The US Centers for Disease Control and Prevention is issuing new guidelines for how states should deal with people at risk of contracting Ebola. The CDC now recommends that those with a high risk of exposure voluntarily isolate themselves and agree to be actively monitored for symptoms. Few people in the US will fall into the high-risk group, as the CDC defines it as people who have cared for an Ebola patient without protective equipment and people who have been stuck with a needle used by someone else exposed to the virus.
"These are based on science."
That means healthcare workers returning from West Africa do not fall into the "high risk" group, the CDC says. It does not recommend that they undergo a voluntary isolation. Instead, healthcare workers should undergo what it calls "direct active monitoring," where local authorities work with them to monitor the emergence of possible symptoms. That monitoring should be done on a case-by-case basis; in some cases, that may mean returning healthcare workers should limit use of public transit or their presence at work or other areas where people congregate.
The recommendations follow days-old policies in New York and New Jersey, which require that healthcare workers are quarantined for 21 days following their return. New Jersey was particularly subject to criticism for keeping one returning nurse in quarantine for several days, even though she had no symptoms. According to CNN, the nurse is finally being released today. The nurse says that the quarantine felt like a violation of her "basic human rights" but is undecided about pursuing legal action. The New York Times reports that both states have since slightly lightened the policy, allowing the quarantined person to spend the monitoring period at home.
The policies in New York and New Jersey have been criticized by health experts who feel that the strict measures are unnecessary for public protection. While the CDC has not directly spoken to these policies, it stresses that its own guidelines are based on science and its continued experience with Ebola. "They have a strong level of protection and a strong level of assurance," CDC director Tom Frieden explains on a call explaining the new guidelines to reporters. Between regular monitoring and the information that it's providing to all travelers returning from West Africa, Frieden says, these measures are "what we think will be most protective of healthcare workers and their families."
"If [local governments] wish to be more stringent than what the CDC recommends, that's within their authority," Frieden says, "but these are based on science."
"If we turn them into pariahs ... things may happen that none of us want to happen."
The CDC seems relatively opposed to the required isolation of healthcare workers, fearing that doing so could ultimately reduce safety. "We have to recognize that it we do things that make it too difficult for people to come back, if we turn them into pariahs instead recognizing the heroic work that they're doing, a couple of things may happen that none of us want to happen," Frieden says. He's concerned that healthcare workers may not disclose the work that they've been doing, thus avoiding Ebola monitoring altogether. He's also concerned that healthcare workers will be less likely to go to West Africa to help battle Ebola and stop the virus there. In both cases, he says, "The risk to us would increase."
Only around 100 people per day have been returning to the US from West Africa, with 5 to 6 percent of those being returning healthcare workers. The CDC has prior guidelines recommending what type of monitoring returning travelers should undergo, but these updated recommendations address people with different risk of infection in more detail. Existing rules that require people traveling from West Africa fly through select airports and receive enhanced screenings still stand.
"I understand that people are afraid. Ebola is unfamiliar. It is a severe disease," Frieden says. "But it is not highly contagious."