New York revises controversial policy on Ebola quarantines amid pressure

New York Gov. Andrew M. Cuomo (D) on Sunday revised a controversial policy to quarantine returning health-care workers from Ebola-stricken nations, under pressure from the Obama administration and medical experts over the aggressive measures.
Elaborating on the procedures, Cuomo said health-care workers who have been in contact with Ebola patients but do not show symptoms of the deadly virus can return to their homes but will be forced to remain there while being monitored by state health officials for symptoms. He said those being monitored can interact with family and friends.
“It’s not like this is the toughest duty,” Cuomo said in a news conference late Sunday with New York City Mayor Bill de Blasio (D).
The change separates the state’s quarantine process from that of New Jersey, which has come under scrutiny after the weekend retention of a nurse who showed no symptoms of Ebola. Kaci Hickox, who returned from Sierra Leone after working with Doctors Without Borders, has been held in isolation at a site attached to a New Jersey hospital.
On Sunday, Hickox told CNN’s Candy Crowley on “State of the Union”: “This is an extreme that is really unacceptable, and I feel like my basic human rights have been violated.”
Cuomo said New York’s new policy is more in line with those of the Centers for Disease Control and Prevention. He said people who are quarantined in their homes will be able to interact with family members while health officials come unannounced twice a day to monitor their health.
The fast-moving changes by the state come after a top federal health official and medical experts earlier Sunday sharply criticized New York and New Jersey’s mandatory quarantines of aid workers returning from Ebola-stricken nations, saying the strict mandates could hamper overall efforts to combat the deadly virus at its epicenters.
The conflicting interests of federal and state officials highlight a conundrum for the United States as it takes a leading role in fighting the contagion of Ebola in West Africa while also trying to calm rising anxieties about the potential spread of the disease at home.
Cuomo insisted the state would help alleviate any burdens posed by the home-based 21-day quarantine for health-care workers returning from West Africa. If a person loses pay because of workdays missed, the governor said, he or she will be compensated and state officials will talk to employers if necessary.

If a person arrives with no symptoms and had no direct contact with Ebola patients, there will be no home confinement.

“My personal preference is to err on the side of caution,” Cuomo said, saying he and de Blasio will urge New York medical experts to encourage hospital staff to volunteer in Ebola efforts in West Africa. “I understand that some people believe the 21-day home quarantine is a burden. I would ask for their cooperation and understanding and remember what we are trying to balance.”

The Obama administration said Sunday that it had expressed concerns to Cuomo and Christie about the “unintended consequences” of the quarantines and how they could deter volunteers from deploying to West Africa, where the spread of Ebola continues to rage.
“We have let the governors of New York, New Jersey and other states know that we have concerns with the unintended consequences . . . policies not grounded in science may have on efforts to combat Ebola at its source in West Africa,” said a senior administration official, who spoke on the condition of anonymity to comment on the private discussions.
On several Sunday news talk shows, Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases, strongly objected to the quarantine policies. He said sending American volunteers to countries such as Liberia, Guinea and Sierra Leone is vital to efforts to contain the virus there, and he warned that stringent isolation policies for the aid workers upon their return would hamper the global fight against Ebola.
“The best way to protect us is to stop the epidemic in Africa, and we need those health-care workers, so we do not want to put them in a position where it makes it very, very uncomfortable for them to even volunteer to go,” Fauci said on “Fox News Sunday.”

He recommended voluntary monitoring, not isolation, for returning health-care workers, stressing that Ebola cannot be spread unless symptoms appear.

The White House plans to announce guidelines for returning health-care workers to help prevent imported cases of Ebola while encouraging volunteers to combat the disease abroad, the administration official said, adding that the White House would consult with states on new federal policies.

On Sunday, President Obama convened his top health and security advisers and directed them to create policies that would help mitigate the risk of additional Ebola cases in the United States. The meeting included Defense Secretary Chuck Hagel, Secretary of State John F. Kerry, and Health and Human Services Secretary Sylvia Mathews Burwell, who advised the president on considerations for new measures for returning health-care workers.

“The President underscored that the steps we take must be guided by the best medical science, as informed by our most knowledgeable public health experts,” said a White House statement. “He also emphasized that these measures must recognize that healthcare workers are an indispensable element of our effort to lead the international community to contain and ultimately end this outbreak at its source, and should be crafted so as not to unnecessarily discourage those workers from serving.”
Christie and Cuomo argued Sunday that the potential threat of spreading the disease was too great to leave to self-monitoring by returning aid workers. Already, hundreds of volunteers have deployed and hundreds more American health-care workers, military service members and humanitarian workers are expected to join them in coming weeks.
“I don’t believe when you’re dealing with something as serious as this that we can count on a voluntary system,” Christie said on “Fox News Sunday.” “The government’s job is to protect [the] safety and health of our citizens. And so we’ve taken this action, and I absolutely have no second thoughts about it.”
Christie’s office on Sunday responded to Cuomo’s actions, saying New Jersey’s procedure also included in-home quarantine for residents of the state. Non-residents, however, would be transferred to their homes if possible or contained in a local hospital if necessary, a spokesman said. The new details of both state plans still left questions about how the quarantine procedures would be implemented and whether they would be effective.
Christie and Cuomo announced their quarantine orders Friday after aid worker Craig Spencer was diagnosed with the virus earlier in the week. Spencer is being treated in isolation at Bellevue Hospital Center in Manhattan. Ram Raju, a Bellevue doctor, said in a news conference Sunday afternoon with de Blasio that Spencer is “looking a little bit better than he looked yesterday. But he remains in serious but stable condition with the expected symptoms of the virus.”
The governors of Illinois and Florida followed New York and New Jersey with stronger mandates to monitor airline passengers returning from West Africa.
Florida Gov. Rick Scott (R) on Saturday ordered that any travelers returning from Guinea, Liberia and Sierra Leone must get twice-daily health evaluations by state health officials for 21 days. There has not been a case of Ebola in Florida. Scott said the policy was put into place out of frustration that the Centers for Disease Control and Prevention had not provided risk assessments for four people who had entered the state from the Ebola-stricken nations. The measures go beyond federal guidelines and the recommendations of infectious-disease experts.
The states’ policies have drawn criticism from infectious-disease experts and humanitarian organizations.

“These are the real heroes, and we want to do everything we can to support them, not isolate and deter them,” said Lawrence Gostin, a professor of global health law at Georgetown University and the director of the World Health Organization’s center on public-health law. “The public and politicians understand that you need to attack terrorism at its source, but somehow they fail to understand that is equally and probably more true with infectious diseases.”
Medical experts complain that the responses of New Jersey and New York are not grounded in science. Ebola can be spread only through contact with bodily fluids and only once symptoms appear. So the best way to ensure that returning health-care workers do not carry the virus is to monitor them for symptoms, they say.
Health officials will conduct the twice-daily evaluations in subjects’ homes and can put into quarantine anyone they determine to be “high-risk,” said Frank Collins, a spokesman for the governor’s office.
The White House has tried to quell anxieties about the danger of Ebola spreading in the United States. In his weekly address to the nation, Obama stressed that only a handful of people have been diagnosed with the virus in this country.
“We have to keep leading the global response,” Obama said. “We have to be guided by science, guided by facts, not by fear.”
Juliet Eilperin contributed to this report.