Just two days after the U.S Centers for Disease Control and Prevention recommended a 21-day isolation period for travelers at the highest risk of Ebola, the California Department of Public Health has issued its own quarantine order, one of a handful of states to do so.
The order, released Wednesday by department Director Dr. Ron Chapman, says any person arriving in California from an Ebola-affected country who had contact with an Ebola-infected person will be quarantined for 21 days. This policy, like the ones issued by New York and New Jersey, appears to be stricter than that issued by the CDC on Monday, which only applies to people deemed “high-risk” because they were caring for an infected person without proper protective clothing or were exposed to the virus through needle-stick or injury.
Ebola-affected areas, as defined by the CDC, currently include Guinea, Liberia and Sierra Leone. Travelers returning from those countries who did not come into contact with someone with a confirmed case of Ebola will not be subject to quarantine, according to the state order. There have been no confirmed cases of Ebola in California.
The location and limitations of California’s quarantine will be determined on a case-by-case basis by the state and county health departments, but can include isolation at home and daily health monitoring, with allowances for greater movement for those deemed to be at lower risk, according to a press release from the Public Health Department. Depending on initial symptoms and risk level, the state Public Health Department and CDC may recommend moving the person to a health care facility.
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“Not everyone who has been to an Ebola-affected area should be considered high risk,” Chapman said in the release. “This order will allow local health officers to determine, for those coming into California, who is most at risk for developing this disease, and to contain any potential spread of infectious disease by responding to those risks appropriately.”
Govs. Andrew Cuomo and Chris Christie, of New York and New Jersey, respectively, initially mandated quarantine last Friday of any exposed health care worker returning from the region, whether symptomatic or not.
The policy prompted a backlash from the White House and the United Nations after New Jersey authorities confined Kaci Hickox, a nurse who had recently treated Ebola patients in Sierra Leone, to a tent at the airport, despite her showing no symptoms. She called her treatment “inhumane.”
The governors of New York and New Jersey both loosened their guidelines Sunday and are now allowing residents who came into contact with the infected to be quarantined in their homes. Hickox was allowed to return home to Maine, where state officials say she must remain confined to her house. Hickox threatened Wednesday to go to court to challenge the state’s 21-day quarantine policy.
According to a recently released California guideline for local health officers, the CDC is monitoring travelers nationwide from the affected region at ports of entry. Those who have symptoms are referred to the CDC for further screening. Those who do not are released with a digital thermometer and fever and symptom log.
The CDC will provide daily lists to the state public health department of all travelers screened whose final destination is California. The department will send those lists on the same day to local health departments at that traveler’s specific destination. County officials will then assess level of risk by interviewing the returning traveler with a newly developed form issued by the Public Health Department. It recommends that traveler interviews and daily symptom checks be conducted via telephone or other electronic means to minimize potential risk.
Sacramento County Department of Public Health has not quarantined anyone yet, but last week was monitoring two individuals who recently returned from West Africa. Those individuals were considered “low risk” and had been reporting their temperatures to the county daily.
“If there is someone who fits those categories, we would follow the (quarantine) guidelines,” said county spokeswoman Laura McCasland.
In California, local officials have the authority to quarantine individuals who may have infectious diseases that threaten public health. The new quarantine order aims to ensure consistent application of that authority throughout the state, according to the release.
The Public Health Department acknowledges that California is home to many health care workers who will be subject to this quarantine.
“They will be treated with respect and dignity when they come home as these important public health actions are taken,” Chapman said. “We value those who volunteer to help those in need, and appreciate their willingness to serve.”
Dr. Hernando Garzon, a Kaiser Permanente emergency department physician, is serving with the International Medical Corps in Sierra Leone and expects to return to the U.S. on Nov. 9. Under the new state guidelines, the doctor will likely be put under some form of quarantine in his Davis home, though he said before leaving that he believed his chances of contracting the virus were low.
“There are extensive WHO and CDC guidelines and protocols and procedures about how to operate safely,” he said. “All health care workers are at this point are quite vigilant ... the adherence has increased over time as more health workers become infected.”
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