On Friday, the governors of New York and New Jersey announced mandatory quarantines in both states for medical workers and others returning to the United States from the Ebola-ravaged countries in West Africa. They were acting swiftly, New Jersey Gov. Chris Christie (R) said, because they had to do so. “We simply were not satisfied” with the federal guidelines, Christie said. New York Gov. Andrew Cuomo (D) echoed this, saying that there was a “need to go further” than the existing rules. They were acting because action was needed, they said.
The mandatory quarantines were not particularly well-received. So within days, the governors acted swiftly in walking back some of their rules and actions, responding to broad criticism from a range of aid groups and medical experts by changing things while denying that they had changed much of anything.
This confusion in New York and New Jersey speaks to a problem that crops up when facing immediate dangers from long-term problems. There is a need for elected leaders to act, to show forceful and decisive leadership, because failure to act leaves one open to consequences both real (what if additional cases occurred and they did nothing to stop it?) and less consequential (what if they are viewed as being too slow to act? Won’t someone think of the optics?). Taking a bold stance against the spread of Ebola in the United States is a more immediate concern for governors looking to keep their states safe and appear active in doing so; what these actions would mean for the ongoing fight against Ebola becomes less important in this scenario.
Part of the reason for action, of course, is because people are worried, and when people are worried about something they want to know that someone, somewhere, is doing something about it. In this case, people are concerned about Ebola, with about four in 10 Americans worried about getting the virus or someone in their family getting it, according to a recent Pew survey. Leaders have to act so that the worried public knows someone is in charge.
Of course, there are concerns. The chief issue raised by various groups was that mandatory quarantines would hinder the response to Ebola in West Africa, causing people who would otherwise go to think twice. The prime reason for these concerns, and the loudest argument being made against mandatory quarantines, is based on simple math: More people fighting Ebola in West Africa means better odds that the outbreak is stemmed. If the outbreak is not stemmed, they say, it becomes more likely that other cases are diagnosed here and in other parts of the world.
“Any regulation not based on scientific medical grounds, which would isolate healthy aid workers, will very likely serve as a disincentive to others to combat the epidemic at its source, in West Africa,” Sophie Delaunay, executive director of Doctors Without Borders in the United States, said in a statement. Mandatory quarantines “may do more harm than good by creating additional barriers to effective treatment of patients with Ebola and impede global efforts to contain and ultimately prevent further spread of the disease,” the American College of Physicians said in a statement. These quarantines would “lead to increased difficulty in assembling care teams in West Africa and the U.S.,” the Association for Professionals in Infection Control and Epidemiology said. An editorial in the New England Journal of Medicine said that these quarantines are “unfair and unwise, and will impede essential efforts to stop these awful outbreaks” in West Africa. On and on it went.
Much of the initial debate centered on New Jersey, where such a quarantine was seen in practice rather than debate. Kaci Hickox, a nurse who had flown to Newark after treating patients in Sierra Leone, was placed into isolation Friday despite not having any symptoms. She tested negative the following day for Ebola, but was quarantined and placed in a tent. Hickox was ultimately released Monday after being symptom free for 24 hours, the N.J. Health Department said in a statement, though it is unclear why this time frame was cited.
Hickox was not particularly pleased with the quarantine. “This is an extreme that is really unacceptable, and I feel like my basic human rights have been violated,”she told CNN. After Christie told reporters that Hickox was “obviously ill,” she told CNN: “First of all, I don’t think he’s a doctor.” (As my colleague Nia-Malika Henderson put it: Kaci Hickox 1, Chris Christie 0.)
Cuomo had revised his state’s policy on Sunday, saying that health-care workers who had no symptoms but had been exposed to Ebola patients could return to their homes, where they would have to remain. A day later, New Jersey opted to release Hickox and let her travel to Maine. Though Christie had said Friday that Hickox would be quarantined “in New Jersey or New York,” and said that they had the legal authority to do that, he still insisted Monday that he had not changed his policy. “I didn’t reverse my decision,” he told reporters in Florida during a campaign event for Gov. Rick Scott. “Why are you saying I reversed my decision? If she was continuing to be ill, she’d have to stay.”
By Monday, the Centers for Disease Control and Prevention had released its own revised standards, which called for direct monitoring of “high-risk” individuals but not quarantines. Christie, speaking to the Today Show on Tuesday, continued arguing in favor of the New Jersey policy, claiming that the CDC was slowly “moving towards our position.” He also criticized the CDC for its response and added: “This is because they don’t want to admit that we’re right and they were wrong. I’m sorry about that.”
The end result, though, is that there are still different guidelines governing different states and people around the country. The CDC has its guidelines, New York and New Jersey have settled on some form of quarantines that are stricter than these rulings, and states from Illinois to Virginia have their own rules. In effect, a person flying back to the United States from West Africa could encounter very different rules depending on what airport they choose. It is unclear if this will be sorted out, as the push and pull between politics and science persists here while an outbreak rages in West Africa. Additional cases are likely coming to the United States, and with them fears, a desire for swift action and the possibility of yet another new policy somewhere.