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EbolaLack of federal authority makes fashioning coherent national Ebola policy difficult

Published 30 October 2014

Earlier this week, the Centers for Disease Control and Prevention(CDC) issued new guidelines on how states should deal with travelers from Ebola-stricken regions, but a lack of federal authority to mandate such guidelines has led to conflicting strategies, varying from state to state, which includes mandatory at-home quarantine for some travelers. Under current U.S. law, the states have the authority to issue quarantine or isolation policies, and they also control the enforcement of these policies within their territories.

Thomas Duncan's apartment patroled by security personnel // Source: tempo.co

Earlier this week, the Centers for Disease Control and Prevention (CDC) issued new guidelines on how states should deal with travelers from Ebola-stricken regions, but a lack of federal authority to mandate such guidelines has led to conflicting strategies, varying from state to state, which includes mandatory at-home quarantine for some travelers. Under current U.S. law, the states have the authority to issue quarantine or isolation policies, and they also control the enforcement of these policies within their territories. “It goes back to federalism,” said Felice Batlan, a professor and associate dean for the Chicago-Kent College of Law. “This is federalism on hormones, in that you have these multiple jurisdictions that all have the power to regulate,” Batlan said of various states’ approaches to Ebola.

The CDC recommends the monitoring of travelers based on four levels of potential Ebola exposure, from high risk to no risk. Quarantine is not recommended for travelers who prove to be symptom-free. “We base our decisions on science and experience,” CDC director Dr. Thomas Frieden said in a recent news briefing. Quarantines could lead travelers to hide their travel histories and discourage medical workers from going to West Africa to fight Ebola. “If we turn them into pariahs instead of recognizing the heroic work they’re doing,” Frieden said, “they may be less likely to go and stop” Ebola at the source.

According to the Los Angeles Times, Maine, Minnesota, New York, New Jersey, Illinois, and Georgia already have quarantine measures in place for travelers from Ebola-stricken regions, including those who are not symptomatic. Pennsylvania, Florida, and Virginia airports will perform enhanced screening of travelers from West Africa, and high-risk individuals will be subject to bans on the use of public transportation. Still, the CDC is hoping that states will adopt a unified protocol for dealing with at-risk Ebola patients.

It’s a very ineffective way” to assure Americans’ safety in a public health emergency, said Lawrence Gostin, a public health expert at Georgetown University. “We need to have much more uniformity in funding of local health departments. And we need to make sure procedures are standardized across states and the country. At the moment there’s just far too much variability.”

New Jersey has released Kaci Hickox, an asymptomatic nurse who had been working with Ebola patients in Sierra Leone and was ordered into quarantine when she arrived in Newark. Hickox has now traveled home to Maine by private vehicle in accordance with New Jersey’s rules. Maine health officials note that Hickox will be quarantined in her home twenty-one days after her last exposure to Ebola patients.

On Hickox’s forced quarantine and similar measures adopted by some states, “the governors have it wrong,” said Jeffrey M. Drazen, the editor in chief of the New England Journal of Medicine. “The governors’ action is like driving a carpet tack with a sledgehammer. It gets the job done but overall is more destructive than beneficial,” said the editorial written by Drazen and a team of Journal editors.

States’ quarantine policies can lead to inconsistencies, said Trish Perl, a professor of medicine at Johns Hopkins University and senior epidemiologist for the Johns Hopkins health system. According to Perl, under New York’s policy towards at-risk Ebola patients, health workers coming from West Africa would be quarantined, but not those exposed to Ebola in U.S. hospitals. Healthcare workers treating New York’s Ebola patient, Craig Spencer, are not restricted from moving around the city, but they would be quarantined if they came back from treating patients in West Africa.