The nurse quarantined in New Jersey is expected to be released — sort of.
The office of New Jersey Governor Chris Christie has announced that Kaci Hickox will be discharged and allowed to return home to Maine:
After consulting with her, she has requested transport to Maine, and that transport will be arranged via a private carrier not via mass transit or commercial aircraft. She will remain subject to New Jersey’s mandatory quarantine order while in New Jersey. Health officials in Maine have been notified of her arrangements and will make a determination under their own laws on her treatment when she arrives.
If Hickox subsequently turns out to be infected, then Maine Governor Paul LePage will be responsible for managing any public health threat. (Christie’s statement suggests that Maine officials were not consulted.)
Many major news accounts focus not science or public health policy but rather on the political aspects of quarantines, including Hickox’ threat to file suit alleging that her quarantine somehow violated her civil rights.
Here are some examples.
The WSJ’s Josh Dawsey says
Mr. Christie had faced criticism in recent days after the nurse, Kaci Hickox, documented her isolation in Newark. He had also faced sharp attacks from medical health professionals and civil liberties groups on the mandatory quarantine for travelers returning from Ebola-ravaged countries.”
The criticism to which Dawsey alludes is attributed to unidentified “public health officials” who allege that quarantines could discourage American health care workers from traveling to West Africa to help contain the outbreak. While such an adaptive response might occur, it would not if the government made quarantine on US re-entry relatively pleasant. (The marginal cost of making quarantine pleasant is likely to be very small.)
A more immediate and predictable outcome is that American health care workers will choose not to reenter the US via Newark Liberty International Airport. Not coincidentally, this also solves the policy problem for Governor Christie.
ABC News John Margolin cites Hickox’ civil rights attorney Norman Siegel as if he were a medical expert giving policy advice:
“Medically speaking there’s no reason for the state of New Jersey to keep her quarantined,” Siegel said outside the hospital on Sunday. “She very simply wants to be released. We will advocate for the state of New Jersey and the governor to release her as soon as possible.”
Margolin also cites a senior federal public health official who objects to the States’ decisions to quarantine on the ground that it is inconsistent with his public policy views:
“As a scientist and as a health person, if I were asked I would not have recommended [mandatory quarantines],” Dr. Anthony Fauci, director of NIH’s National Institute of Allergy and Infectious Diseases, said [Sunday] on “This Week.”
NBC News also reports Fauci’s remarks, but accompanies them with the results of a Today Show poll (of unreported quality) showing that the public supports quarantines 94% to 6%.
The New York Times’ Benjamin Weiser and J. David Goodman describe quarantines as rare and ineffective, but cite no evidence for the latter assertion. The “sharp criticism” they mention comes from “public health advocates and civil liberties lawyers.” The Times’ Matt Flegenheimer, Michael D. Shear and Michael Barbano imply that New York Governor Cuomo capitulated under pressure from the White House, saying “on Sunday night appeared to try to dial back his rhetoric and stake out a middle ground.” They describe Governors’ Cuomo and Christie as having “drawn withering criticism from many medical experts,” none of whom they identify. Meanwhile, they report that both governors deny having been pressured.
The substantive issue with all quarantines is the manner in which they are implemented. Hickox’ first-person account is mostly about the medical and logistical incompetence of government officials she encountered and the disrespect she says they showed her. Both are predictable attributes of a rushed policy implemented substantially by unqualified people.
Why the New Jersey quarantine was implemented badly is suggested by Flegenheimer et al.:
The Cuomo and Christie administrations began seriously considering a quarantine on Tuesday, aides said, after federal officials decreed that travelers returning from countries affected by Ebola in West Africa could enter the United States only at five designated airports, including Kennedy and Newark Liberty International.
Mr. Christie had grown increasingly frustrated by mid-October, aides said, over the failure of medical professionals to properly isolate themselves on a voluntary basis after returning from West Africa.
He was startled to learn that Dr. Nancy Snyderman, an NBC News correspondent who had traveled to Liberia and whose cameraman had contracted Ebola, left her home in Princeton, N.J., on Oct. 9 to pick up food at a favorite local restaurant.
When a doctor, Craig Spencer, tested positive in New York City on Thursday, the two governors watched as city officials strained to trace his every movement — on the subway, at a bowling alley, at a meatball shop.
What appeared to be a triumph of meticulous forensic work by city health officials, in retracing Dr. Spencer’s every step late last week, looked like a potential nightmare to governors who suddenly contemplated having to repeat such an exercise over and over.
Faced with a federal government directing travelers from West Africa to New York and New Jersey airports, but unwilling to implement a plausibly effective screening regime (it failed to intercept Craig Spencer) , it is unsurprising that Cuomo and Christie acted on their own and with relatively little accommodation of health care workers returning from West Africa. It is easier to relax travel restrictions in cases where it appears reasonable to do so than it is to tighten those restrictions in the handful of cases where the severest restrictions are justified. Some of those cases are likely to involve health care workers returning from West Africa.
A reasonable expectation is that more States will enact travel restrictions in the form of quarantines similar to those imposed by Governors Cuomo and Christie. Officials in Connecticut, Florida, Illinois and Virginia have already done so. More are likely to follow until the federal government acts to effectively restrict entry to the US.