It was just Friday that New York Governor Andrew Cuomo and New Jersey Governor Chris Christie announced a new policy that would require anyone who had been in any of the three African nations that are most affected by the Ebola outbreak in west Africa and had been in contact with someone who had Ebola would be required to submit to an involuntary quarantine for at least 21 days to ensure that they didn’t show signs of developing the disease. Since the policy followed on the heels of the announcement that Dr. Craig Spencer, a volunteer with Doctors Without Borders, had tested positive for the disease and admitted to a New York City hospital, it was clear that the policy was primarily directed at health care workers returning from the so-called “hot zone.” Indeed, the first person who was impacted by the policy was a nurse from Maine who had just returned from a month in Guinea who was taken into custody at Newark Liberty Airport on Friday afternoon and taken to a Newark hospital where she is remains and is presently being kept in a tent in the parking lot isolated from the rest of the hospital. Yesterday, her case made national headlines thanks in no small part to a column published under her name in the Dallas Morning News and an appearance by phone on CNN’s State of the Union and rather direct criticism from the head of the National Institutes of Health. As the day went on, reports began to leak that Whiite House officials were pressuring both Cuomo and Christie to modify their policy, and, late yesterday, both Governor’s relented and allowed a policy change that would let people who are not symptomatic stay at home under monitoring, but questions remain about how the policy will be implemented, especially as it applies to people who don’t have a residence in either state:
Facing fierce resistance from the White House and medical experts to a strict new mandatory quarantine policy, Gov. Andrew M. Cuomo said on Sunday night that medical workers who had contact with Ebola patients in West Africa but did not show symptoms of the disease would be allowed to remain at home and would receive compensation for lost income.
Mr. Cuomo’s decision capped a frenzied weekend of behind-the-scenes pleas from administration officials, who urged him and Gov. Chris Christie of New Jersey to reconsider the mandatory quarantine they had announced on Friday. Aides to President Obama also asked other governors and mayors to follow a policy based on science, seeking to stem a steady movement toward more stringent measures in recent days at the state level.
The announcement by Mr. Cuomo seemed intended to draw a sharp contrast — both in tone and in fact — to the policy’s implementation in New Jersey, where a nurse from Maine who arrived on Friday from Sierra Leone was swiftly quarantined in a tent set up inside a Newark hospital, with a portable toilet but with no shower.
It was the second striking shift in Mr. Cuomo’s public posture on the Ebola crisis in 72 hours; after urging calm on Thursday night, then joining Mr. Christie to highlight the risks of lax policy on Friday, Mr. Cuomo on Sunday night appeared to try to dial back his rhetoric and stake out a middle ground.
He said his decision balanced public safety with the need to avoid deterring medical professionals from volunteering in West Africa. “My No. 1 job is to protect the people of New York, and this does that,” he said. Those quarantined at home will be visited twice a day by local authorities, he said. Family members will be allowed to stay, and friends may visit with the approval of health officials.
Mayor Bill de Blasio, sitting beside Mr. Cuomo at a news conference in Manhattan, nodded in approval, and praised the governor for developing a set of flexible quarantine guidelines that, the mayor said, would show proper respect to those required to abide by them.
After Mr. Cuomo’s announcement, Mr. Christie issued a statement saying that, under protocols announced on Wednesday, New Jersey residents not displaying symptoms would also be allowed to quarantine in their homes.
Until Sunday night, the quarantine orders by Mr. Christie, a Republican, and Mr. Cuomo, a Democrat, had drawn withering criticism from many medical experts, who said they would discourage aid workers from volunteering to help eradicate the disease at its source. By midday Sunday, Kaci Hickox, the nurse who became the first person isolated under the new protocols in New Jersey, emerged as the public face of the opposition, calling the treatment she received “inhumane” and disputing Mr. Christie’s assertion a day earlier that she was “obviously ill.”
“If he knew anything about Ebola he would know that asymptomatic people are not infectious,” Ms. Hickox told CNN.
Even some who acknowledged the states’ authority to enact the policy took issue with its implementation in New Jersey.
“We have to think how we treat the people who are doing this noble work,” Mr. de Blasio said. At a late afternoon news conference, he said Ms. Hickox’s treatment was “inappropriate,” adding: “We owe her better than that.”
Yet amid heightened public anxiety about the government’s handling of the crisis, state authorities have increasingly calculated that the mandatory quarantines will prove prescient. Since the governors’ announcement, Illinois and Florida have said they were instituting similar measures.
“I think this is a policy that will become a national policy sooner rather than later,” Mr. Christie said in an interview on Fox News Sunday.
Left unstated by the statements about the changes in policy in both states is the question of what would happen to someone who arrived at either John F. Kennedy Airport or Newark Liberty Airport who doesn’t have a residence in New York or New Jersey that they could do so. This is the situation that Ms. Hickcox faces since she she lives in Maine and apparently doesn’t have any family in the area whose residence could be used as a quarantine spot. The changes that Governor Christie announced, for example, seem to make clear that they would only apply to New Jersey residents who would be able to self-quarantine in their homes during the incubation period. Theoretically, I suppose, they could allow someone who lives in another state to do the same thing, but then there would have to be arrangements made for transportation and the local health authorities at their destination would have to be informed, trained, and consent to the arrival of a potential Ebola case.
Even though his announcement doesn’t seem to limit itself to New York residents, the same issues arise with the respect to Governor Cuomo’s modifications. Given the fact that JFK and Newark are, quite often, gateway airports that people arriving from overseas use to travel to other parts of the United States once arriving back in the country from overseas, it seems inevitable that many of the people who fit into the criteria of the quarantine order will be people who don’t live in the Tri-State area. Obviously, one option would be for those people to arrive via Dulles Airport in Virginia given that the authorities in the D.C. area have rejected the idea of a quarantine like the one the Christie and Cuomo announced. However, that may not be an option for everyone and, given reports that we may see a national policy announced this week that mirrors to some extent the modified policy that Cuomo announced last night, the issue of what to do with people who don’t live in the area where the five airports that are receiving travelers from west Africa is one that will have to be dealt with at some point.
Notwithstanding these caveats, the modified policy strikes me as being a fairly good compromise given the issues involved here and the fact that, if someone does begin displaying symptoms of Ebola, quick action is required to get them to a facility where they can be isolated and treated. To some extent, the modifications are similar to the policies that Doctors Without Borders had already recommended that volunteers like Spencer and Hickcox follow, and that Dr. Spencer was in fact following prior to his admission to Bellevue last week. The major difference, of course, is that it would require the people involved to actually confine themselves to a set space for the entirety of the 21 day incubation period, something that isn’t necessarily justified by medical science given the fact that even someone who definitely has the Ebola virus inside them is not contagious until they actually start displaying symptoms.In that respect, the restrictions of movement is clearly intended more to address public anxiety than it is based on science. Additionally, while mandatory at-home quarantine is certainly not as restrictive as mandatory quarantine in a medical facility, it is still a restriction of liberty that could potentially be challenged in the same way that lawyers are apparently planning on challenging the quarantine of Kaci Hickcox. All that being said, though, the modified quarantine announced last night strikes me as something of a reasonable medium between the overreaction that Cuomo and Christie initially engaged in and not doing anything at all.
