Anyone flying into John F. Kennedy or Newark Liberty International Airport after having contact with Ebola-infected patients in one of three West African nations battling an epidemic of the deadly virus will face a mandatory 21-day quarantine, the governors of New York and New Jersey announced Friday.
“We have to do more," New York Gov. Andrew Cuomo said Friday. "It's too serious of a situation to leave it to the honor system of compliance."
The new measures came one day after a doctor who had recently returned from an Ebola assignment in Guinea was diagnosed with the virus in New York City. In addition to the mandatory quarantine for those who came in direct contact with patients in the Ebola-ravaged nations of Liberia, Sierra Leone or Guinea, health officials at those two airports have been authorized to actively monitor and quarantine if necessary anyone with a travel history in that region.
Craig Spencer, a doctor just back from a month-long stint treating Ebola patients for Doctors Without Borders, was admitted into an isolation unit at Bellevue Hospital on Thursday, less than a week after he arrived home. In the days prior to his Ebola diagnosis, he made several outings in the city, including coffee in one of Manhattan’s tourist-packed parks, a stop by a meatball shop and a subway ride to Brooklyn for an evening of bowling with friends.
While Spencer followed the self-monitoring protocols issued by the Centers for Disease Control and Prevention, some experts are now suggesting health workers who return from Ebola-ravaged areas do more to avoid public places.
City officials praised the quick response to his illness and said Spencer, the city's first reported Ebola patient, followed all the proper steps to monitor his health and minimize exposure. But Cuomo and New Jersey Gov. Chris Christie said in retrospect those steps weren't enough.
"New Jersey and New York are going to determine the standards of quarantine since the CDC's guidance is continually changing," Christie said.
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The governor tweeted that a health care worker who arrived at Newark International Airport after treating Ebola patients in West Africa is now under quarantine and has no symptoms.
The Obama administration also is considering quarantining healthcare workers returning to the United States from the Ebola hot zone of West Africa, Reuters reported.
Tom Skinner, a spokesman for the U.S. Centers for Disease Control and Prevention, told Reuters on Friday that quarantine was one option being discussed regarding the monitoring of healthcare workers.
"We want to strike the right balance of doing what is best to protect the public’s health while not impeding whatsoever our ability to combat the epidemic in West Africa,” Skinner said. “Our risk here will not be zero until we stop the epidemic there.”
Some public health experts were already urging added extra caution as more doctors and others potentially exposed to the virus return from the front lines of fighting the outbreak in West Africa. Tighter restrictions on such health care workers could prevent mass hysteria and make the job easier on health detectives in the event of a positive Ebola test, they say.
Dr. Joseph McCormick, a professor at the University of Texas School of Public Health who has cared for Ebola patients, said while putting a large number of people in quarantine because of possible casual interaction “is not warranted,” as the virus can only be spread by contact with the bodily fluids of person with symptoms, some situations may merit more prudence.
“I would say that for somebody like a health provider like the physician who clearly was in direct contact with patients, I’m not sure that total quarantine is needed but I think a more cautious approach to traveling around the city probably would be warranted,” McCormick, a former Centers for Disease Control and Prevention official who investigated the first Ebola epidemic, said. “We all have to balance our messages here.”
The safeguards followed by Spencer, recommended by the CDC and Doctors Without Borders, included taking his temperature twice daily, watching for fever and other symptoms during the virus’ 21-day incubation period. Living in New York, he was well within the recommended 4-hour radius of a hospital with isolation facilities. When his temperature hit 100.3 degrees Thursday morning, he called health officials and was quickly moved to Bellevue Hospital.
Still, at least one other relief group operating in West Africa has gone beyond the CDC recommendations in light of the heightened public concern following the infection of two nurses treating an Ebola patient at a Dallas hospital, including one who took flights to and from Ohio while she was self-monitoring for signs of the virus.
Samaritan’s Purse is mandating that employees who return from its efforts in Liberia undergo a “self-imposed, no-touch self sequestration” for 21 days that limits even physical contact with family members, according to Kendell Kauffeldt, the Christian international relief organization’s longtime country director in Liberia. Employees of the organization, which made headlines after its own Dr. Kent Brantly survived an infection, are also required to take their temperature four times a day, with the trigger for alerting officials set one degree lower than the CDC's level. They require returning staff, including three who are currently in the incubation period, stay within 90 minutes of an isolation facility for those three weeks.
Kauffeldt, who lived in Liberia for 10 years before returning to the United States with his family in August, stressed that Spencer took all the required steps and the potential of “anyone else becoming infected is almost zero because he followed the protocol.” He said the added precautions enacted for his own colleagues were simply meant to go even farther to ensure general public health, the safety of their employees and peace of mind.
“It was really just in reaction to the situations in Dallas and just recognizing that there is a level of uninformed fear, but we still as an organization have a responsibility to the general public to ensure we were doing everything possible for their safety and their health,’ he said.
The protocols for monitoring and protecting those workers will likely remain in the spotlight, as more are deployed to fight an outbreak that has sickened more than 10,000 since March. Demand for doctors is still high, and thousands have volunteered through an online portal USAID set up in early September to match qualified applicants with aid organizations.
Doctors, nurses and other medical aides are considered at the highest risk for contracting the virus because they deal with bodily fluids from the sickest of patients and the World Health Organization says an “unprecedented” number have been infected in this outbreak. In all, more than 440 health care workers have contracted Ebola and 244 have died as of Oct. 19, the WHO says. Six other American health workers — four who worked in Africa and two from a Dallas hospital that treated a patient from Liberia — contracted Ebola and recovered after receiving treatment in the U.S.
Both New York City Health Commissioner Mary Bassett and National Institute of Health’s Anthony Fauci, who cared for one of the Dallas nurses, suggested Friday that the federal guidelines for monitoring are the subject of active discussion.
Eden Wells, clinical associate professor of epidemiology and director of the Preventive Medicine Residency at the University of Michigan’s School of Public Health, said she would personally restrict her movements if she were returning from West Africa or had been caring for someone with Ebola. She stressed she did was not criticizing Spencer, who she noted followed the current protocols.
She’d take the more cautious approach “not only just to reassure the public but it is also to aid public health epidemiologist disease detective, because the more contact that’s out there that has to be investigated because someone did leave the home really taxes the system.”
“Whether they’re sick or not sick what happens is any time a case like this happens there’s an incredible amount of resources undertaken to do the investigation to reassure everyone that there’s not then another case as a result of a contact,” she said.
Doctors Without Borders, which did not return multiple interview requests, said in a statement Friday that it will investigate how Spencer contracted the virus. But it acknowledged that even with its “Extremely strict procedures “ for staff, the “risk cannot be completely eliminated.”
"Tragically, as we struggle to bring the Ebola outbreak in West Africa under control, some members of our staff have not been spared," Executive Director Sophie Delaunay said in a statement."Our thoughts are with our colleague in his own struggle right now, and we sincerely hope for his quick and full recovery."