Kaci Hickox- what side are you on? Mandatory quarantine or not?

[JBaxter]

From the current CDC web page on Ebola, concerning high risk,asymptomatic people (which this nurse is) -

Asymptomatic individuals in the high risk category should have direct active monitoring for 21 days after the last potential exposure. The individual should be ensured, through public health orders as necessary, to undergo direct active monitoring, have restricted movement within the community, and not travel on any public conveyances. Non-congregate public activities while maintaining a 3-foot distance from others may be permitted. These individuals are subject to controlled movement which will be enforced by federal public health travel restrictions; travel, if allowed, should occur only by noncommercial conveyances, with coordination by origin and destination states to ensure a coordinated hand-off of public health orders, if issued, and uninterrupted direct active monitoring.

Direct, active monitoring, which is being done. Restricted movement, also being done. NIH has similar guidelines. So we are ignoring our biggest healthcare resources, a world renowned infectious disease doctor, and common sense to follow fear and politicians. Embarrassing....

I think she didnt want to agree to those. There is a court order now She must stay 3 ft away from people no public transportation or trips ( or so the news said)
AP.. A judge signed a temporary order Thursday limiting Hickox's movement until a further court order expected Friday. For now, police are monitoring Hickox and her public interactions but cannot detain her.

Hickox, who treated Ebola patients in Sierra Leone, says confinement violates her rights. She says that she has no symptoms and poses no risk to the public.

The state is seeking to limit her travel, keep her out of public places, and require a 3-foot buffer if she comes into contact with people.

The quarantine attempt is shaping up as the nation's biggest test case yet in the struggle to balance public health and fear of Ebola against personal freedom.

[westwoodmom04]

From the current CDC web page on Ebola, concerning high risk,asymptomatic people (which this nurse is) -

Asymptomatic individuals in the high risk category should have direct active monitoring for 21 days after the last potential exposure. The individual should be ensured, through public health orders as necessary, to undergo direct active monitoring, have restricted movement within the community, and not travel on any public conveyances. Non-congregate public activities while maintaining a 3-foot distance from others may be permitted. These individuals are subject to controlled movement which will be enforced by federal public health travel restrictions; travel, if allowed, should occur only by noncommercial conveyances, with coordination by origin and destination states to ensure a coordinated hand-off of public health orders, if issued, and uninterrupted direct active monitoring.

Direct, active monitoring, which is being done. Restricted movement, also being done. NIH has similar guidelines. So we are ignoring our biggest healthcare resources, a world renowned infectious disease doctor, and common sense to follow fear and politicians. Embarrassing....

I'm pretty sure she has refused to agree to most of this other than active monitoring, hence the court order. The CDC is currently categorizing all returning health care workers under a different category, medium risk.

Here's the high risk standards, which the CDC describes as involving a voluntary quarantine:

Travelers will now be placed into four categories, based on their level of risk of developing Ebola, CDC Director Dr. Tom Frieden said today at a news conference. People will be considered to fall into the "high risk" category of developing the deadly disease if they are known to have had direct contact with an Ebola patient, Frieden said. For example, a health care worker who was stuck with a needle while caring for an Ebola patient, or a person who helped to care for a family member with Ebola, would fall into this group.

People at high risk will be recommended to voluntarily quarantine themselves in their homes, and should undergo "direct active monitoring" of their health, Frieden said. This means that, daily, a public health authority should observe the person's temperature check, as well have conversations with the person about how they are feeling. The individual will go through a detailed list of symptoms, and discuss what activities they have planned.

Here's the lower risk category:

The second category consists of people at "some risk" of developing the disease, such as returning health care workers who were caring for Ebola patients. People in this group are recommended to also undergo direct active monitoring, and local public health authorities should determine, based on the person's individual situation (such as exactly what the person's Ebola exposure may have been, and how quickly they could be isolated if they were to develop symptoms), whether the person should be recommended to avoid public transportation, their workplace, or public gatherings, during their monitoring period.

This category was added in the last week as a response to the governor's actions in NY and NJ last weekend. Really the dispute is whether the states can put returning health care workers with direct patient contact into the high risk category, and mandate a quarantine if a person refuses to do a voluntary quarantine.

[SnuggleBuggles]

I'm pretty sure she has refused to agree to most of this other than active monitoring, hence the court order. The CDC is currently categorizing all returning health care workers under a different category, medium risk.

Here's the high risk standards, which the CDC describes as involving a voluntary quarantine:

Travelers will now be placed into four categories, based on their level of risk of developing Ebola, CDC Director Dr. Tom Frieden said today at a news conference. People will be considered to fall into the "high risk" category of developing the deadly disease if they are known to have had direct contact with an Ebola patient, Frieden said. For example, a health care worker who was stuck with a needle while caring for an Ebola patient, or a person who helped to care for a family member with Ebola, would fall into this group.

People at high risk will be recommended to voluntarily quarantine themselves in their homes, and should undergo "direct active monitoring" of their health, Frieden said. This means that, daily, a public health authority should observe the person's temperature check, as well have conversations with the person about how they are feeling. The individual will go through a detailed list of symptoms, and discuss what activities they have planned.

Here's the lower risk category:

The second category consists of people at "some risk" of developing the disease, such as returning health care workers who were caring for Ebola patients, but who did not have direct contact with the sick person themselves. People in this group are recommended to also undergo direct active monitoring, and local public health authorities should determine, based on the person's individual situation (such as exactly what the person's Ebola exposure may have been, and how quickly they could be isolated if they were to develop symptoms), whether the person should be recommended to avoid public transportation, their workplace, or public gatherings, during their monitoring period.

This category was added in the last week as a response to the governor's actions in NY and NJ last weekend. Really the dispute is whether the states can put returning health care workers with direct patient contact into the high risk category, and mandate a quarantine if a person refuses to do a voluntary quarantine.

Thanks for saving me the time to find the categories. They discussed them on the Diane Rhem show the other day.

[citymama]

I think she's courageous and heroic for her work in Africa. She's a nurse who has worked with dying Ebola patients. She knows exactly how awful this is, how to protect oneself and others. Chris Christie's decision was based on politics and not science, and by all accounts, her quarantine conditions were quite undesirable. I was impressed with how she succeeded in getting out of the quarantine, exposing the hypocrisy and bad science behind the quarantine, and getting back home. I don't think she is doing anything to endanger people, she has tested negative for Ebola. I consider her actions to be more civil disobedience than criminal.

[AngB]

So much for "limited gov't" from Christie, eh?

I am totally on the nurse's side on this and hope she sues the snot out of NJ. I do think this needs to make it's way through the court system, though, to set some precedents for other returning healthcare workers.

Quarantining the military also seems unnecessary but military personnel don't really have the same rights as civilians, many of them would joke about being "govt property" when DH was active duty.

[TxCat]

I think that's a false equivalence -- HIV is only transmitted via sexual contact or a blood transfusion where ebola can be transmitted via sneezes, vomit, diarrhea, sweat. HIV has a much longer incubation period, and time from infection to death if untreated is months or years. Ebola shows up within a week or two and can kill in a matter of days. People go from asymptomatic to symptomatic in a matter of hours, the CDC describes it as "abrupt" onset.

Sawyer did manage to infect some of those he came into contact with at the airport before being brought to the hospital(see the article in my last post). He also lied to the hospital workers about the nature of his disease initially.

In a perfect world, where people follow the guidelines strictly and everyone does exactly what they are suppose to, I would agree with you that we don't need quarantines. That isn't how the world works in reality however. Spencer and Vinson came very close to being out and about when symptomatic. Spencer initially lied to the first responders about the extent of his movements. We have a very small sample size here with only three cases where the incubation period has passed for contacts.

Incidentally, the CDC's own guidelines for quarantine do not require the subjects to be symptomatic (from the ebola guidance page):

Quarantine in general means the separation of an individual or group reasonably believed to have been exposed to a quarantinable communicable disease, but who is not yet ill (not presenting signs or symptoms), from others who have not been so exposed, to prevent the possible spread of the quarantinable communicable disease.



It's a bit of hyperbole to compare staying home for a three week incubation period to the Ryan White saga. Many, if not most, of the returning healthcare workers are being asked to stay home by their employers anyway.

According to your own articles, Sawyer was reported to have symptoms of the disease prior to leaving Liberia and according to multiple reports, was obviously very ill on arrival to Lagos. That's very different than people coming into contact with someone who is not yet showing symptoms. Additionally, there are no details about the level of contact those individuals had with Sawyer, which obviously changes the risk profile. That's still not equivalent to riding the same subway with a Ebola-infected individual who is yet to show symptoms.

I'm not equating the transmission and infectivity of HIV and Ebola, but I am equating some of the hysteria, panic, and knee jerk responses that surrounded them both in the early days. There was no reason in 1987 or 1988 to refuse to be in the same room with an HIV-infected individual, or have your kids in the same classroom. And yet, that's exactly what happened to all too many HIV-infected individuals, not just Ryan White. It seems ludicrous to us now because most of us know better. I wonder how we'll look back on the U.S. Ebola Panic of 2014 five years from now.

[JBaxter]

What part of SHE REGISTERED A FEVER at the airport is everyone missing? That was the reason she was detained in Newark. If it was an inaccurate reading then it was corrected and sent home to Maine to self quarantine. What was NJ supposed to do with they had a DR the day before who was supposed to be self monitoring running around NYC just a few hours before he spiked a fever and came down with Ebola. Then BAM another healthcare worker who had been treating Ebola patients gets off a plane registering a fever. I agree that it needs to be uniform but we have had 2 drs get ebola and a camera man. She's a nurse with CDC training. The risk may be low but I sure dont want her sitting next to my kids or going back to work before her 21 days are up.
I think had she not had the fever she would have continued to Maine with the assumption she would self monitor and stay away from people.
My sister runs and ER and they have Ebola protocol in place. Her staff has asked if they volunteer to treat if they can stay at the hospital and way from their family for the incubation period. I have no issue with her being required to stay out of public and away from people for the next 11 days. I hope to God she doesnt come down with it.

[westwoodmom04]

According to your own articles, Sawyer was reported to have symptoms of the disease prior to leaving Liberia and according to multiple reports, was obviously very ill on arrival to Lagos. That's very different than people coming into contact with someone who is not yet showing symptoms. Additionally, there are no details about the level of contact those individuals had with Sawyer, which obviously changes the risk profile. That's still not equivalent to riding the same subway with a Ebola-infected individual who is yet to show symptoms.

I'm not equating the transmission and infectivity of HIV and Ebola, but I am equating some of the hysteria, panic, and knee jerk responses that surrounded them both in the early days. There was no reason in 1987 or 1988 to refuse to be in the same room with an HIV-infected individual, or have your kids in the same classroom. And yet, that's exactly what happened to all too many HIV-infected individuals, not just Ryan White. It seems ludicrous to us now because most of us know better. I wonder how we'll look back on the U.S. Ebola Panic of 2014 five years from now.

I think we are talking across each other. Of course he was symptomatic. He was also in denial. My point is that is unreasonable to expect that every symptomatic person is going to act reasonably and promptly admit themselves through the proper channel the minute they develop symptoms. Most will, but there will be outliers. With something as infectious as ebola in the later stages, a conservative public health policy seems warranted. The CDC has already had several embarrassing incidents when it assumed perfect behavior and didn't get it -- i.e. the CDC totally overestimated the readiness of the Dallas hospital to handle an ebola patient, and as a result, two nurses got infected, thousands were spent on contact tracing and most likely, hundreds of thousands on medical care to get them better.

A bigger problem with HIV was an unwillingness to acknowledge its significance in the early stages and invest in research and public education, mostly because it was seen as a gay disease. Thousands of lives would likely have been saved with an earlier public health intervention. The delay with closing bath houses in particular was almost criminal but that was seen as a personal liberty situation as well. I think the lesson from AIDs is act early before you have an epidemic.

[TxCat]

I think we are talking across each other. Of course he was symptomatic. He was also in denial. My point is that is unreasonable to expect that every symptomatic person is going to act reasonably and promptly admit themselves through the proper channel the minute they develop symptoms. Most will, but there will be outliers. With something as infectious as ebola in the later stages, a conservative public health policy seems warranted. The CDC has already had several embarrassing incidents when it assumed perfect behavior and didn't get it -- i.e. the CDC totally overestimated the readiness of the Dallas hospital to handle an ebola patient, and as a result, two nurses got infected, thousands were spent on contact tracing and most likely, hundreds of thousands on medical care to get them better.

I don't think we're talking past each other, I think we just disagree. The public can still be protected with direct monitoring, taking away some of the chance of rogue outlier behavior, vs. quarantining lots of asymptomatic and likely healthy people. Apparently the judge in Maine agrees. http://news.yahoo.com/life-goes-nurs...053514854.html

[TxCat]

What part of SHE REGISTERED A FEVER at the airport is everyone missing? That was the reason she was detained in Newark. If it was an inaccurate reading then it was corrected and sent home to Maine to self quarantine. What was NJ supposed to do with they had a DR the day before who was supposed to be self monitoring running around NYC just a few hours before he spiked a fever and came down with Ebola. Then BAM another healthcare worker who had been treating Ebola patients gets off a plane registering a fever. I agree that it needs to be uniform but we have had 2 drs get ebola and a camera man. She's a nurse with CDC training. The risk may be low but I sure dont want her sitting next to my kids or going back to work before her 21 days are up.
I think had she not had the fever she would have continued to Maine with the assumption she would self monitor and stay away from people.

She did not have a fever. There was one likely erroneous reading from a external temperature monitor, monitors which are notoriously finicky, prone to user error. All subsequent temperatures, including those taken orally (the gold standard for adults) were within normal limits.