In U.S. Ebola fight, no two quarantines are quite the same

By Jonathan Allen and Yasmeen Abutaleb

NEW YORK (Reuters) – In the U.S. battle against Ebola, quarantine rules depend on your zip zode.

For some it may feel like imprisonment or house arrest. For others it may be more like a staycation, albeit one with a scary and stressful edge.

If they are lucky, the quarantined may get assigned a case worker who can play the role of a personal concierge by buying groceries and running errands. Some authorities are allowing visitors, or even giving those in quarantine permission to take trips outside to walk the dog or take a jog.

A month after the first confirmed case of Ebola in the United States, state and local health authorities across the country have imposed a hodgepodge of often conflicting rules.

Fears about a possible U.S. outbreak were reignited after American doctor Craig Spencer was hospitalized with Ebola in New York last Thursday after helping treat patients in West Africa, the epicentre of the worst outbreak on record.

Some states, such as New York and New Jersey, have gone as far as quarantining all healthy people returning from working with Ebola patients in West Africa. Others, such as Virginia and Maryland, said they will monitor returning healthcare workers and only quarantine those who had unprotected contact with patients. For a factbox, see:

In Minnesota, people being monitored by the state’s health department are banned from going on trips on public transit that last longer than three hours – the aim being to reduce exposure to others if someone does start to develop symptoms during a journey. But people with known exposure to Ebola patients will be restricted to their homes without any physical contact allowed. 

Spencer’s case has fanned public fears about the deadly virus, pressuring U.S. politicians to bring in harsh quarantine measures. Health experts have criticized such moves, noting the virus can only be transmitted through bodily fluids once an infected person has symptoms, from a fever to vomiting or diarrhoea.

The U.S. Centres for Disease Control and Prevention has tried to establish a national standard, recommending on Monday that only people who had direct contact with Ebola patients without any protective gear submit to isolation at home for 21 days, the maximum period for symptoms to develop. They would still be allowed to go outside on a jog or to walk their dogs, but cannot come within three feet of others or visit places with groups of people, such as a restaurant.   

    

SMALLER DETAILS

The smaller details – ranging from how groceries are delivered to who can visit – differ by state and even by city.

Three people who came into close contact with Spencer, including his fiancée, Morgan Dixon, are each being looked after by two case workers. One of the workers is from the New York City health department, and monitors their temperatures and watches for other signs of illness. The other is from the city’s social services department, and acts as a kind of round-the-clock concierge.

For some, the difficulties of being confined alone in a small apartment are beginning to take their toll.

“We have noticed in the past few days it has become much more difficult for the people in terms of the stress levels that one would experience being physically on your own,” said Dr. Jay Varma, a deputy commissioner at the city’s health department, in a telephone interview. “It’s quite an emotional challenge to be separated from your regular social network.”

On Wednesday evening, the city told the three people under quarantine that they could have relatives and friends to visit after all – previously they had been barred. As long as a health worker has come by that day to check that the quarantined person is still not showing symptoms, up to three people can come over at any one time provided they aren’t themselves ill.

The visitors can behave normally, hugging or sharing a meal with the quarantined if they want, Varma said. A friend or relative may even move in for the rest of the confinement if they like, he added.

PROBLEM SOLVING

Still, mundane problems can be more difficult than normal to solve. For example, the oven broke down in the apartment of one of Spencer’s quarantined friends, and the case worker had to cast about for someone willing to come in and fix it. Not an easy task, though someone has now been found to do so, said Varma.

Police officers are posted outside all three apartment buildings, not only to keep journalists and other unwanted people out, but to keep the quarantined in, Varma said. “We’ve instructed our officers to not use physical force,” he said, “but to attempt to explain to somebody why they should be staying there.”

If someone does leave, the officer will raise the alarm with the health department, Varma said.

Dixon, 30, could not be reached for comment, and the other friends of Spencer’s have not been publicly identified..

Kaci Hickox, a nurse who arrived at Newark Liberty International Airport on Friday after working with Doctors Without Borders in Sierra Leone, found herself in much bleaker surroundings for the first few days of her quarantine.

New Jersey officials confined her to a tent without a flushing toilet and no shower. It was cold, Hickox said in an article decrying her conditions as a breach of her rights, and the paper clothes they gave her were scratchy.

She has since returned to her home state of Maine but has refused to comply with orders of an in-state home quarantine, the state’s health department said. Hickox says she will fight Maine’s quarantine order in court if it is not lifted.

Hickox’s defiance did not sit well with Maine’s Republican Governor Paul LePage, who said he would seek legal authority to keep her isolated at home until Nov. 10.

NO EVIDENCE

“This an overly extreme and non-evidence-based policy,” said Dr. Anthony Harris, an infectious disease expert at the University of Maryland School of Medicine. “There’s no reason to have policies with that level of detail because there’s no risk.”

In Illinois, health department officials expect family members and friends to deliver food to quarantined individuals,  said Melaney Arnold, a spokeswoman for the Illinois Department of Public Health. The Red Cross in Chicago will provide those quarantined with gift cards for food and other products, said Julie Morita, chief medical officer at the Chicago Department of Public Health.

Illinois has yet to work out who, if anyone, will pay for three weeks of missed work time, but said it expects employers to cover the cost.

One question that none of the state health officials contacted by Reuters could answer was whether the 21-day mandatory quarantines applied to health workers who had arrived from West Africa before the rules were in place but who may still be at risk of infection.

“I don’t know that it needs to be retroactive,” Illinois spokeswoman Arnold said. “They’re not putting others at risk.”

(Editing by Michele Gershberg and Martin Howell)

In U.S. Ebola fight, no two quarantines are quite the same