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Nurse criticizes Ebola quarantine, raising concern

October 26, 2014

NEW YORK (AP) — The nurse who was quarantined at a New Jersey hospital because she had contact with Ebola patients in West Africa criticized the way her case has been handled, raising concerns from humanitarian and human rights groups over unclear policies for the newly launched quarantine program.

Kaci Hickox, the first traveler quarantined under Ebola watches in New Jersey and New York, wrote the first-person account for the Dallas Morning News, which was posted on the paper’s website Saturday. Her preliminary tests for Ebola came back negative.

“This is not a situation I would wish on anyone, and I am scared for those who will follow me,” Hickox wrote of her quarantine. “I am scared about how health care workers will be treated at airports when they declare that they have been fighting Ebola in West Africa. I am scared that, like me, they will arrive and see a frenzy of disorganization, fear and, most frightening, quarantine. ... The U.S. must treat returning health care workers with dignity and humanity.”

New York Gov. Andrew Cuomo and New Jersey Gov. Chris Christie on Friday imposed a mandatory quarantine of 21 days — the incubation period of the deadly virus — on travelers who have had contact with Ebola patients in the countries ravaged by Ebola — Liberia, Guinea and Sierra Leone. Similar measures were announced in Illinois and Florida.

The hazy details of how such quarantines will be handled are drawing sharp criticism as infectious disease experts say enforcement logistics are up in the air. Health officials in states with quarantine policies did not return messages from The Associated Press seeking details about enforcement.

Cuomo on Saturday acknowledged that the policy might be hard to enforce, according to the New York Daily News.

The governor said officials had never considered whether people refusing to go along with the order could face prosecution or arrest, adding “It’s nothing that we’ve discussed, no,” the newspaper said.

In her essay, Hickox described being stopped at Newark Liberty International airport and questioned over several hours after touching down Friday. She said none of those who questioned her would explain what was going on or what would happen to her.

Hickox is a nurse who had been working with Doctors Without Borders in Sierra Leone. Officials said she was taken to a hospital after developing a fever, but Hickox said she was merely flushed because she was upset by the process. Hickox remained isolated in a building adjacent to the hospital, state health department officials said Sunday.

Doctors Without Borders executive director Sophie Delaunay complained Saturday about the “notable lack of clarity” from state officials about the quarantine policies, and an American Civil Liberties Union official in New Jersey said the state must provide more information on how it determined that mandatory quarantines were necessary.

“Coercive measures like mandatory quarantine of people exhibiting no symptoms of Ebola and when not medically necessary raise serious constitutional concerns about the state abusing its powers,” said Udi Ofer, executive director of the ACLU of New Jersey.

Doctors Without Borders said Hickox has not been issued an order of quarantine specifying how long she must be isolated and is being kept in an unheated tent. It urged the “fair and reasonable treatment” of health workers fighting the Ebola outbreak.

“We are attempting to clarify the details of the protocols with each state’s departments of health to gain a full understanding of their requirements and implications,” Delaunay said in a statement.

A top federal health official said Sunday that mandatory 21-day quarantines on health care workers returning from Ebola-ravaged West Africa can have the unintended consequence of discouraging them from volunteering.

Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said that as a physician and scientist, he would have recommended against a quarantine.

“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.” he said.

He said active and direct monitoring can accomplish the same thing as a quarantine because people infected with Ebola do not become contagious until they start showing symptoms.

Christie told “Fox News Sunday” that he had concluded the quarantine was necessary to protect public health in his state and that he thinks the federal Centers for Disease Control and Prevention “eventually will come around to our point of view on this.”

Christie said Fauci was counting on “a voluntary system with folks who may or may not comply.”

The governor pointed to an NBC News crew that had returned from West Africa was supposed to self-quarantine because its cameraman was hospitalized with Ebola. “Two days later they were out picking up takeout food in Princeton and walking around the streets of Princeton,” he said. The cameraman has recovered and has been released from the hospital.

Christie said Saturday, while campaigning in Iowa, that he sympathizes with Hickox, while also noting that state and local health officials would make sure quarantine rules are enforced. He said the New Jersey State Police won’t be involved.

Health officials said preliminary tests for Ebola came back negative for Hickox but Newark University Hospital would not say if she would be released for the balance of the quarantine period or remain in the hospital.

In the very early stages of Ebola, patients may still test negative because the virus has not yet reached detectable levels in the blood. The U.S. Centers for Disease Control and Prevention says it may take up to three days after the onset of symptoms for the virus to reach detectable levels in some patients, prompting repeat testing in some cases.

Hickox’s mother, Karen Hickox, said Saturday her daughter probably wasn’t expecting to be quarantined upon her return to the United States, but is dealing with it.

“I spoke with her (Friday and Saturday),” she said. “She was more frustrated (Friday) but there were some tears (Saturday) ... If you knew her, she’s a very compassionate person but she doesn’t usually get emotional.”

The quarantine measures were announced after a New York physician, Craig Spencer, working for Doctors Without Borders returned from Guinea and was admitted to Manhattan’s Bellevue Hospital Center earlier this week to be treated for Ebola. Hospital officials said Saturday he was experiencing gastrointestinal symptoms and “entering the next phase of his illness.”

A senior White House official said Saturday that how to treat health care workers returning from the affected West African countries continues to be discussed at meetings on Ebola as the administration continues to take a “careful look” at its policies.

Dr. Irwin Redlener, a Columbia University professor and director of the New York-based National Center for Disaster Preparedness, said the logistics of the states’ new quarantine policy are “a problem.”

“The challenge now is how you translate this quarantine plan to operational protocol,” Redlener said.

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Associated Press writers Darlene Superville in Washington, D.C., Jonathan Lemire in New York, Jill Colvin in Clive, Iowa, and Bruce Shipkowski in Trenton, New Jersey, contributed to this story.

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