Ebola Muddle: CDC, States Alter Quarantine Policies

Ebola Muddle: CDC, States Alter Quarantine Policies

By Alexis Simendinger - October 28, 2014

Ebola quarantine policies in the states became a confused test of gubernatorial leadership, political grandstanding and states’ rights after President Obama and his advisers tripped into yet another phase of America’s infection of fear.

On Monday, the jostling among governors to respond (and then amend) policies to handle isolation and quarantine of people entering their states after traveling from West Africa was only slightly more confused than the newest (amended) guidelines issued by the Centers for Disease Control and Prevention.

The CDC revisions issued Monday, which the agency’s director, Dr. Thomas Frieden, conceded were adaptations made after weekend events in New York and New Jersey, were conveyed “in active discussions with other states,” he told reporters.

Without federalizing Ebola response and policies, or sorting out the human, legal and public relations ramifications of quarantine in all 50 states, the Obama administration can offer guidance but cannot compel state and local politicians to heed the advice.

The jurisdictional tangles continued on full display after the CDC championed “revised interim guidance” Monday for four levels of risk measured against Ebola exposure, each of which is paired with recommended health monitoring labeled “active” or “direct active monitoring rather than having people monitor themselves.” Hospital isolation is not recommended unless a person develops symptoms of infection.

Asked if the president’s new Ebola response coordinator, Ron Klain, or Obama talked to New York Gov. Andrew Cuomo or New Jersey Gov. Chris Christie before or after their joint news conference Friday, White House Press Secretary Josh Earnest declined to answer. Last week, in contrast, Obama volunteered that he’d spoken with Texas Gov. Rick Perry and Ohio Gov. John Kasich to offer federal assistance for Ebola monitoring in their respective states.

Late Friday, Cuomo and Christie ordered all returning health care workers from West Africa to be quarantined for 21 days in hospitals in their respective states, arguing that as governors they had a duty to leap over CDC recommendations in order to keep their citizens safe. But by Monday, they backed down (although Christie denied he’d budged an inch).

Nurse Kaci Hickox, forced into quarantine last week in a New Jersey hospital without any symptoms of Ebola, was released by state officials after complaining that her “basic human rights” were being violated. As an epidemiologist, she helped care for Ebola patients in Sierra Leone, but showed no signs of infection in transit or in New Jersey, and complained to media outlets and through her attorney that she was confined like a criminal by overzealous politicians.

While in Florida to campaign for Florida Gov. Rick Scott, Christie defended the New Jersey policy, arguing that Hickox’s outrage was not as important as the health of his constituents.

"I know she didn't want to be there. No one ever wants to be in the hospital, I suspect, and so I understand that," he told reporters. "But the fact is I have a much greater, bigger responsibility to the people and the public, and so I think when she has time to reflect, she will understand that as well."

Christie, in effect, released Hickox to the medical supervision of Maine, where she lives, and in the process handed a public relations mess to fellow Republican Gov. Paul LePage, who is this week trying to retain his job in a close contest with Democratic challenger Rep. Mike Michaud. With Election Day nearing, quarantine policy suddenly became a hotter topic politically.

Obama, as it happens, will campaign this week for Democratic candidates in select governors’ races, including in Maine, Wisconsin, Michigan and Pennsylvania. The president will rally for Michaud in Portland on Thursday.

The CDC’s clarified policy appears most relevant in states where health care workers who depart West Africa fly into the United States (New York, New Jersey, Georgia, Illinois, and Virginia), and in a few additional states into which most such workers migrate after arriving (described by the CDC to include Maryland and Pennsylvania).

The president will campaign in Philadelphia on Sunday for Democrat Tom Wolf, who is seeking to defeat Pennsylvania Gov. Tom Corbett.

In Georgia, Republican Gov. Nathan Deal recently stumbled over the Ebola issue, suggesting in a re-election debate that the virus is transmitted in water, an assertion infectious disease experts deny. On Monday, Deal issued a new quarantine policy that appeared more restrictive than the new CDC guidance, ordering that any person traveling into his state who has had direct contact with a patient treated for Ebola will be “subject to quarantine at a designated facility.”

Hickox, for example, had direct contact with Ebola patients, but now will be monitored by health professionals while at home for the duration of the virus’s three-week incubation period.

Illinois Gov. Pat Quinn, for whom Obama has energetically raised money, also appeared to get caught up in the quarantine swoon, issuing restrictions on Friday that said any Ebola health care worker would face mandatory 21-day home confinement. On Monday, Quinn and state health officials sought to clarify their initial policy, eliminating compulsory home quarantine for health workers who wore personal protective equipment while treating Ebola patients.

Matching the states’ achievements in creating quarantine quandaries was the Pentagon.

The military over the weekend quarantined the commander of U.S. Army Africa and 10 other personnel, who were in transit from West Africa and are now under “controlled monitoring” in Italy for three weeks to ensure they aren’t infected with Ebola. None was sick upon arrival.

White House spokesman Earnest, asked to untangle the military muddle, said, “If it wasn’t clear before, it is now that I’ve helped make it clear, that the Department of Defense policy has not been settled and implemented yet.”

Alexis Simendinger covers the White House for RealClearPolitics. She can be reached at Follow her on Twitter @ASimendinger.

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