Christie Defends Forced Quarantines While Cuomo Backs Down on Harsh Stance

Andrew Kitchenman | October 27, 2014 | Health Care
White House reportedly pressures NJ and NY governors to reconsider measures to block spread of Ebola virus

Credit: Governor's Office
Gov. Chris Christie at Sunday's press conference on New Jersey's Ebola policy.
Gov. Chris Christie continued yesterday to stand by his decision to involuntarily quarantine anyone who has had direct contact with Ebola patients if they arrive at Newark Liberty International Airport, even if they have shown no signs of infection.

If anything, Christie, who was out of New Jersey while campaigning for a GOP candidate in Florida, appeared to be digging in his heels.

“New Jersey is not changing its quarantine protocol,” according to Kevin Roberts, a spokesman for the governor’s office.

“The protocol is clear that a New Jersey resident with no symptoms, but who has come into contact with someone with Ebola, such as a health care provider, would be subject to a mandatory quarantine order and quarantined at home,” he continued.

Roberts indicated that “[n]on-residents would be transported to their homes if feasible and, if not, quarantined in New Jersey.”

Federal officials, however, have resisted mandatory detentions, and most health experts say they are unnecessary and excessive.

The New York Times reported yesterday that federal officials have asked the governors of New Jersey and New York to reconsider their positions. New York Gov. Andrew Cuomo, who had ordered similar mandatory quarantine guidelines, said Sunday evening that he would ease those tough requirements. . In response to reporters’ questions on Sunday, Christie said he had not heard from the White House.

State health officials said on Monday that healthcare worker Kaci Hickox, who was being held in quarantine in a tent located outside University Hospital in Newark, would be transported to Maine, where she lives.

Hickox described her treatment after arriving at the airport as inhumane. She was detained in Newark after returning from West Africa — even though she had exhibited no signs of being infected with the Ebola virus.

Hickox said she had hired a civil-rights lawyer to fight for her release.

Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said on CBS’s “Face the Nation” earlier Sunday that federal officials were concerned that such quarantine policies would discourage volunteers who are needed in Liberia, Sierra Leone and Guinea.

“The best way to protect Americans is to stop the epidemic in Africa and we need those healthcare workers to do that,” he said. “And so to put them in a position when they come back that — no matter what — they’re under quarantine, can actually have unintended consequences.”

Christie said in announcing the quarantine that New Jersey would do whatever is necessary to protect the public health. He said on Fox News Sunday that he thought a voluntary quarantine was insufficient, citing the recent case in Princeton in which members of an NBC News crew violated a voluntary quarantine, going out in public to pick up a restaurant takeout order.

Christie said earlier Sunday that he had “no second thoughts” about his decision even after hearing Fauci’s concerns.

Hickox was forcibly detained at the airport and put in isolation at the hospital, even though she hasn’t exhibited symptoms of the disease, which is thought to be contagious only after symptoms appear. A forehead scanner initially indicated that Hickox had a high temperature, but a later, more accurate measurement using an oral thermometer showed a normal temperature.

She said yesterday that she even lacked access to a flushable toilet or a shower.

“It (her quarantine) is not based on any clear public health evidence and it’s not the recommendation of public health and medical experts at this point,” she said in an interview with CNN’s Candy Crowley. “You know, I think we have to be very careful about letting politicians make medical and public-health decisions.”

State Department of Health spokeswoman Donna Leusner said in a statement that Hickox had computer and cell-phone access, and had received take-out food and drink.

“Our primary concern is ensuring the health of the patient and the public,” said Leusner.

Fauci said self-monitoring is effective. He said policymakers should keep in mind that – despite public fears to the contrary – unlike the flu, Ebola isn’t spread through airborne droplets.

“Be careful and make sure that what your decisions and policy are based on scientific data and scientific evaluation,” Fauci said, adding: “Right now we have a devastating epidemic in West Africa and we’re having an epidemic of fear in the United States, so we’ve got to continue to try and educate people about what they need to or do not need to be afraid of.”

In addition, the Society for Healthcare Epidemiology of America said it opposedopposed the mandatory quarantine for people who don’t have symptoms of the disease, citing the same scientific evidence that these people can’t spread the virus.

Not all public health experts disagreed with a mandatory quarantine – although some said such detentions need not be at a hospital. Dr. Pascal Imperato, dean of the SUNY Downstate Medical Center School of Public Health in New York, said he would like to see home-based quarantines in which the person could have contact with a limited number of family members.

“I don’t believe they need to be institutionalized,” he said. “The goal here is to minimize their contacts with large numbers of people over that 21-day period and keep them in active monitoring.”

He said that wouldn’t be significantly different than Doctors Without Borders’ guidelines, which suggest that returning volunteers stay out of work for three weeks. He noted that another volunteer group — Samaritan’s Purse — already enforces a 21-day isolation period for its volunteers.

Imperato, who worked in West Africa for six years, noted that there are no national rules in place for volunteers returning from the affected region, including when they should return to work. For example, he raised the possibility of an intensive-care-unit doctor quickly returning to work without mandatory quarantine rules in place.

Public fears increased after the recent Ebola infections of two nurses who helped treat Thomas Eric Duncan, who died from Ebola at their hospital in Dallas, even though the nurses had followed protective measures recommended by the CDC.

The CDC has since revised its protocols, so that healthcare workers must now have all of their skin covered when treating Ebola patients.

The public was again unnerved last week after Dr. Craig Spencer, a returning healthcare worker, was hospitalized for Ebola a day after he rode the New York City subway and went bowling in Brooklyn.

Spencer did not have a fever until the day he was hospitalized, although he reportedly had said that he was feeling not quite right.

Imperato said Spencer correctly followed the guidelines of Doctors Without Borders – the organization with which he volunteered – but that those guidelines should be stricter. Instead of relying on whether the person has a fever to determine whether to contact medical professionals, people who fear they may be infected should call as soon as they feel “a bit sick.”

However, Imperato acknowledged that based on current evidence, it’s unlikely Spencer could have transmitted Ebola either the day before or on the day he sought medical care.

Dr. Albert Wu, an infectious disease expert at the Johns Hopkins Bloomberg School of Public Health in Baltimore, said there was a misperception that Spencer acted irresponsibly. “In my opinion, he acted very responsibly,” seeking medical care as soon as he had a fever, Wu said.

Wu expressed skepticism that any healthcare workers who volunteer in West Africa would recklessly fail to report symptoms.

“In general, this is a group of people who are very dedicated to the public health,” Wu said.

Wu suggested that the best way to reduce New Jerseyans’ risk of Ebola infection would be to support organizations that are treating Ebola patients in Africa, such as Doctors Without Borders.

“Really, if you’re freaked out by Ebola, I think the most effective thing you can do is donate money,” he said.

American Civil Liberties Union of New Jersey executive director Udi Ofer said in a statement that the quarantine of people without Ebola symptoms raised constitutional questions about the state abusing its power.

“By forcibly detaining people we are also frightening the public and may deter genuinely sick people who fear quarantine from seeking the treatments they deserve, while also discouraging caregivers and first responders from helping sick patients who need their assistance,” Ofer said.