WASHINGTON (AP) — The quarantine of a nurse in Maine who recently returned from the Ebola hot zone in West Africa has touched off a battle between the authority of states to confine people to protect public health and the right of Americans to move about freely.
Kaci Hickox, who returned to the U.S. last week after treating Ebola patients in Sierra Leone, is defying Maine's efforts to quarantine her at home until the 21-day incubation period for developing the deadly disease has passed. Some questions and answers about Hickox and the legal underpinnings in this tug-of-war between public health and civil liberties.
Q: Why all the attention to Hickox, when so many U.S. medical workers have been helping out in West Africa?
A: Timing. The 33-year-old nurse was the first U.S. medical worker returning from West Africa to get caught up after several states went beyond federal Ebola guidelines and established quarantine rules covering all those who have had contact with Ebola victims in Africa. When Hickox's flight arrived in New Jersey, the state put her in mandatory quarantine in a tent, then released her after three days to complete her journey home to Maine by private car. In Maine, state officials said she should stay in quarantine at home for the rest of the 21-day incubation period.
Q: What's wrong with that?
A: Hickox says a quarantine is unnecessary and is no way to treat health-care workers who've been fighting a scourge. A preliminary test in New Jersey found no evidence she had Ebola, and she's exhibiting no symptoms of the disease. People infected with the virus are not contagious until they have symptoms.
Q: What's the argument in favor of quarantine?
A: Maine Health and Human Services Commissioner Mary Mayhew says the federal government's screening of travelers returning from West Africa has been of limited effectiveness, pointing to the New York doctor who developed symptoms several days after returning home. Mayhew says an in-home quarantine for those who have had direct contact with Ebola patients is a "reasonable, commonsense approach" to avoid a public health crisis.
Q: Can states do that?
A: In general, state and local health departments have broad authority to issue quarantine and isolation orders when needed to protect public health, although the specific rules vary from state to state. That quarantine authority predates the drafting of the Constitution, going all the way back to the colonies, and is part of what's known as the police powers that states have to protect public health and safety.
Q: That's an awesome power. What kind of limits are there on that quarantine authority?
A: The courts have said that imposing a quarantine is a massive deprivation of liberty that can only be done if there's an individual assessment that a person poses a significant risk to the public based on scientific evidence, according to Georgetown Law School Professor Lawrence Gostin, who wrote a textbook on public health law. "You can't simply deprive an American of their freedom for three weeks based upon an abundance of caution, or a political imperative or public reassurance," he says. "Liberty matters much more than that in the United States."
Q: How does that apply in the Maine case?
A: That will probably be left for the courts to sort out, and there are arguments on both sides. Peter Jacobson, a University of Michigan professor of health law and policy, says no state public health official wants to be in the position of not taking sufficient action to avoid the spread of Ebola, and judges will be loathe to overrule the judgment those medical officials. Gostin, for his part, thinks Maine over-reached by issuing a quarantine rule that covers a broad class of people, and says judges are likely to give strong weight to the looser guidance of the federal Centers for Disease Control and Prevention.
Q: What does CDC recommend?
A: It says mandatory quarantines of those without symptoms are unnecessarily severe and will discourage health workers from going to West Africa to fight the epidemic. It says people at the highest risk of contracting Ebola but who have no symptoms — such as those who came into direct contact with an Ebola patient's body fluids — should avoid public transportation and public places like shopping centers and movie theaters, even if they have no symptoms. Activities like jogging, in which the person maintains a 3-foot distance from others, are allowed. For health workers who wore appropriate protective equipment, the CDC recommends such steps be decided on a case-by-case basis.
Q: Back to Hickox: What exactly did she do in Sierra Leone?
A: She wrote in the Dallas Morning News that she "spent a month watching children die, alone. ... I tried to help when much of the world has looked on and done nothing." On her last night in an Ebola center, she wrote, "I was called in at midnight because a 10-year-old girl was having seizures. I coaxed crushed tablets of Tylenol and an anti-seizure medicine into her mouth as her body jolted in the bed. It was the hardest night of my life."
Q: With mandatory quarantine rules for Ebola health workers who've been in West Africa taking effect in a number of states, are more challenges likely?
A: You bet.
AP Medical Writer Lauran Neergaard contributed to this report.
CDC guidelines: http://www.cdc.gov/vhf/ebola/exposure/monitoring-and-movement-of-persons-with-exposure.html
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