The Obama administration is pushing back against several states' quarantine policies for Ebola health workers, unveiling new restrictions Monday that apply only to “high-risk” individuals returning from West Africa.
The guidelines from the Centers for Disease Control and Prevention (CDC) stop far short of 21-day quarantines imposed by several states that have been heavily criticized by public health experts and the Obama administration.
Only individuals known to have direct exposure to the disease, such as a family member who cared for an Ebola patient without protective gear, are told to remain home under the new recommendations.
Health workers are only required to self-isolate if they had direct exposure — for example, if a needle-stick punctured their protective gear or if contaminated fluids accidentally splashed into their eyes or mouth.
Most returning doctors and nurses would undergo twice-daily active monitoring, including at least once in person. If those individuals wish to travel, they would have to consult with local and state health agencies, which would then evaluate their specific level of exposure.
The individuals might also be subject to a “do not board” order for air travel, restrictions on using public transportation or attending public gatherings, depending on their risk level.
The federal policies would likely not have restricted the behavior of Dr. Craig Spencer, the Ebola-infected patient in New York City who was diagnosed exactly one week after returning from Guinea.
Spencer monitored his symptoms daily and immediately checked himself into the hospital after noticing a fever. He mostly stayed in his apartment, though he also rode the subway, took a taxi and visited a bowling alley before his symptoms emerged.
While the CDC does not have the authority to enforce its recommendations, Director Tom Frieden said most state and local health officials follow federal directions when trying to limit the spread of infectious diseases.
“If they wish to be more stringent, that’s within their authority,” Frieden said on a call with reporters. “But we believe these guidelines are based on science.”
The new guidelines underscore the Obama administration's strife with mandatory 21-day quarantines ordered for returning healthcare workers in New York and New Jersey. Illinois, which initially had a similar policy, walked back on its quarantine policy Monday, with its Gov. Pat Quinn saying health workers only need to be quarantined if they've been directly exposed.
But the federal standards do little to counter what is emerging as a patchwork of state rules for people who return from West Africa after contact with Ebola patients.
Nearly a half-dozen states have already created policies that require potentially exposed health workers to limit contact with the public.
New Jersey's approach – one of the most stringent in the country – came under particularly harsh criticism from nurse Kaci Hickox, who said she felt her “basic human rights” had been violated after she was quarantined on Friday.
New Jersey Gov. Chris Christie (R) on Monday said he would allow Hickox to return to her home in Maine, but insisted he was not reversing his policy. He also said health workers could be quarantined at home instead of makeshift sites at airports and hospitals, such as the one Hickox was first put in.
Spencer, the New York City doctor, is only the third international staff member from Doctors Without Borders to contract the disease out of 700 workers.
Doctors Without Borders, also known by its French name, Médecins Sans Frontières, said Monday that the harsh state policies are already prompting some of its volunteers to reduce the length of their commitment.
“We need to be guided by science and not political agendas,” Dr. Joanne Liu, the group's international president, wrote in a statement. She warned that other countries could follow suit and enact similarly “short sighted” rules.
She stressed that diligent monitoring was a far better policy than “coercive isolation of asymptomatic individuals.”
This story was updated at 5:58 p.m.