Wrong Policy

The Wrong Policy for the Wrong Reasons

New York and New Jersey’s mandatory Ebola quarantine is about politics, not public health.

By Josh Voorhees

As of late Sunday night, Kaci Hickox remained in an isolation tent at a New Jersey hospital in circumstances she described as “inhumane.” Hickox, a nurse who had been working with Doctors Without Borders in Sierra Leone, has twice tested negative for the Ebola virus. Even so, she has been involuntarily isolated under a mandatory 21-day quarantine instituted for anyone who arrives in New Jersey or New York from West Africa after having contact with an Ebola patient. But that quarantine, imposed by Gov. Chris Christie and Gov. Andrew Cuomo, appears to be less about public health than the politicians’ own public images.

“It was my conclusion that we needed to do this to protect the public health of the people of New Jersey,” Christie said on Fox News Sunday, adding that he was having “no second thoughts” about the decision. Cuomo, meanwhile, appeared to soften his stance slightly in the face of a weekend’s worth of White House pressure, announcing his state would allow asymptomatic individuals to be quarantined at home, where family can join them and friends can visit. The state will also compensate the medical workers for any income lost during those three weeks. “My No. 1 job is to protect the people of New York, and this does that,” Cuomo said Sunday night, adding, “It's a home quarantine but it is a mandatory quarantine.” Following Cuomo’s press conference, Christie’s office released a statement saying that home quarantines were always an option for state residents without any symptoms. Hickox, however, lives in Maine, and so New Jersey authorities may well confine her in the Garden State for three weeks.

If Cuomo, a Democrat, and Christie, a Republican, do believe they’re acting in the public’s best interest, then they haven’t done their research. Public health experts have made it clear that quarantining asymptomatic individuals will do little if any good. More troubling is the risk of a cascade of unintended consequences that could make it more difficult to contain the virus in West Africa, where it has already claimed more than 5,000 lives and will likely claim thousands more.

At best, the bipartisan pair is giving in to the fears of a misinformed public. At worst, Christie and Cuomo—whose respective presidential ambitions are no secret—are capitalizing on those fears to score cheap political points by appearing to be guardians of their constituents’ safety. The chance to bolster their respective profiles appears too good for them to pass up, even if such gains are paid for by risking West African lives.

The most serious concern is that the new policies will make doctors and nurses less likely to volunteer to go to Liberia, Sierra Leone, and Guinea. American medical workers are crucial to international efforts to contain an outbreak that the World Health Organization warns could result in 10,000 new cases a week before the end of the year. The American presence in West Africa helps at home, too. Containing the virus there is the only way to guarantee that it does not spread globally, and that cases do not continue to reach U.S. soil.

That already difficult task becomes a much bigger challenge if American doctors and nurses know they’ll lose the better part of a month to a quarantine at the end of their trip. “All of us need to make clear what these health workers mean to us and how much we value their services, how much we value their contribution,” Samantha Power, the U.S. Ambassador to the United Nations, said on NBC’s Meet the Press. “We need to make sure they are treated like conquering heroes and not in any other way.”

Hickox didn’t receive anything resembling a hero’s welcome when she landed at Newark Liberty International a few days ago. As she documented in an op-ed in the Dallas Morning News, her arrival was met with something between confusion and hostility. “This is not a situation I would wish on anyone, and I am scared for those who will follow me,” she wrote. ”I am scared about how health care workers will be treated at airports when they declare that they have been fighting Ebola in West Africa. I am scared that, like me, they will arrive and see a frenzy of disorganization, fear and, most frightening, quarantine.” Don’t expect to see that blurb on a Doctors Without Borders brochure. (New York’s income-reimbursement policy will reduce the burden on returning health workers, but it will do little to ease the stigma that is associated with a mandatory isolation.)

It’s not just the long-term risks that make forced quarantines bad policy. There’s also good reason to believe that Christie and Cuomo are offering a solution when there’s no problem to begin with.

The ostensible logic behind their mandatory quarantines is that health workers can’t be trusted to self-report potential Ebola symptoms voluntarily. “I don't believe that when you're dealing with a serious situation like this that we can count on a voluntary system,” Christie told Fox. “This is the government's job.”

In reality, all three health professionals who developed Ebola symptoms while in the United States were quick to alert authorities. Nina Pham and Amber Vinson, the two nurses who were infected while treating Liberian Thomas Eric Duncan in Dallas, were admitted to the hospital earlier this month while displaying low-grade fevers—an early sign of Ebola but one that occurs before someone becomes contagious. (Even Vinson, who sparked fears by flying to and from Cleveland, only boarded the flights after getting the green light from authorities, a decision the CDC has since suggested was a mistake.) To date, no one who came into contact with either nurse has become infected. And even Duncan, who wasn’t a trained medical professional, went to a Dallas emergency room at the first sign of his own symptoms—only to be sent home by an unprepared hospital.

Likewise, Craig Spencer, the New York City doctor who was diagnosed on Thursday after returning from Guinea, was transported to Bellevue Hospital immediately after falling ill. According to New York City Health Commissioner Mary Travis Bassett, Spencer had a fever of 100.3—just below the 100.5 threshold at which doctors believe a patient is contagious. Meanwhile, city health officials proved that they’ve learned from the early mistakes that were on display in Dallas. The paramedics who went to get Spencer wore protective suits, and he was quickly placed in a state-of-the-art isolation ward. While health officials will continue to monitor those who came in contact with Spencer for the virus’ full 21-day incubation period, there’s been nothing to suggest that the virus spread, which happens only through contact with bodily fluids.

In all three cases, trusting health workers appears to have paid off. That shouldn’t be a surprise—after all, it is the doctors and nurses who have been exposed to Ebola that know firsthand just how horrible a virus it is. Hickox, for one, says she spent her final night in West Africa treating a 10-year-old girl. “I coaxed crushed tablets of Tylenol and an anti-seizure medicine into her mouth as her body jolted in the bed,” Hickox wrote. “It was the hardest night of my life.”

Christie and Cuomo’s quarantine isn’t just a bad policy. It’s also being implemented poorly. Two days after the pair made their announcement at a hastily called press conference, details of how the quarantine will work remained hard to come by. Medical workers who fly in to JFK or Newark are expected to be isolated, but it is unclear if the states will take the same measures for Ebola-exposed travelers who enter the state by other means. That uncertainty was only amplified Sunday when both states clarified that individuals could be quarantined in their homes, but neither governor spelled out how such quarantines would work in regards to family members who live in the same dwelling.

The White House asked both Christie and Cuomo to reverse their original policies, and it’s unlikely the administration will be completely satisfied with the clarified home-isolation protocol. Meanwhile, the federal government is moving ahead with its own new policy, one that will require anyone returning from Sierra Leone, Liberia, or Guinea to routinely check in with local health authorities, and to provide details of where they’ll be staying during the three weeks after they arrive.

The federal plan splits the difference between New York and New Jersey’s overheated response and Dallas’ lack of one. What’s worrisome is that Christie and Cuomo’s shortsighted policy could catch on in other states. Already, Illinois Gov. Pat Quinn has issued his own emergency order calling for similar mandatory quarantines. Other governors could follow suit, further muddling the government’s response to a virus that has yet to spread to a single American outside of a hospital.

“We don’t need politicians to make these kinds of decisions,” Hickox told CNN on Sunday from her isolation tent inside Newark’s University Hospital. “We need public health experts to make these decisions.” Let’s hope Hickox’s message gets through, and that Christie and Cuomo recognize that they’re not the right men for this job.