|A New York City Health department official hands out information on the Ebola virus outside a school in the Bronx, New York . Photograph: Mike Segar/Reuters|
Medics flying into the US after treating Ebola patients in Guinea, Liberia or Sierra Leone should be more closely monitored by local authorities for 21 days, according to new national guidelines published by the Centers for Disease Control and Prevention (CDC).
However only those deemed “high risk” – those who did not wearing proper protective clothing, or were exposed to the virus via a needle or other injury – should automatically require quarantines in their homes, Tom Frieden, the CDC director, told a conference call.
The new advisory should “increase the level of protection of the health and safety of Americans” while “protecting those who are doing the heroic work of protecting us from Ebola as they fight it on the shores of Africa as well,” said Frieden.
His latest guidelines followed a backlash to mandatory quarantines announced by New York and New Jersey last Friday for all healthcare workers who came into contact with infected people in west Africa, after a doctor, Craig Spencer, was diagnosed with Ebola in New York City last week.
The quarantine rules have since been loosened by governors Chris Christie of New Jersey and Andrew Cuomo of New York. Ban Ki-moon, the UN secretary general, in a statement released by the UN, said that returning medics “should not be subjected to restrictions that are not based on science” and “those who develop infections should be supported, not stigmatised”.
His criticism came shortly after New Jersey authorities announced that Kaci Hickox, a nurse who was confined to a quarantine tent with a portable toilet and no shower despite showing no symptoms after returning to the US from treating patients in Sierra Leone, would be released and allowed to return to her home to Maine.
The White House appeared to accept on Monday that a patchwork system of Ebola restrictions was inevitable given that public health policies were a matter for individual states. “We have a federal system in this country in which states are given significant authority for governing their constituents,” White House spokesman Josh Earnest told a briefing. “That is certainly true when it comes to public safety and public health.”
Meanwhile about a dozen US troops, who had been in Liberia as part of an operation to help tackle the Ebola outbreak, were being quarantined in Italy after returning to base in Vicenza and reportedly met by police in hazmat suits.
Under the CDC’s latest “active monitoring” guideline, all returning healthcare workers are deemed to be at “some risk” of Ebola, and should register with regional authorities. They would then have daily temperature checks observed by an official, Frieden said, adding that this would help swifter action in the event of any symptoms developing.
These medics should also notify regional authorities at their destinations before travelling away from home, according to the CDC, so that there would be no break in the daily monitoring of their condition.
By contrast, “for the high-risk individuals, we are recommending voluntary at-home isolation, including not going on public transportation and flying,” Frieden said. Regional authorities may want to impose these rules on returning medics not initially regarded as high risk on “the basis of a specific assessment of an individual’s situation”, the CDC director said.
Following a scaling back in the states’ original plans, those in New York and New Jersey are now allowed to be under home quarantines for 21 days, with friends and family visits confirmed as permitted in New York.
Frieden said that fewer than 100 people were travelling to the US from the affected African countries each day, and that between 5% and 6% of these were returning medics. He added that 70% of those returning were coming through the states of New York, Maryland, New Jersey, Pennsylvania, Georgia and Virginia.
In Georgia, governor Nathan Deal appeared to sidestep the controversy by announcing detentions for all travellers potentially exposed to the disease, but exempted healthcare workers who will be allowed to monitor themselves at home and choosing other restrictions that may have limited practical impact.
Deal said officials at the Atlanta airport, one of five designated entry points for travellers from Sierra Leone, Guinea and Liberia, would rely on questioning arrivals on their potential exposure to determine whether they should face the mandatory quarantine detention.
Georgia’s rules are likely to provoke less controversy than those in New York and New Jersey by allowing travellers to be monitored at home via video link or visits from officials.
“We have learned from what other states have done especially in the area of healthcare workers where we saw some push back,” said Deal. “We believe our policy will give them the freedom they deserve; we trust them to report if they have symptoms.”
Travellers arriving via Atlanta from affected countries who do not exhibit any symptoms or admit to a history of exposure will be required to sign an agreement requiring them to monitor their temperature and stay in touch with authorities for a 21 day period.
The CDC director again stressed that Americans were highly unlikely to contract Ebola. “I understand that people are afraid. People are unfamiliar,” said Frieden. “It is a severe disease, but it is not highly contagious.”
Only one person in the US is confirmed as currently suffering from Ebola – Spencer of Doctors Without Borders, who treated patients in Guinea. Mayor Bill de Blasio said at a press conference on Monday morning that Spencer’s condition at Bellevue hospital remained “serious but stable” and that his fiancee and two friends continued to show no symptoms