As doctors, nurses, and other health care professionals return to the U.S. from fighting the Ebola outbreak in West Africa, they're facing a messy and inconsistent patchwork of rules about where they can go and what they can do.
Some health care workers will be placed in a tightly controlled quarantine as soon as they return to the U.S. Others will be allowed to leave the house, as long as they don't come within 3 feet of anyone. And others will be free to live their lives—even to go bowling—as long as they're vigilantly checking themselves for symptoms.
It all depends where they live—and, to some extent, on the political aspirations of their governors.
Public-health experts, including the Centers for Disease Control and Prevention, strongly oppose mandatory quarantines, especially for people who don't have any symptoms of Ebola. (Infected patients are only contagious when they're symptomatic.) CDC has laid out its own series of recommendations for people entering the U.S. from West Africa.
But several governors—many of whom are locked in tough reelection races—have rejected CDC's guidelines. New Jersey Gov. Chris Christie is unapologetically standing by mandatory, across-the-board quarantines, while others, including Florida's Rick Scott, have announced that they're setting their own protocols but haven't filled in most of the details.
Here's a quick guide to the states that have specified their own protocols for people traveling from West Africa, and how significantly those policies differ from the CDC recommendations.
The most restrictive policies:
New York: New York Gov. Andrew Cuomo and New Jersey Gov. Chris Christie on Friday announced a mandatory 21-day quarantine for all health care workers returning from Ebola-affected countries in West Africa. Facing criticism, Cuomo clarified his policy Sunday, saying asymptomatic individuals could choose where to spend their quarantine. Those who are symptomatic upon arrival will be immediately transported to a hospital and quarantined there, while individuals who had direct contact with Ebola patients but do not present with symptoms will be permitted to return home to complete their quarantine, with at least two unannounced visits from local health officials each day to check on their symptoms and ensure they're following the quarantine. Quarantined individuals will receive financial reimbursements for the 21-day period.
Those who did not have direct contact with Ebola patients will be actively monitored twice a day by health officials for the 21-day period, and quarantined if deemed necessary.
New Jersey: Like New York, New Jersey will quarantine all health workers returning from Guinea, Sierra Leone, and Liberia.
The state has been at the center of the debate over quarantine protocols after Kaci Hickox, a 33-year-old nurse returning from working for Doctors Without Borders in Sierra Leone, was quarantined at a tent at University Hospital in Newark for three days following a forehead scan that showed an elevated temperature. She tested negative in two preliminary Ebola tests and has not shown any symptoms of the virus, but was held inside the tent for three days before being released to her home in Maine.
Christie remains unapologetic, and committed to the state's quarantine policy. "I don't care what happens. We are not changing our policy," he said Wednesday. "This is our policy. It will be our policy as long as this crisis is going on."
Maine: Gov. Paul LePage said Maine will follow CDC guidelines for returning health care workers and set up an at-home quarantine and monitoring system.
LePage has called the state's quarantine "voluntary," as is advised by the CDC, but the governor said he plans to seek legal authority to enforce Hickox's at-home quarantine until Nov. 10 after she defied the quarantine order by taking a bike ride Thursday morning. Hickox said she is prepared to go to court to fight such an order if necessary.
Georgia: Atlanta is one of the five cities through which people are allowed to enter the U.S. from West Africa. Once they land, "high-risk" travelers—those who had direct contact with an Ebola patient—are subject to a 21-day quarantine, regardless of whether they wore protective gear or are displaying any symptoms. Health care workers must self-check for symptoms and will be observed by the state health department, in person or on video, every day for 21 days.
The blanket approach is significantly tougher than CDC's guidelines, which call for only a few optional, case-by-case restrictions on people who had contact with Ebola patients but not their bodily fluids.
And unlike New York, which is also imposing mandatory quarantines, Georgia Gov. Nathan Deal has said he has no interest in compensating quarantined travelers for any wages they lose during their isolation.
California: Anyone who had direct contact with an Ebola patient is subject to a 21-day quarantine, irrespective of whether they wore protective gear or whether they're displaying any symptoms. But the state is defining the terms of a "quarantine" on a case-by-case basis.
According to the Los Angeles Times, for example, one doctor in California is allowed to leave his house for activities like jogging alone, but can't go to work or have close contact with anyone. CDC doesn't explicitly call for such restrictions on doctors who wore the appropriate protective gear, but it does list them as options for state and local health agencies to consider. So, depending on the terms of each quarantine, California might be taking a conservative approach to CDC's guidelines rather than blowing past them.
Connecticut: Connecticut is determining quarantine protocols on a case-by-case basis—an approach that has raised concerns about the potential for discrimination. Gov. Dannel Malloy issued an executive order on Oct. 7 that gives the Department of Public Health the authority to quarantine anyone who may have been exposed to Ebola. The state is requiring active monitoring of all travellers from Liberia, Sierra Leone, and Guinea for 21 days, and a mandatory quarantine could be instituted if the DPH decides it is necessary based on the monitoring or on information obtained during the screening process.
So far, four quarantine orders have been issued involving a total of nine people. One has since been retracted, leaving eight individuals currently in quarantine in the state.
The military: There's some Ebola dissonance within the federal government. While CDC and other public health experts have called for calm, the Pentagon has imposed the strictest policy in the country: a mandatory 21-day quarantine for all troops returning from the military's Ebola mission in West Africa. Soldiers will be kept isolated and monitored regularly for a full three weeks, even though most of them will not be treating patients directly.
Mostly in line with CDC:
Louisiana: Louisiana is following CDC guidance that says people who had contact with Ebola patients should avoid large public spaces for 21 days upon their return. But the state has taken this to the seemingly illogical extreme: State health officials sent a letter Wednesday to scientists participating in the American Society for Tropical Medicine and Hygiene's annual conference in New Orleans next week, saying anyone who has been to an Ebola-affected country or treated patients elsewhere in the last 21 days is uninvited from the conference—which is on infectious diseases like Ebola.
"Given that conference participants with a travel and exposure history for [Ebola] are recommended not to participate in large group settings (such as this conference) or to utilize public transport, we see no utility in you traveling to New Orleans to simply be confined to your room," the letter says.
Illinois: Gov. Pat Quinn has ordered a mandatory home quarantine for anyone who had unprotected contact with an Ebola patient. That's a bit more aggressive than the CDC guidelines, which say those doctors can leave the house but can't go to work, use public transportation, or come within 3 feet of anyone else. Illinois is following CDC's guidelines for doctors who wore protective gear, requiring active monitoring for any symptoms but no quarantine or travel restrictions.
Washington, D.C. area: Officials in Virginia, Maryland, and Washington have agreed on a coordinated set of rules for returning Ebola doctors. Those with known breaches in protocol—who had a patient's bodily fluids splash onto their exposed skin, for example—are subject to a 21-day home quarantine. Doctors who did not experience a safety breach aren't under quarantine, but will face specific travel restrictions, such as a ban on using public transportation or attending public events, on a case-by-case basis.
Florida: Florida is requiring in-person temperature checks, twice a day, for anyone who travels to the state within 21 days of departing from West Africa—even if they had no known exposure to Ebola. That's roughly in line with CDC's guidelines.
Gov. Rick Scott has also authorized quarantines for high-risk patients, but hasn't defined "high-risk" or outlined the terms of a quarantine—whether it can be served out at home, for example. CDC defines a high-risk patient as one who came into direct contact with an Ebola patient's bodily fluids without adequate protective gear.