WASHINGTON (AP) — A top administration health official is defending U.S. policy on Ebola in the wake of criticism about conflicting federal-state rules.
Dr. Anthony Fauci says local officials are within their legal rights to impose more severe restrictions on people who have possibly been infected. He refuses to characterize the more stringent pursued by New York Gov. Andrew Cuomo and New Jersey Gov. Chris Christie as a “mistake.”
“I don’t want to use the word mistake,” he said. “They’re doing it in good faith.”
Christie said Tuesday he feels the latest guidance from the Centers for Disease Control and Prevention is “incredibly confusing.”
“The CDC is behind on this,” he said on NBC’s “Today” show. “Governors ultimately have responsibility to protect the public health of people within their borders.”
Fauci, appearing on CNN, said the CDC guidelines are “based on the science, on what we know and how it’s transmitted. It’s a good matching, based on science, of the level of risk with the kind of monitoring the kind of restrictions. Based on scientific evidence as well as experience.”
“When you start getting the viral load that is enough to be able to be transmitted,” he said, “you’re feeling very, very poorly.”
For the first time, the CDC recommended 21 days of isolation and travel restrictions for people at highest risk for Ebola — a nurse stuck by a needle while treating an Ebola patient in Guinea, for example — even if they have no symptoms.
But the recommendations are just that: recommendations.
States are still free to go above and beyond the CDC guidelines. And if states were to opt to be more lenient, there’s next to nothing Obama could do to force their hand.
Case in point: An order issued Friday by New Jersey, like one in New York, requires three-week quarantines for anyone who treated Ebola patients in West Africa — not just those deemed high-risk because of a needle-stick or failure to use proper protective gear. But under the new federal guidelines, those lower-risk workers merely must have their temperatures monitored twice a day.
Legal experts say New York and New Jersey could be on shaky legal ground. To justify infringing on an individual’s civil liberties, like freedom of movement, states face a high bar to prove their orders are based on science and epidemiology. Courts also like to see that states are acting as narrowly as possible rather than in broad strokes, such as lumping together everyone who treated Ebola patients even if they’re healthy.
“We have not seen for decades and decades the state or federal government say a whole category is going to be subjected to quarantines,” said David Fidler, who teaches international and public health law at Indiana University.
In fact, such broad quarantines are almost unheard of in U.S. history. Almost always, they have been limited to diseases that are airborne and easy to catch. Public health experts say Ebola is neither.
When an influenza pandemic dubbed the “Spanish Flu” infected millions in 1918, major U.S. cities closed schools and imposed strict quarantines. New York considered quarantining tuberculosis patients in the 1990s, and isolated some who wouldn’t comply with treatment.
But as any school nurse can tell you, TB and the flu can be passed from person to person by sneezing or coughing, while Ebola requires direct contact with an infected person’s bodily fluids.
President Barack Obama and top federal officials have echoed aid groups like Doctors Without Borders in warning that mandatory quarantines will dissuade doctors and nurses from volunteering to fight Ebola in West Africa, therefore making it harder to stop the disease at its source.
But others warn of another risk to public confidence here at home: If Obama insists people without Ebolasymptoms aren’t contagious while states are quarantining those same people, whom should people believe?
“What several of these governors are doing is giving very confusing and mixed messages to the public,” said Lawrence Gostin, who heads the national and global health law program at Georgetown University. “It’s an inherent problem in our federalist system. We are designed as 51-plus governments. They can speak with different voices.”
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