R) set guidelines that order all healthcare workers who treated Ebola patients in West Africa to be quarantined in their homes for 21 days after the last possible exposure to the virus, according to a recent report.
Ms. Hickox continued to make the news through her adamant efforts to defy Maine's Ebola protocol. After publically stating she would not abide the state's 21-day home quarantine, on Oct. 29 Mr. LePage ordered state police vehicles to be stationed outside her home to help enforce the quarantine according to a recent report. Ms. Hickox has maintained that she is asymptomatic and believes the quarantine orders enforced upon her were unconstitutional and infringed on her liberty, according to the report.
On Oct. 31, Ms. Hickox officially won the right to go outside after District Court Chief Judge Charles LaVerdiere ruled that she could leave her home and could not be barred from any public places, according to CNN. Judge LaVerdiere ordered Ms. Hickox to submit to "direct active monitoring," coordinate travel with public health officials and immediately notify health authorities if any Ebola symptoms appear.
Connecticut's Governor Dannel P. Malloy (D) and Public Health Commissioner Jewel Mullen, MD, set the state's Ebola quarantine guidelines to affect all people coming to the state after traveling to Liberia, Sierra Leone and Guinea. Travelers entering Connecticut from these countries will face 21 days of mandatory monitoring involving contact with state health officials on a daily basis, according to a recent report.
Gov. Malloy stated health officials' plans to interview every person entering Connecticut from the above-mentioned West African countries and, based on those interviews, determine if mandatory quarantine should be ordered. Each individual will be evaluated based on a detailed analysis of his or her symptoms and background, according to the report.
California State Health Officer and California Department of Public Health Director Ron Chapman, MD, issued a quarantine order and associated guidelines that require counties to individually screen and assess travelers arriving to the state from Sierra Leone, Liberia and Guinea, or healthcare workers who have treated infected patients, to determine if they are at risk for the virus and if they should be quarantined for the virus' three-week incubation period, according to a report issued by the California Department of Public Health.
According to the report, individuals will be subject to a 21-day quarantine if they are have both traveled to California from regions afflicted by Ebola and have had contact with someone who has a confirmed case of Ebola. Passengers arriving in California from these West African countries but have not come into contact with a person infected with the disease will not be subject to quarantine, according to the guidelines. Quarantine orders will be applied on a case-by-case basis.
Illinois Governor Pat Quinn (D) issued mandatory 21-day home quarantine for individuals at "high-risk" for having the Ebola virus and to be subject to daily checkups, according to a recent report. Under the federal definition, people at high-risk are those who have had direct unprotected contact with an Ebola patient or their bodily fluids. In comparison, the Obama administration recommends voluntary home quarantine for these individuals.
According to the report, Illinois officials clarified that the Ebola quarantine guidelines do not include medical workers who wore appropriate protective clothing when in contact with Ebola patients unless they had a breach, which would initiate further assessment. Additionally, Gov. Quinn's guidelines permit visitors to the homes of individuals in quarantine.
Ohio travelers returning to the state from West Africa are now subject to stricter monitoring and quarantine protocol, according to a recent report on new guidelines by the Ohio Department of Health.
Travelers returning to Ohio from Guinea, Liberia or Sierra Leone within the past three weeks but have not had any contact with Ebola patients will be subject to direct monitoring, prohibited from traveling and banned from public spaces, according to the report. Travelers who provided healthcare services to Ebola patients in those countries will be subject to home or other quarantine, regardless of whether they are presenting symptoms of the virus.
Virginia Governor Terry McAuliffe (D) announced a monitoring program for all travelers arriving from Guinea, Liberia and Sierra Leone, which could result in quarantine if determined necessary. Under these guidelines, screeners at airports of entry will record the names and contact information for all travelers arriving from these Ebola-affected areas and provide them with information and phone numbers for 24-hour assistance. All travelers will be required to take their temperature twice a day, and local health districts will coordinate daily contact with the travelers for the 21 day incubation period.
Should a traveler develop concerning symptoms, he or she may be asked to stay inside their home for the remainder of the 21 days with close monitoring, even if the initial medical evaluation is negative for Ebola.
Virginia's guidelines include special provisions for healthcare workings returning to the state after treating Ebola patients. All healthcare workers are required to sign agreements for restrictions in activity, acknowledging that the state will check on compliance and reserves the right to issue a quarantine order if determined necessary.
Maryland Governor Martin O'Malley (D) set the Ebola protocol to allow the state to directly monitor the health of all returning travelers from Liberia, Sierra Leone and Guinea. Like in Virginia, screeners at the airport will collect travelers' contact information and the state will coordinate daily contact with the travelers for 21 days, according to a report issued by the governor's office.
Special provisions mandate that healthcare workers who had contact with Ebola patients will be subject to varied levels of monitoring and restrictions based on their level of risk. Individuals at high risk with known exposure to Ebola will be subject to home quarantine for 21 days after entering Maryland. Those individuals who are at "some risk," or who wore personal protective equipment during care for Ebola patients, will be instructed to avoid mass gatherings and using public transportation. They will also be closely monitored by state and local health officials.
Georgia Governor Nathan Deal (R) added measures to the state's policy for monitoring travelers returning from West Africa that go beyond those that the CDC recommends, according to a recent article in The Guardian. Under Georgia's Ebola protocol, passengers entering Georgia from Ebola-afflicted regions are placed in a quarantine station where officials check their temperature and for signs of symptoms. If symptoms are present, the traveler will be immediately isolated and transferred to a designated hospital for further evaluation.
Travelers who don't present any symptoms are labeled either high-risk, low-risk or medical personnel. High-risk travelers will be subject to 21-day quarantine at a designated isolation facility. Low-risk travelers with no known exposure to the disease must report their temperature and any sign of symptoms to a public health official once a day, and those who don't comply with these orders can be issued with a mandatory quarantine order.
Healthcare workers who treated Ebola patients will be monitored every day for 21 days by health officials.
Florida's Governor Rick Scott (R) signed an executive order mandating twice-daily health monitoring by state health officials for people entering the state from Liberia, Sierra Leone and Guinea for 21 days, regardless of whether or not they show symptoms, according to the article in The Guardian. Each traveler will be assessed for risk upon their arrival.
Gov. Scott reportedly signed the order after the CDC failed to respond to a request for more information on the risk levels posed by travelers returning from West Africa.