RUTHFULLY YOURS

White House Pushes Back on State Ebola Quarantines: By Colleen McCain Nelson, Melanie Grayce West and Betsy McKay

Posted By Ruth King on October 27th, 2014

http://online.wsj.com/articles/christie-defends-mandatory-ebola-quarantine-for-health-care-workers-1414335046?mod=WSJ_hp_LEFTTopStories

The White House pushed back against the governors of New York, New Jersey, Illinois and other states that instituted procedures to forcibly quarantine medical workers returning from West Africa, deepening an emotional debate brought on by recent Ebola cases in the U.S.

A senior administration official said Sunday that new federal guidelines under development would protect Americans from imported cases of the disease but not interfere with the flow of U.S. health workers to and from West Africa to fight the epidemic there.

“We have let the governors of New York, New Jersey and other states know that we have concerns with the unintended consequences… [that quarantine] policies not grounded in science may have on efforts to combat Ebola at its source,” the official said.

It wasn’t clear what action the Obama administration could take to end the quarantines.

New York Gov. Andrew Cuomo on Sunday night gave the first new details about how his state’s quarantine would work, noting that individuals would be allowed to stay in their homes for 21 days. State and local health-care workers would check on quarantined people twice a day to monitor for Ebola symptoms. Those with symptoms would be taken to a hospital. People whose jobs won’t compensate them during their quarantine would be paid by the state.

Travelers who have had no direct contact with Ebola patients wouldn’t be subject to confinement at home, but they would be consulted twice-daily by health officials over the three-week period.

New York officials said the new protocols still went further than those recommended by the federal government.

“My personal practice is to err on the side of caution,” said Mr. Cuomo. Asked if he got White House pressure to shape the policy, Mr. Cuomo said: “I have had none.”

The New York quarantine policy appears designed to strike a different tone from New Jersey, where Kaci Hickox, a 33-year-old Doctors Without Borders nurse, has been held in a tent in a Newark hospital for three days under conditions that she said Sunday were “really inhumane.”

New Jersey state officials said late Sunday night that they wouldn’t change their protocols, which allowed for home quarantine. A New Jersey resident who has no symptoms but has come into contact with someone with Ebola would be quarantined at home. Non-residents would be transported to their homes if feasible, or quarantined in New Jersey if not.

Ms. Hickox, who lives in Maine, has retained lawyers to challenge her quarantine. One of those lawyers, Norman Siegel, a prominent civil rights attorney, said the quarantine policy infringed on her constitutional rights.

New Jersey Gov. Chris Christie held firm on his decision to quarantine returning health-care workers. “I absolutely have no second thoughts about it,” he said on Fox News.

Mr. Cuomo’s announcement on Sunday was made with New York Mayor Bill de Blasio , who had criticized how Ms. Hickox was treated. “State governments have the right to make decisions. But this hero coming back from the front, having done the right thing, was treated with disrespect,” Mr. de Blasio told reporters.

Mr. Christie said Saturday that “I’m sorry if in any way she was inconvenienced, but inconvenience that could occur from having folks that are symptomatic and ill out amongst the public is a much, much greater concern of mine. So certainly nothing was done intentionally to try to inconvenience her or try to make her uncomfortable.”

Although Mr. Cuomo’s policy appears different from New Jersey’s handling of a quarantine case, the White House declined to comment on the New York measures beyond reiterating the principles guiding its own decision-making.

Ebola has killed nearly 5,000 people in West Africa. Nine people have been treated for the virus in the U.S., four of whom either became ill or were infected here. One died.

President Barack Obama convened a meeting of top public health and national security advisers on Sunday to discuss the issue.

Federal, state and local officials are grappling with ways to quell anxiety and protect the public. The different approaches they are taking reflect the layered public health system in the U.S. State and local authorities hold most quarantine powers, while the federal government’s power is more limited, according to legal experts.

The federal government technically could find an argument for challenging state decisions to impose quarantines, said Polly Price, professor at Emory University School of Law. “I could see an argument that there are interstate ramifications,” she said, such as economic disruption. But she said she thought it unlikely, given the political environment and public anxiety over Ebola.

In most cases, the federal government can’t override state quarantines. The Centers for Disease Control and Prevention has powers at ports of entry to the U.S., and can quarantine people who are traveling between states and have infectious diseases such as tuberculosis. Ebola, which can’t be spread through the air, isn’t considered as infectious.

ENLARGE

New York Governor Andrew Cuomo, left, and New Jersey Governor Chris Christie announced a mandatory quarantine for “high risk” people returning to the U.S. through airports in New York and New Jersey. Associated Press

Craig Spencer, a New York doctor diagnosed Thursday with Ebola after his return from West Africa, appeared to have played a part in the quarantine moves by New Jersey and New York. He was reported in serious but stable condition Sunday at Bellevue Hospital Center in Manhattan.

The Christie administration believes it would win any legal challenge because state law is clear on the government’s ability to quarantine people in public-health emergencies, said a New Jersey state official familiar with the new policy.

During a campaign stop in Florida Sunday, Mr. Christie said that no federal officials had reached out to him about revising the mandatory quarantine.

Christie administration officials knew that public-health experts would disagree with their decision but decided they wanted a broad, tough policy that would calm people’s fears, a Christie official said.

Mr. Cuomo said last week that he consulted with the Centers for Disease Control and Prevention before launching the mandatory-quarantine policy, but Christie administration officials didn’t, a Christie spokesman said.

Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, part of the National Institutes of Health, said Sunday that the administration is considering a risk-based monitoring system that would elevate the required supervision of health-care workers returning from West African nations.

But he said the protocols would stop short of a mandatory, 21-day isolation of health-care workers that several states have imposed, which risks deterring volunteers heading to Africa to fight the disease.

“You fashion what you do with them according to the risk,” Dr. Fauci said Sunday morning on NBC. “One of the ways you can mitigate against this issue is by…different types of monitoring.”

Supervision would ratchet up from passive monitoring—individuals regularly taking their temperatures—to “direct active” monitoring, where those who are deemed high-risk are checked by medical workers, he said on NBC.

Scientists say that people who aren’t showing symptoms of Ebola don’t transmit the disease, and Dr. Fauci said other steps besides a mandatory quarantine could ensure public safety. Telling health-care workers that upon returning from West Africa “you still have 21 days out of your life where you can’t move, I think, will have unintended negative consequences,” he said.

Legal experts disagreed on Ms. Hickox’s ability to successfully challenge her quarantine.

Lawrence Gostin, a Georgetown University professor who leads the O’Neill Institute for National and Global Health Law, and is offering help to Ms. Hickox, said she has two main ways to contest her quarantine. The policy in New Jersey applies to a class of people and there “was no individualized assessment of her individual risk,” he said.

The second possible avenue is to argue she wasn’t quarantined in a humane health environment.

“Because this is not a prison sentence, the person has not been convicted. It’s civil and so you’re not supposed to punish them,” said Mr. Gostin.

Mr. Gostin said this was the first time in his memory where such a quarantine was implemented.

But Michael C. Dorf, a professor at Cornell University Law School, said there may not be a sound legal case to challenge a quarantine. The state laws used to implement mandatory quarantines in New York, New Jersey and Illinois are clear and “there is no serious doubt about the affirmative power of either the states and the federal government to quarantine,” Mr. Dorf said.

—Yoni Bashan, Josh Dawsey
and Heather Haddon
contributed to this article.

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