First States Issue Mandatory Quarantines for Ebola-Exposed Docs

Late Friday, New York Gov. Andrew Cuomo and New Jersey Gov. Chris Christie imposed automatic, 21-day quarantines on anyone who has had contact or possible contact with infected people from Ebola-stricken countries in West Africa. And federal officials might issue formal quarantine guidelines for medical workers who treat Ebola patients in West Africa.

The case of Craig Spencer, a doctor just returned to New York from Guinea in West Africa, the epicenter of the disease, spurred the newest spike in concern about the deadly virus’s potential spread in the United States. Spencer did not self-quarantine after arriving back in the country on Oct. 17. He also didn’t display any symptoms until late this week. On Wednesday, he rode the subway from Manhattan to a bowling alley in Brooklyn, then hired a car service to take him home. He woke up Thursday with a high fever and was diagnosed with Ebola that evening.

New York City public-health officials are scrambling to clean up the locations Spencer has visited. They also placed his fiancée and two friends in quarantine.

The hurried cleanup efforts in New York were in stark contrast with the mood in Washington. Here, public-health officials celebrated the recovery of Nina Pham, a nurse who contracted Ebola after treating Thomas Eric Duncan, the Liberian man who was the first diagnosed case on American soil and who later died; Pham even got to meet President Barack Obama on Friday before returning to Dallas. On Capitol Hill Friday morning, lawmakers held a hearing on the federal government’s response to the virus, but the tone was friendly compared to the grilling Obama administration officials received last week.

But the next steps taken by New York and New Jersey, and the one that the White House is considering, speak to how seriously Obama is taking the threat.

"Based on the information and science known today on the Ebola virus, isolating all of [Doctors Without Borders’] or other organizations’ staff returning from West Africa would be an excessive measure to take at this stage. Other organizations such as WHO and CDC are on the same line and don’t recommend that measure," Tim Shenk, the press officer for Doctors Without Borders, said in a statement.

As for how such guidelines might hinder medical personnel recruitment, Shenk said: "At any point during their time in the field, international staff have the choice to return home if they do not feel safe. It’s impossible to predict what impact this case will have on future recruitment, but [Doctors Without Borders] is committed to continuing its struggle against Ebola in West Africa."

Both Eden Wells, a prominent University of Michigan epidemiologist, and Arthur Reingold, the head of epidemiology at the University of California, Berkeley, said a formal quarantine, while unnecessary, is also quite likely.

"What we’re seeing in this disease is that it is not community-transmitted like it is in West Africa," Wells said. "But it does raise some questions, though, about whether a more active quarantine could be instituted for health care workers to reassure the public."

Reingold added: "The idea that you might have to spend three weeks in quarantine, it’s not necessary. But I’m not sure whether [public-health officials] feel they have to do that."

David Dausey, a Yale-trained epidemiologist who works on controlling pandemics and who is dean of the School of Health Professions and Public Health at Mercyhurst University, disagreed, saying that public-health officials aren’t going far enough.

"This is a disease with a 50 to 70 percent mortality rate. We can’t treat this disease like it’s seasonal influenza," he said.

Dausey said more formal quarantine rules were needed. He suggested off-site quarantine for the medial workers most at risk, and self-quarantine for those with less exposure to the virus.

"I feel like we’re just so informal with everything," he said. "We need a more formal process to track this.

"Why wasn’t there someone advising [Spencer] not to go to a bowling alley?" he asked. "Why isn’t someone talking to the nurse [Pham] who gets on a plane to Cleveland? The disease can spread," Dausey added.

Infectious-disease experts told Foreign Policy that any such quarantine would likely last 21 days. Those under observation could be watched in Africa or at a facility on American soil.