Ebola quarantines show deeply conflicting impulses facing politicians

New Jersey released nurse Kaci Hickox from an Ebola quarantine Monday and New York State eased up on its quarantine rules for 'high-risk' personnel. Such quarantines are an attempt to address public fear, but they might be counterproductive, experts say.

As the fallout from the first diagnosed case of Ebola in New York continues to reverberate throughout the densely populated region, political leaders are grappling with the deeply conflicting impulses the virus evokes.

On one hand, the Obama administration and other public officials, following the lead of health experts, have tried to calm public anxiety – directly addressing the impulse to flee from those who have been diagnosed or to prevent the arrival of others who might be.

But recent decisions by the governors of New York and New Jersey show the other side of the equation. As elected officials governing a jittery public, they have gone beyond what health officials say is necessary in imposing a three-week mandatory quarantine for everyone who has come into direct contact with Ebola patients while in West Africa.

To health officials, they have potentially hurt America's Ebola response by stigmatizing health workers for no accepted medical reason. Workers who could help quell the outbreak in Africa might decide not to put up with such conditions, the thinking goes.

But public pressure is high. Although there have been only four confirmed diagnoses of Ebola on US soil, 4 in 10 Americans worry that they or a family member might contract the virus, and wide majorities still support travel restrictions on those returning from west Africa, polls find. Moreover, public confidence in the federal government's ability to handle Ebola is dropping, according to a recent Gallup poll.

An unscientific poll on NJ.com on Monday afternoon showed that 55 percent of respondents said New Jersey Gov. Chris Christie is doing the best job of responding to the Ebola crisis. President Obama was second at 20 percent.

“It is common for the public to favor a policy action that on its face seems like it will be effective, but which experts warn us against and suggest may prove to be counterproductive,” writes Jeanne Zaino, professor of political campaign management at New York University, in an opinion article in Newsday. “In these instances, the polls are driven by fear and it is incumbent on elected officials to weigh the evidence and make the best decision possible – not the most politically expedient decision, but the one that is in the best interest of our health and safety.”

Both Governor Christie and New York Gov. Andrew Cuomo have backtracked a bit after facing intense pressure from health experts and the Obama administration.

On Monday morning, New Jersey health department officials announced that Kaci Hickox, the nurse who had been held against her will in a tent outside a New Jersey medical center over the weekend and the first to fall under the new policy, would be discharged and allowed to fly home in a private flight to Maine.

And on Sunday, Governor Cuomo announced he would ease some of the details of the state’s restrictive new quarantine policy – the second time in three days he has seemed to backtrack on his public health decisions. Those who had contact with Ebola patients while in West Africa, but were not showing any symptoms, would be allowed to be quarantined at home rather than a hospital, the governor said. Those quarantined would also be compensated for lost income, he said.

This came after the governor joined New York City Mayor Bill de Blasio on Thursday at the announcement that a Manhattan doctor who had just returned from volunteering in Guinea had been diagnosed. He said the state was well prepared, it had learned from the mistakes of Dallas, and citizens had nothing to fear.

Still, the very next day, Cuomo blindsided New York City officials and the Obama administration, joining Christie, a Republican and likely presidential aspirant, to impose the mandatory quarantine for anyone deemed “high risk” of carrying the virus – a quarantine that had not been part of any of the plans mapped out and drilled for weeks in New York City.

The announcement outraged New York City officials behind the scenes, The New York Times reported, and the Obama administration said on Monday it had “concerns” about the policy.

On Friday, Mr. Obama hugged Nina Pham, the Dallas nurse who had just been declared Ebola-free. She had treated Thomas Duncan, the first American diagnosed with Ebola on US soil, and the only person to die of the disease in the US.

The president’s photo op last Friday underscored the administration’s hope to alleviate the fear of contagion and to celebrate health workers' efforts.

Ms. Hickox, who had been volunteering with the humanitarian group Doctors Without Borders, had been protesting her confinement, calling it “inhumane” and a violation of her basic human rights. She had also hired a legal team to fight for her release this weekend, arguing that since she showed no symptoms and had twice tested negative for the virus, there were no legal grounds to keep her confined in an isolated tent with only a portable toilet and no shower facilities or a TV.

New York Mayor de Blasio, while straining to avoid the appearance of deep divisions among regional officials, nevertheless distanced himself from the quarantine policy.

"Anyone who has heard nurse Hickox explain her situation in her proud, compassionate, intelligent voice knows that what happened to her was inappropriate," de Blasio said over the weekend. "Each government has to make decisions. We understand that.... But the problem here is this hero is coming back from the front, having done the right thing, was treated with disrespect was treated with a sense that she had done something wrong when she hadn't. We owe her better than that.”

Both Christie and Cuomo, too, have urged Americans to see those volunteering on the front lines as heroes, not pariahs, and have emphasized that all evidence shows that the only way to contract Ebola involves direct, intimate contact with victims who are showing symptoms.