New York, New Jersey Order Quarantine For Arrivals From Ebola Stricken Nations

A surprise move from Governors Christie and Cuomo that sounds like a good idea but may not be as effective, or legal, as it sounds.

Ebola Virus And Caduceus

The Governors of New York and New Jersey have both imposed a quarantine policy that would require any person who has been to one of the nations in west Africa that has been stricken with Ebola, and been in contact with someone who has the disease, to be quarantined in a hospital:

The governors of New York and New Jersey on Friday ordered quarantines for all people entering the country through two area airports if they had direct contact with Ebola patients in Guinea, Liberia and Sierra Leone.

The announcement signaled an immediate shift in mood, since public officials had gone to great lengths to ease public anxiety after a New York City doctor received a diagnosis of Ebola on Thursday.

A few hours later, New Jersey health officials said a nurse who had recently worked with Ebola patients in Africa and landed in Newark on Friday had developed a fever and was being placed in isolation at a hospital. The nurse, who was not identified, had been quarantined earlier in the day under the new policy, even before she had symptoms. Officials did not know Friday night whether or not she had the virus.

The new measures go beyond what federal guidelines require and what infectious disease experts recommend. They were also taken without consulting the city’s health department, according to a senior city official.

But both governors, Andrew M. Cuomo of New York and Chris Christie of New Jersey, portrayed them as a necessary step. “A voluntary Ebola quarantine is not enough,” Mr. Cuomo said. “This is too serious a public health situation.”

In New York City, disease investigators continued their search for anyone who had come into contact with the city’s first Ebola patient, Dr. Craig Spencer, since Tuesday morning. Three people who had contact with Dr. Spencer, 33, have been quarantined, and investigators have compiled a detailed accounting of his movements in the days before he was placed in isolation at Bellevue Hospital Center on Thursday.

He remained in stable condition on Friday, and doctors were discussing the use of various experimental treatments. He was able to talk on his cellphone and was even well enough to do yoga in his room, according to friends.

The new protocols at the airports, outlined by the governors in an afternoon news conference, raised a host of questions, including how the screening process would work and whom it would target. The two airports in question are Kennedy International and Newark.

Officials from New York and New Jersey said they were still working out many details, including where people would be quarantined, how the quarantine would be enforced and how they would handle travelers who do not live in either of those states.

The mandatory quarantine for nonsymptomatic travelers will last 21 days, the longest documented period it has taken for an infected person to show symptoms of the disease.

On Friday, the White House sidestepped questions about whether a nationwide quarantine of returning health care workers was being considered. Instead, officials defended the procedures the administration has put in place, including enhanced airport screenings and the monitoring of people arriving from Ebola-afflicted countries.

(…)

Mr. Christie, a Republican, said he and Mr. Cuomo, a Democrat, had decided to take action because the federal guidelines were not strict enough. “We are no longer relying on C.D.C. standards,” he said, referring to the federal Centers for Disease Control and Prevention.

The C.D.C., in a terse statement, said that it would make its decisions based on the best available science but that the states were within their legal rights to institute the measures.

This policy announcement was prompted, quite obviously, by the announcement Thursday that Craig Spencer, a New York City physician who had returned earlier this month from a stint in Guinea volunteering with Doctors Without Borders and working with people infected with the Ebola virus, had himself become infected with the virus. While reports indicate that Spencer had been following the protocols established by the group upon his return — including monitoring his temperature at least twice a day — and that he apparently didn’t begin to exhibit symptoms until Thursday morning, which he promptly reported and set in motion the events that led to his isolation at Bellevue Hospital, that has led to many complaints that further steps should be taken. One of the obvious steps, of course, would be to quarantine everyone coming into the area from the Ebola stricken countries who did or could have contact with someone who has Ebola and monitor them for the twenty-one day incubation period for signs of any of the symptoms that they might have been infected, and that’s what Christie and Cuomo have done here.

On the surface, I suppose, the idea of a quarantine like this does make some sense on a policy level. As the cases of Dr. Spencer and Timothy Eric Duncan have both shown us, the screening that is done upon departure from west Africa and, under the new policies announced earlier this week by the Federal Government, at the five airports in the United States where all arrivals from the region will be routed regardless of their ultimate destination. In fact, that policy was expanded late in the week when it was announced that these arrivals, while not placed in a strict quarantine, would be monitored by C.D.C. and local health authorities during the twenty-one incubation period for the disease, although they would not be quarantined. In some sense, then, the policy that Christie and Cuomo announced yesterday is simply an expansion of already existing policy, prompted by the case of Dr. Spencer and the rather obvious question of what could have happened if someone with a similar travel history, but who was far less fastidious in reporting his condition to authorities when symptoms began to appear, could end up spreading the disease around a one of the most heavily congested areas in the country without anyone being aware of their condition. In reality, of course, this seems as if this is an overstated fear given the fact that people with Ebola are most contagious when they are displaying symptoms and the such people are generally not going to be in the kind of physical condition that would make it likely that they’d just be walking around a city like New York, but they could potentially pose a risk to friends, family members, and others with whom they might have close contact during the period before they ended up in a hospital. Given that, the motivation for imposing the policy is, at the very least, understandable.

While understandable, though, it strikes me that this policy may prove harder to implement, and potentially less effective, than it seems on the surface. At the top of the list, of course, is the question of how and where the people who might be subject to this policy are going to be quarantined. The New York/New Jersey area is fortunate in that respect, I suppose, because it has a huge number of hospitals among whom potential quarantine patients could be sent to depending on the circumstances. At a press conference earlier yesterday, for example, Governor Cuomo said that, over the summer, the state had identified eight hospitals that could serve as facilities to treat someone with Ebola, which presumably means that they have the proper isolation facilities for such a situation and that their respective staffs were prepared for the possibility of dealing with such a case. Expanding into New Jersey, there are several hospitals in the Newark area, and in the New Brunswick area near Rutgers and Princeton Universities. I don’t know what the isolation bed capacity ads up to here, but it would not be unlimited, and it seems odd to keep everyone who meets the initial criteria in full isolation even when they aren’t displaying systems so one would think there would have to be some non-hospital form of isolation available.

The bed space question, of course, leads to the second question of how you identify who is covered by the quarantine. People arriving in the United States from one of the Ebola stricken nations are obvious candidates for isolation, of course, but the question becomes more difficult if we’re just talking about people who have arrived here from Guinea, Sierra Leone, or Liberia but who aren’t displaying any symptoms. There would not seem to be any legal basis for forcing such people into quarantine even if they aren’t U.S. citizens or Permanent Resident Aliens. For another, you’re essentially relying on self-reporting here and the case of Mr. Duncan already showed us that people aren’t always going to tell the truth if they have been in contact with someone who had Ebola, or it’s entirely possible that they did but weren’t even aware of it. Faced with the prospect of being forced into quarantine for three weeks even though they aren’t feeling sick, some people are going to lie, and they’re inevitably going to slip through the cracks.

The people who are likely to be the most honest, of course, are people like Dr. Spencer who have already put their lives on the line by volunteering to go to west Africa where isolation procedures are far less stringent than they are in the United States, and where dozens of health care worker volunteers have already been infected and died from the very disease they were trying to fight. That raises the obvious concern that a policy like this could discourage people from volunteering like Dr. Spencer did. To be fair, the groups that coordinate these volunteers, such as Doctors Without Borders and others, already make certain recommendations for health care workers returning from the Ebola zone, and to date they haven’t necessarily objected to the mandatory quarantine that New York and New Jersey imposed here. At the same time, though, just as with the calls for the travel ban, the potential impact that a policy like this could have on the effort to fight Ebola at its source, which is the only way the disease is going to be brought under control, and hopefully eradicated before it becomes endemic in the population there, is something that should not be lightly dismissed.

As a final note, there are some obvious legal questions that this announcement raises. Public health laws do give the authorities some power to quarantine people who are infectous or carriers of a disease that poses a danger to the general public, and Ebola certainly constitutes a danger to the public. Imposing such a quarantine on someone who has arrived and showed symptoms that could indicate that are Ebola positive, then, would seem to be both a prudent and legally permissible move. The question becomes far murkier, though, when you’re speaking of someone who is merely returning from one of the Ebola stricken nations and may have had contact with someone who is Ebola positive. In that case, the case for some kind of at-home isolation and monitoring wouldn’t be hard to make, I would think, but I’m uncertain about the legal authority to place someone like that under the kind of strict medical quarantine that Christie and Cuomo are talking about here. Under the circumstances, it’s not likely that anyone is going to challenge the state’s actions in such cases, of course, but that doesn’t mean that we shouldn’t at least think about whether the government has the authority to do something like this just as we should question whether it should do it and whether it will have the desired impact.

FILED UNDER: Health, Law and the Courts, , , , , ,
Doug Mataconis
About Doug Mataconis
Doug holds a B.A. in Political Science from Rutgers University and J.D. from George Mason University School of Law. He joined the staff of OTB in May 2010. Before joining OTB, he wrote at Below The BeltwayThe Liberty Papers, and United Liberty Follow Doug on Twitter | Facebook

Comments

  1. beth says:

    Haven’t medical volunteers and missionary/aid workers been coming back to this country for quite a while now without managing to infect anyone? It’s not like they only started going over to Africa in the last few weeks. As usual, we get more government by knee jerk, panicked reaction so we can placate the pants pissers. What a way to run a country – it’s embarrassing.

  2. @beth:

    It is knee-jerk.

    As I said, if someone arrives at JFK or Newark after having come through one of these nations, then getting them into a medical facility until it can be determined if they have Ebola seems like a prudent and rational step to take. Expanding that policy to everyone who has been to one of these nations and may have had contact with someone with Ebola seems like overreach, although I can somewhat understand applying a more stringent monitoring policy to returning health care workers since, other than Mr. Duncan and the NBC cameraman, they are the ones who have proven to be most vulnerable.

  3. Mikey says:

    @beth:

    Haven’t medical volunteers and missionary/aid workers been coming back to this country for quite a while now without managing to infect anyone?

    The current outbreak started almost a year ago. So far, no aid workers or volunteers have infected anyone in the U. S. The only person who has infected anyone was Duncan, and the two people he infected are now Ebola-free.

    But, hey, imposing a quarantine will make people think the authorities are Doing Something, so who cares if its legality is debatable and its effect non-existent?

  4. beth says:

    I’d like to see some hard numbers on just how many people have returned to this country from treating patients. I haven’t seen any reporting on that.

    How are they defining contact? Does talking to a patient count? Touching? Handling bodily fluids or dead bodies? I fear that Christie and Cuomo have just done their part to extend this outbreak in Africa and we’lll be very sorry in hindsight.

    ETA – there are labs, both private and governmental, working on Ebola right now in this country. Should those lab workers be quarantined? After all, they’re handling Ebola every day and who knows what could happen?

  5. Dave Schuler says:
  6. Bob@Youngstown says:

    Unfounded fear trumps science yet again!

  7. Stonetools says:

    Sigh. Now I understand why so many liberals hate Governor Cuomo. I expected nothing from Christie, but I do expect the liberal to be rational and science based.
    Given the role right wing media has played in fostering a climate of fear in this issue , I honestly now think we should consider reinstating the ” fairness” doctrine. It’s simply just too easy to whip up fear, uncertainty and doubt among the general populace, who are then going to press politicians to undertake wrongheaded measures like this. The marketplace of ideas ideal in which good ideas inevitably drive out bad ideas just doesn’t seem to work in the real world.

  8. JKB says:

    Seems a bit overreach, but politically necessary when you have densification and force public transportation. People are a bit more skittish about contagions when they are densely packed.

    But it also stems from the inconsistency of the “professionals”. Supposedly, this doctor was monitoring and reported himself when he hit the symptomatic threshold of concern on Thursday. But we have

    In New York City, disease investigators continued their search for anyone who had come into contact with the city’s first Ebola patient,

    going back to Tuesday.

    Well, wasn’t he a-ok on Tuesday according to the “experts”? So why track those people down? Perhaps their should be a monitored tiered symptomatic thresholds. Any of the basic symptoms such as fatigue, mild fever, joint pain, etc., the person is put in home isolation. Then if their symptoms increase, the men in space suits come take them away to hospital isolation and care. Now we’ve eliminated a guy with mild symptoms from freaking out users of public transportation or forcing business to shutdown if they move to full-blown sick.

    And at what threshold can they verify Ebola in a person? Why wait until the temperature reaches such heights or vomiting/diarrhea start?

    Seems simple. If you’ve had a risk of being exposed to Ebola and you develop flu like symptoms, do what all people who have the start of a cold or flu should do, stay the F home. If they worsen, seek treatment. But don’t try to power through it exposing everyone you come in contact with. You might be contagious.

  9. JKB says:

    @Stonetools:

    This may be getting out of their control but you have to see the Ebola concerns from the Democratic Party perspective. If Ebola wasn’t controlling the airwaves, someone in the media might start reporting on the Enterovirus outbreak and now Measles which have ties to the Obama administration’s spread of illegal immigrant children throughout the country without verifying their threat to public health.

    Which would you rather discuss right before the election?

  10. beth says:

    @JKB: Is there a conspiracy theory you don’t subscribe to?

  11. anjin-san says:

    @JKB:

    but politically necessary when you have densification and force public transportation a nation of scared little boys.

    Fixed that. And yes, I am talking about you.

  12. beth says:

    @JKB: From the CDC briefing which the Examiner didn’t bother to quote:

    Why are we having such a bad measles year? There are two factors. First, measles is coming in on airplanes from places where the disease still circulates or where large outbreaks are occurring. Second, imported measles virus is landing in places in the U.S., where groups of unimmunized people live. That setting gives the measles virus a welcome wagon by providing a chance for outbreaks to occur, and the larger the outbreak, the more difficult to stop.

    Yeah, all those kids who came in along the border ON AIRPLANES. Oh, and the anti-vaxxers who don’t immunize their kids had nothing to do with it either, right?

    Don’t you ever get tired of only hearing one side of the story?

  13. Bob E says:

    Mike Osterholm, an infectious disease epidemiologist at the University of Minnesota,
    “You want to try to eliminate not just real risk, but perceived risk.”

    Auto accidents occur everyday to innocent drivers, so the perception that you might be involved is real. Ergo, eliminate the cause of the risk….. do go out on the roadways.

  14. JKB says:

    @anjin-san:

    You are confused with your name calling. I am neither governor of NY or NJ, I do not reside in NY or NJ, I do not live in a dense urbanized area or use public transportation. The only Ebola “risk” near me was a couple hundred miles away where a few months ago, a recently returned doctor self quarantined himself in his home and actually stayed home. He did not contract Ebola.

    So if you are worried about “little boys” I suggest you look in NYC.

  15. lounsbury says:

    @JKB: Presumably the persons being tracked down are for Panic Prevention, rather than actual medical reasons.

  16. Gustopher says:

    This quarantines the people who are far more likely to follow the self-monitoring protocols, and leaves the people who are less likely to follow it with a false sense of security (“if they aren’t quarantining me, I must be fine”), making them even les likely to follow it.

    Great.

  17. MikeSJ says:

    I hope this disgraceful catering to cowardice disqualifies Cuomo from any consideration for higher office.

    I don’t expect much from Jersey Fats but NY should try show a minimum of common sense.

  18. anjin-san says:

    @JKB:

    You are confused with your name calling.

    No, not confused at all. You are the guy who has reeked of fear right here on OTB since the fist ebola case was reported in the US.

  19. Ken_L says:

    @Stonetools:

    Needless to say, conservatives are now denying they fostered a climate of fear. It was all the fault of the liberal media apparently; telling people to stay calm made them panic. Conservatives only have a rational, responsible concern about Obama’s competence to deal with Ebola given his lawless, crisis-plagued administration (copy/paste standard list here of IRS, Fast & Furious, Benghazi etc laced with golf jokes).

  20. Hal_10000 says:

    Doug, I think you understate the concern people have about this policy making things worse. The concern is that it will make people who have potentially been exposed to Ebola lie about that exposure until they become dangerously sick. So someone who would have taken himself to the hospital the second his temperature spikes (as Spencer did, as the Yale researcher did, as numerous people have done) will be too scared to admit they lied until they are very infection (e.g., Duncan).

    (I would also add that routinely putting people into isolation in a hospital is not a bad idea. Hospitals are dangerous places to work and stay because of opportunistic infections and drug-resistant diseases. It’s why doctors want to get you out as quickly as practicable.)

  21. sam says:

    @JKB:

    So if you are worried about “little boys” I suggest you look in NYC.

    Really? New York Mayor Bill de Blasio reassures unruffled Manhattanites over Ebola

    I was just in Madrid for a week. Spanish TV was giving wall-to-wall coverage re their first Ebola patient (a nurse). I didn’t see anyone freaking out there, either.

  22. JKB says:

    @sam:

    An extraordinary number of Bellevue Hospital staffers called in sick on Friday rather than treat the city’s first Ebola patient — and those who showed up were terrified to enter his isolation chamber, sources told The Post.

    Apparently, in all the beautiful planning for Ebola of which Bellevue is purportedly the flagship, the city, federal and hospital bureaucrats forgot to include the employees who would have to actually get up close with the virus.

  23. beth says:

    @JKB: Is this going to wind up to be another one of your easily disproved conspiracy theories? The hospital has denied this story. Really, at what point do you stop believing this nonsense?

  24. Tyrell says:

    I have not seen an explanation of the huge increase in the ebola outbreak from 2013 to 2014. If anyone knows a source, please list it.

  25. @Doug Mataconis: The legal authority of the governors is questionable at best. At the federal level the DHHS and CDC have authority to seek mandatory quarantine, and most states give authority to local and state public health officers, and require court approval to impose a legally-enforceable quarantine on an individual (see summary of statutes at http://www.ncsl.org/research/health/state-quarantine-and-isolation-statutes.aspx). What seems to escape most people in this situation, blinded by fear, is that the governors of these states have essentially said they have the power to strip individuals of their liberty and due process, without either public health or court approval. I live in Dallas and the elected officials thought of declaring a disaster to impose similar restrictions, but decided at the last minute not to sign a declaration…they may have received advice from counsel and thought better. The governors are on very shaky legal grounds. But who cares about the law in an election year….

  26. sam says:

    @JKB:

    Yeah. Well, unsourced stories in the New York Post are excellent for wrapping fish.