NEW YORK (Reuters) - Illinois joined New York and New Jersey in imposing mandatory quarantines for people arriving with a risk of having contracted Ebola in West Africa, but the first person isolated under the new rules, a nurse returning from Sierra Leone, strongly criticized her treatment.
Under a policy introduced on Friday, anyone arriving at John F. Kennedy International Airport or Newark Liberty International Airport after having contact with Ebola patients in Liberia, Sierra Leone or Guinea must submit to a mandatory quarantine for 21 days. Three weeks is the longest documented period for an Ebola infection to emerge.
Kaci Hickox, a nurse, was placed in quarantine at Newark after returning on Friday from working with medical charity Doctors Without Borders in Sierra Leone.
Hickox, who was transferred from the airport to a hospital where she was placed in isolation, described a confusing and upsetting experience at the airport and worried the same treatment was in store for other American health workers trying to help combat the epidemic.
"I ... thought of many colleagues who will return home to America and face the same ordeal," Hickox wrote in an article published on Saturday by The Dallas Morning. "Will they be made to feel like criminals and prisoners?"
"I am scared that, like me, they will arrive and see a frenzy of disorganization, fear and, most frightening, quarantine," she said in the article, published on the paper's website.
The state quarantines were imposed after a New York City doctor was diagnosed with the disease on Thursday, days after returning to the city from working with Ebola patients for Doctors Without Borders in Guinea.
Dr. Craig Spencer, now being treated at Bellevue Hospital Center in Manhattan and described as in stable condition, was the fourth person to be diagnosed with the illness in the United States and the first in the country's largest city.
His case, and the fact he was out and about in the city in the period before his symptoms emerged, set off renewed worries in the United States about the spread of the disease, which has killed thousands of people in West Africa. The concern over Ebola has become a political issue ahead of Nov. 4 congressional elections.
ILLINOIS JOINS IN
Illinois will also require a mandatory quarantine of anyone who has had direct contact with Ebola patients in those countries, Governor Pat Quinn said in a statement on Friday.
His announcement did not explicitly discuss it, but the new measure was likely aimed at people arriving at Chicago O'Hare International Airport.
The airport is one of five U.S. airports where health screening is in place for passengers whose journeys originated in the three West African countries that have borne the brunt of the worst Ebola outbreak on record. Such passengers are now obliged to route their journeys into the United States through those five airports.
Quinn's office and local health officials did not respond to requests for further comment.
Health officials in Virginia, where Washington Dulles International Airport is located, said the state is reviewing its quarantine policies. In Georgia, where the Hartsfield-Jackson Atlanta International Airport is located, officials were not immediately available for comment.
The mandatory quarantines imposed by states exceed current federal guidelines, although the Obama administration is discussing similar measures.
President Barack Obama urged Americans on Saturday to be guided by "facts not fear" as they worry about the spread of Ebola. "We have been examining the protocols for protecting our brave healthcare workers, and, guided by the science, we'll continue to work with state and local officials to take the necessary steps to ensure the safety and health of the American people," he said in his weekly radio address.
'MEDICAL EQUIVALENT OF A BATTLE ZONE'
Ebola has killed almost half of more than 10,000 people diagnosed with the disease -- predominantly in Liberia, Sierra Leone and Guinea -- although the true toll is far higher, according to the World Health Organization.
The virus is spread through direct contact with bodily fluids from an infected person. It is not transmitted by people who are not showing symptoms, but the quarantine measures in New Jersey, New York and Illinois were prompted in part by the fact that Spencer traveled around the city between arriving home and developing symptoms on Thursday, including riding the subway, taking a cab and going to a bowling alley.
New York City Mayor Bill de Blasio said he was not consulted in advance of the new screening rules.
"The state has the right to make its decision, just like the CDC does, and we're going to work with them," he told reporters after visiting a sandwich shop where Spencer ate earlier in the week. The shop was briefly closed on Friday before health officials allowed it to reopen.
Asked if he thought Dr Spencer had behaved irresponsibly by going out around town, de Blasio said, "I think that's a really inappropriate characterization ... Here is a doctor who went into the medical equivalent of a war zone. This is no different than a soldier that goes into battle to protect us."
Hickox's account of her treatment echoed concerns of critics of the mandatory quarantines who say they could discourage Americans from going to help control the epidemic in West Africa.
New Jersey's health department said that Hickox, the quarantined nurse, broke into a fever soon after being quarantined and was taken to University Hospital in Newark. She later tested negative for Ebola.
But Hickox disputed that account in her article. She said her temperature was normal when tested orally at the hospital, but showed a fever when she was tested using a non-contact forehead scanner, reflecting the fact she was flustered and anxious.
Doctors Without Borders also criticized Hickox's treatment, saying she had been issued an order of quarantine but it was not clear how long she would be held in isolation, in uncomfortable conditions in a tent set up outside the main hospital building.
"Doctors Without Borders is very concerned about the conditions and uncertainty she is facing," the group said in a statement.
(Additional reporting by Natasja Sheriff and Yasmin Abutaleb in New York; Writing by Jonathan Allen and Edwin Chan; Editing by Frank McGurty and Frances Kerry.
Enhanced Ebola Screening to Start at Five U.S. Airports and New Tracking Program for all People Entering U.S. from Ebola-affected Countries
New layers of screening at airports that receive more than 94% of West African Travelers
The Centers for Disease Control and Prevention (CDC) and the Department of Homeland Security's Customs & Border Protection (CBP) this week will begin new layers of entry screening at five U.S. airports that receive over 94 percent of travelers from the Ebola-affected nations of Guinea, Liberia, and Sierra Leone.
New York's JFK International Airport will begin the new screening on Saturday. In the 12 months ending July 2014, JFK received nearly half of travelers from the three West African nations. The enhanced entry screening at Washington-Dulles, Newark, Chicago-O'Hare, and Atlanta international airports will be implemented next week.
"We work to continuously increase the safety of Americans," said CDC Director Tom Frieden, M.D., M.P.H. "We believe these new measures will further protect the health of Americans, understanding that nothing we can do will get us to absolute zero risk until we end the Ebola epidemic in West Africa."
"CBP personnel will continue to observe all travelers entering the United States for general overt signs of illnesses at all U.S. ports of entry and these expanded screening measures will provide an additional layer of protection to help ensure the risk of Ebola in the United States is minimized," said Secretary of Homeland Security Jeh Johnson. "CBP, working closely with CDC, will continue to assess the risk of the spread of Ebola into the United States, and take additional measures, as necessary, to protect the American people."
CDC is sending additional staff to each of the five airports. After passport review:
- Travelers from Guinea, Liberia, and Sierra Leone will be escorted by CBP to an area of the airport set aside for screening.
- Trained CBP staff will observe them for signs of illness, ask them a series of health and exposure questions and provide health information for Ebola and reminders to monitor themselves for symptoms. Trained medical staff will take their temperature with a non-contact thermometer.
- If the travelers have fever, symptoms or the health questionnaire reveals possible Ebola exposure, they will be evaluated by a CDC quarantine station public health officer. The public health officer will again take a temperature reading and make a public health assessment. Travelers, who after this assessment, are determined to require further evaluation or monitoring will be referred to the appropriate public health authority.
- Travelers from these countries who have neither symptoms/fever nor a known history of exposure will receive health information for self-monitoring.
Entry screening is part of a layered process that includes exit screening and standard public health practices such as patient isolation and contact tracing in countries with Ebola outbreaks. Successful containment of the recent Ebola outbreak in Nigeria demonstrates the effectiveness of this approach.
These measures complement the exit screening protocols that have already been implemented in the affected West African countries, and CDC experts have worked closely with local authorities to implement these measures. Since the beginning of August, CDC has been working with airlines, airports, ministries of health, and other partners to provide technical assistance for the development of exit screening and travel restrictions in countries affected by Ebola. This includes:
- Assessing the capacity to conduct exit screening at international airports;
- Assisting countries with procuring supplies needed to conduct exit screening;
- Supporting with development of exit screening protocols;
- Developing tools such as posters, screening forms, and job-aids; and
- Training staff on exit screening protocols and appropriate personal protective equipment (PPE)
Today, all outbound passengers are screened for Ebola symptoms in the affected countries. Such primary exit screening involves travelers responding to a travel health questionnaire, being visually assessed for potential illness, and having their body temperature measured. In the last two months since exit screening began in the three countries, of 36,000 people screened, 77 people were denied boarding a flight because of the health screening process. None of the 77 passengers were diagnosed with Ebola and many were diagnosed as ill with malaria, a disease common in West Africa, transmitted by mosquitoes and not contagious from one person to another.
Exit screening at airports in countries affected by Ebola remains the principal means of keeping travelers from spreading Ebola to other nations. All three of these nations have asked for, and continue to receive, CDC assistance in strengthening exit screening.
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