Maryland Ebola Quarantine Policy is a ‘Measured Approach’ Driven by Science Instead of Fear

October 30th, 2014 by Maggie Davis

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Last week, the United States Centers for Disease Control and Prevention (CDC) implemented its Active Post-Arrival monitoring program to prevent a domestic Ebola outbreak. Under this program, the six states—which includes Maryland, New York, and New Jersey—that see approximately 70% of travelers from West African countries affected by the Ebola epidemic were asked to begin actively monitoring travelers from impacted countries for 21 days.

In days following this announcement, controversial quarantine resulted in Nurse Kaci Hickox’s confinement in an isolation tent at a New Jersey Hospital while medical experts and government leaders debated how best to monitor healthcare workers returning from West Africa. The New England Journal of Medicine released an editorial this week condemning quarantine policies in New York and New Jersey as “not scientifically based…and will impede essential efforts to stop these awful outbreaks of Ebola disease at their source.”

According to the physicians who wrote the New England Journal of Medicine article, Dr. Craig Spencer who is the only current Ebola patient in the United States acted in an appropriately prudent manner and never put the public at risk of exposure. Spencer was criticized for not quarantining himself in his home while he had been actively monitoring symptoms, although he contacted the appropriate public health authorities when he started experiencing active symptoms. He was transported to an isolation unit at Bellevue Hospital by an EMS HAZ TAC unit that was notified of Spencer’s risk and wore the appropriate Personal Protective Equipment (PPE).

A major criticism of state imposed quarantines for asymptomatic healthcare workers returning from West Africa is that these policies will dissuade healthcare workers from volunteering. With limited equipment and personnel, many healthcare professionals are concerned that a drop in volunteers traveling to West Africa will make the outbreak even harder to control. Some estimate that 90,000 people could die in Liberia alone if the global response is not accelerated.

Generally, public health officials state that Ebola is not contagious until a patient begins showing active symptoms of the disease, such as fever. This guidance drives the current Ebola monitoring policies by the CDC. Under the CDC Active Monitoring program, any person that traveled to an impacted country, such as Liberia, will undergo a 21 day period of monitoring for Ebola symptoms. Each traveler will receive a Check And Report Ebola (CARE) kit, which provides a log to track symptoms, a thermometer and a CDC issued identification card with a unique identification number. Then, returning travelers will report their health status to state and local public health officials daily.

On Monday, Maryland Governor Martin O’Malley announced the state’s new policy for actively monitoring all travelers returning from African countries impacted by the Ebola outbreak. Unlike the New York and New Jersey policies, which forced returning healthcare workers into physical quarantines, the Maryland policy is driven by a medical understanding of Ebola and is very close to the national CDC active monitoring policy.

The Maryland Department of Health and Mental Hygiene will monitor these travelers for the 21 day period and is working with public health officials at the local level to respond if active symptoms appear. Under this monitoring program, travelers are broken into four risk categories by the CDC. Travelers at the “high risk” category include those who had known exposure to the Ebola virus by having contact with bodily fluid from an infected person to a needle-stick injury.  These high risk travelers will be asked to self-quarantine at home during their 21 day monitoring period.

Healthcare workers returning from affected countries that did not have a known exposure, however, are categorized at a lower level and are being asked to refrain from attending mass gatherings, using public transportation, or traveling long distances without approval from the health department, during the 21 day monitoring period.

Maryland’s approach to monitoring healthcare workers returning from West Africa has been praised by several members of the Maryland medical community. Dr. Paul Rothman, who serves as Dean of the Medical Faculty at Johns Hopkins Medicine, was “pleased to see the measured approach that Maryland is implementing to assess healthcare workers returning from West Africa.”

The Maryland Hospital Association similarly supports the state’s policy, saying that it “strikes a critical balance between the need to closely monitor potential high- and medium- risk healthcare workers, and the need to have the right number of health care providers available to quell the virus at its source in West Africa and to take care of potential Ebola patients here in Maryland.”

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