As expected, there is talk of legal action by nurse Kaci Hickox, who was quarantined in New Jersey after allegedly having a fever upon her homecoming to the U.S. during her screening upon entry at Newark airport. Hickox claims she did not have a fever, and that her quarantine was “not scientifically or constitutionally just,” as CNN reported.
New Jersey has had comprehensive rules outlining the authority, scope, and parameters of Quarantine and Isolation of Humans and Animals. The model rules for Quarantine and Isolation “are applicable in jurisdictions in which the local board of health has adopted the model rules by reference in accordance with New Jersey law, but no local board of health is required to adopt the model rules.” N.J.A.C. 8:57-1 APPENDIX
Local Boards of Health have general jurisdictional authority unless “the communicable disease has affected more than one county or has multicounty, statewide, interstate or public health emergency implications.” N.J.A.C. 8:57-1.10.
Communicable diseases, also defined by the State, include: “[v]iral hemorrhagic fevers, including, but not limited to, Ebola, Lassa, and Marburg viruses.” N.J.A.C. 8:57-1.5.
The States guidelines define “quarantine” and “quarantinable disease” and set forth the parameters of the isolation or quarantine, if so ordered.
- “Quarantine” means the physical separation and confinement of an individual or groups of individuals, who are or may have been exposed to a communicable or possibly communicable disease and who do not show signs or symptoms of a communicable disease, from unexposed individuals, to prevent or limit the transmission of the disease to unexposed individuals.
- “Quarantinable disease” means any communicable disease which presents a risk of serious harm to public health and which may require isolation or quarantine to prevent its spread.
In the case of the quarantine of nurse Hickox in New Jersey, it appears that the State had jurisdictional and regulatory authority to issue its quarantine.
So what about Hickox’s claims that her quarantines in New Jersey (and also in Maine) are unwarranted and unjust?
The speard of ebola virus is generally understood to require direct contact with infected bodily fluids, and that, until symptomatic, people cannot spread the virus. We also know that many health care workers in Africa and two in the U.S. were infected with the virus while caring for known infected patients.
Dr. Craig Spencer, as reported by the N.Y. Times, after returning from West Africa was hosptialized after developing a low-grade fever. He has since tested positive for Ebola and his fiancee and two other friends are in “isolation” for 21 days, even though it is unlikely they were exposed to “infected bodily fluids.” Also, public health officials are tracking Dr. Spencer’s movements the day before he developed a fever, to identify potential contacts, even though Mayor Bill de Blasio assured New Yorkers that “Being on the same subway car or living near a person with Ebola does not in itself put someone at risk.”
This may appear to some as mixed or even conflicting messaging.
We may understand the mechanics of the spread of ebola virus, but do not fully understand how and when certain people, particularly health care workers are infected. We would expect nurse Hickox and Dr. Spencer to have used the same protective gear and protocols in Africa, yet at least one was infected with ebola, despite those measures. It is still not clear how the nurses in Texas became infected. If and when we can identify how those exposures occurred, we can help avoid similar contact in the future, and possibly identify those at higher, or lower, risk of infection, modifying isolation and quarantine measures accordingly.
At this point, we know that the incubation period of ebola is 21 days, at least 95% of the time. Therefore, from a strictly scientific standpoint, the best way to minimize the chance of viral spread is to limit exposure to others during that waiting period.
These measures, “out of abundance of caution,” are commonly used to prevent or mimimize disease spread during animal disease outbreaks, including Equine Herpes Virus outbreaks.
Not that people are horses, but reviewing the lessons learned from controlling EHV outbreaks may help in our understanding of how and why quarantines are imposed.
More on “Lessons Learned from Animal Quarantines” coming soon . . .