Ebola Crisis Passes, but Questions on Quarantines Persist


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Laura Skrip, a Yale student, in the apartment where she was quarantined after returning from Liberia in October 2014. She had not worked with Ebola patients, but state-imposed restrictions for health workers and other people often exceeded federal guidelines.

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Christopher Capozziello for The New York Times

On Oct. 15 last year, Laura Skrip, a Yale public health student, received a call from Connecticut health officials ordering her not to leave her one-bedroom apartment.

She and a fellow student, Ryan Boyko, had recently returned from Liberia, where they had been providing computer support to the country’s Health Ministry. Now, Mr. Boyko was at Yale-New Haven Hospital with a fever, being tested for Ebola.

The results were negative. But for the next two weeks, the students, neither of whom had worked with Ebola patients, were quarantined alone in their apartments, with a police officer patrolling outside each building.

“I was a little in shock,” Ms. Skrip said. “I was confused, like how am I going to eat?”

A friend dropped off supplies on the back steps, but when Ms. Skrip went to retrieve them, a frightened neighbor ran outside clutching a pillow and sheets, and another called for the police. For days, Ms. Skrip said, “I never received any paperwork, any formal explanation of what this quarantine was, or even what I could do to fight it.”

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Ryan Boyko, also a Yale student, was quarantined after testing negative for Ebola. He helped write a report on quarantines after the latest Ebola epidemic.

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Christopher Capozziello for The New York Times

The Ebola epidemic has subsided, but in the United States the fallout over how health care workers and their families were treated during the crisis continues.

Throughout the months of fear and uncertainty, the federal Centers for Disease Control and Prevention recommended monitoring people entering the United States from Ebola-affected countries, not confining them, because research showed that people with Ebola are not contagious before they show symptoms. But states, which have the legal authority to impose quarantines, often exceeded those guidelines, restricting the movements of returning health workers and others.

Interviews with more than a dozen people who either were quarantined or were involved in imposing quarantines revealed troubling details about the steps that were taken. Some said they were left without basic necessities like garbage removal and without psychological support. In one case in New York, a stove was left inoperable after an apartment was cleaned and no one was allowed to come fix it. Others were not given the legally required notice of the restrictions to be imposed.

Similar findings are documented in a report released on Thursday by the Yale Global Health Justice Partnership and the American Civil Liberties Union, which for the first time tried to quantify how widespread quarantines were in response to the Ebola epidemic.

The groups found that at least 40 people in 18 states received quarantine orders linked to Ebola. They were confined to their homes for up to three weeks, the maximum incubation period for the virus. An additional 233 went into so-called voluntary quarantines to avoid legal action and unwanted publicity. The report was researched and written in part by Yale graduate students in law and public health, including Mr. Boyko but not Ms. Skrip, and overseen by Gregg Gonsalves, co-director of the Yale partnership.

The numbers may be higher, the writers of the report said, because only six state health departments responded to requests for information, so the authors relied on a search of news articles and interviews.

The United States military also imposed quarantines on 2,815 service members returning from assisting in the Ebola response, according to figures provided by the Army. The cost to the government was about $2,000 per person for food, shelter and services for the 21 days of confinement in circumscribed areas of five military bases in the United States, one in Italy and one in Germany.

None of the people quarantined in the United States or on those bases developed Ebola.

In interviews, officials who authorized the quarantines defended their actions as reasonable. “I do think our decisions were based on the best available evidence,” said Dr. Jay K. Varma, the deputy health commissioner in New York City who decided to quarantine the fiancée and two friends of Craig Spencer, the doctor who fell ill with Ebola after returning from treating patients in Guinea. “I think we did have to factor in what the public appetite is for accepting risk in any given situation.”

(Dr. Spencer, who had not been quarantined before his diagnosis, said his case showed that the monitoring approach worked, because he reported his fever immediately, was promptly isolated at Bellevue Hospital Center, and did not spread the disease.)

In interviews and in the new report, legal experts questioned the legality and even the constitutionality of quarantines in these situations. “The state has to have clear and convincing evidence that the detention is necessary to prevent the spread of disease,” said Wendy Parmet, director of the program on health policy and law at Northeastern University.

Mark A. Rothstein, a law professor and director of the Institute for Bioethics, Health Policy and Law at the University of Louisville School of Medicine, provided informal advice to state health departments during the Ebola epidemic. To meet the requirements of state and federal law, he said, people whose movements were being restricted needed to receive notice and an opportunity to be heard.

Those who were quarantined spoke in interviews of lost wages, stress and fear.

Ms. Skrip said the experience spurred memories of previous trauma in her life. “To be quarantined, that’s like my worst nightmare,” she said. “To be tracked and alone in a space. It was incredibly hard just getting through that.”

Maria Lavandier Bouffard, Yale’s director of emergency management, was the only person who regularly visited Ms. Skrip during her two-week quarantine. She took out her garbage through a window, emptied her mailbox, and moved her car to avoid parking tickets. She also visited Mr. Boyko and said she worried about the students’ physical and mental health.

The students were not even free to leave for a fire alarm. Unless there was an imminent threat to their lives, they were to call the New Haven emergency dispatchers and work out an evacuation plan. “I don’t think people get how complex it is,” Ms. Bouffard said.

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From left: Mr. Boyko, Amy Kapczynski, Gregg Gonsalves, Emma Roth and Erinma Kalu were involved in writing a report that found that 40 people received quarantine orders in 18 states and hundreds more went into voluntary quarantines.

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Christopher Capozziello for The New York Times

Dr. Jewel Mullen, Connecticut’s public health commissioner, who signed the students’ quarantine orders, defended the state’s rules. “We were developing policies to address a scenario that we had never encountered before in our country.”

Dr. Nancy Snyderman, then an NBC journalist who had been in Liberia, across a room from a cameraman a day before he developed Ebola symptoms, was initially asked by her local health department in New Jersey to stay away from large gatherings, monitor herself for fever, and notify a health officer of her movements, according to an official document. But she was formally quarantined by the state after residents reported seeing her in her car getting takeout food — appearing to contradict her statement that she would voluntarily “self-quarantine out of an abundance of caution.”

Dr. Snyderman was excoriated, mocked and threatened on social media. “#NancySnyderman: the Typhoid Mary of #Ebola,” wrote @deptofdave, in a Twitter comment that was milder than many. Fliers went up in Princeton with the names of her children and what someone thought was her home address.

“It was scary,” Dr. Snyderman said in an interview. “I realized during that crazy time maybe we haven’t moved the needle enough on the public’s trust of science.”

Dr. Snyderman resigned from NBC six months later. She said she had misjudged the level of fear in her community and deeply regretted the alarm the incident caused.

According to civil rights lawyers, the only person to have challenged an Ebola quarantine in court is Kaci Hickox, the Doctors Without Borders nurse who was held for 80 hours in a tent at a New Jersey hospital after returning from Sierra Leone. She recently wrote about her experiences.

In October, Ms. Hickox filed a federal civil rights lawsuit against Gov. Chris Christie of New Jersey, Mary O’Dowd, his former state health commissioner, and other officials, seeking $250,000 in damages.

“In the past, quarantine decisions have been made on carefully considered evidence, not flippant decisions by politicians,” Ms. Hickox, who holds a master’s degree in public health and previously worked for the C.D.C., said in an interview. “I think we really need to protect that.”

Ms. O’Dowd did not return a phone call requesting comment. A representative of the governor’s office said the state could not discuss active litigation and referred a reporter to statements Mr. Christie made at the time in which he justified quarantines as a means of protecting the people of New Jersey.

Ms. Hickox already had one legal decision on her side. After being released in New Jersey, she traveled to Maine. The chief judge for the Maine district courts, Charles C. LaVerdiere, found that the state, which tried to quarantine her, had not proved it was necessary to limit her movements to protect others because she was cooperating with health monitoring, an effective and less restrictive measure.

Unlike Ms. Hickox, most people who received quarantine orders did not challenge them, said Alex Abdo, an A.C.L.U. lawyer and one of the authors of the forthcoming report. “They worried about the stigma, and the effects on their kids, families and employment,” he said.

That was the case for Nick Schreiner, who worked in the same Sierra Leone treatment unit as Ms. Hickox. The day after he returned to the United States, a public health nurse presented him with a quarantine order instructing him to stay at his parents’ house in Iowa for the next 20 days, except for solitary outdoor activities and unless expressly permitted to leave by the state’s health department.

Mr. Schreiner said he did not fight the restrictions because he had seen what had happened to Ms. Hickox. “I knew I couldn’t put my family through that, put my parents through that. I just sat tight and did my best to ride it out.”

Dr. Patricia Quinlisk, the Iowa health official who signed Mr. Schreiner’s quarantine order, said state officials discussed the decision for hours and consulted the state attorney general’s office for legal advice. She said the C.D.C. did not have adequate answers to her questions about risk. “A lot of times they’d say, ‘There’s no science to answer that,’” she said. Her top priority, she said, was “ensuring the disease didn’t spread in Iowa.”

Dr. Thomas R. Frieden, the director of the C.D.C., said that it was clear that people who were not yet sick could not spread Ebola, and that quarantines may paradoxically have put Americans at higher risk because they dissuaded medical volunteers from going to West Africa, where the outbreak was raging.

“Can you imagine what it would have been like for the people of Iowa if it had become endemic in Africa?” he said in an interview, meaning so widespread and persistent that many more travelers would have been affected. That, he said, “is the kind of long-term argument that doesn’t get a lot of traction with the public, but it’s really right.”

“There were lots of political pressures,” Dr. Frieden continued, but he said that quarantining individuals with almost no risk of spreading Ebola was not rational. “If you take the slippery slope to zero risk,” he said, “you end up in a rubber room.”

Correction: December 3, 2015
An earlier version of a picture caption of the group who conducted the study misspelled the surname of one member. She is Amy Kapczynski, not Kapczynksi. It also misspelled the given name of another contributor. He is Gregg Gonsalves, not Greg.

Correction: December 5, 2015

An article on Thursday about quarantines for people entering the United States from Ebola-affected countries misstated where Dr. Craig Spencer had treated Ebola patients. It was Guinea, not Sierra Leone.



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