The Centers for Disease Control tightened monitoring guidelines Monday for people entering the United States from nations afflicted with Ebola.
But it stopped short of ordering quarantine for most health workers who have treated patients with the disease in West Africa.
CDC Director Tom Frieden said anyone considered “high risk” must now isolate themselves from the public, either voluntarily or on the orders of local or state public health officials.
Those at high risk will also be banned from boarding commercial flights, he said, but not prohibited from leaving their homes entirely. A high risk person could go jogging, for instance.
The high-risk category does not include all health workers who have recently treated Ebola patients in West Africa. It does include family members who cared for someone with the disease, or a health worker directly exposed to the virus, such by an accidental needle stick.
Health workers who treated the disease without any breaches in protective gear will be considered at “some risk” under the new guidelines, as will people from Ebola-afflicted nations without direct contact with the infection.
They will be monitored by state and local health authorities for 21 days.
Monitoring will include discussing whether it is appropriate for a person to avoid going out in public, even if they are low risk.
“The level of monitoring and restriction placed on individuals depends very much on their particular risk,” Frieden told reporters.
The new guidelines are a small step up from the self-monitoring that the CDC had recommended last week for nearly all symptom-free West African arrivals.
The recommendations come after a New York City doctor began displaying symptoms of Ebola shortly after going out in public and using the subway.
Under the guidelines announced by Frieden, Dr. Craig Spencer would not necessarily have been quarantined unless he disclosed an accidental exposure while he was treating patients in Guinea.
The new CDC recommendations follow a decision by the governors of both New York and New Jersey to quarantine health care workers arriving from West Africa, where Ebola is spreading.
The quarantine resulted in the forced isolation of a nurse who arrived from Sierra Leone with a mild fever at Newark Liberty International Airport. She tested negative for Ebola and was allowed on Monday to return to her home in Maine.
Frieden said the CDC is working closely with the six states that receive 70 precent of West African arrivals, including New York and New Jersey, but that federal officials have no control over state and local decisions.
“If they wish to be more stringent,” Frieden said. “That is within their authority. But we believe these are based on science and they add a strong level of protection and reassurance that someone who is in the ‘some risk’ category is going to be intensely monitored, with their temperature measured each day along with a careful review of symptoms.”
Virginia and Maryland have announced programs to monitor arrivals from Ebola-stricken nations actively.
Frieden says a quarantine policy for returning health care workers could make it more difficult to eradicate the disease in Africa.
“If we turn them into pariahs instead of recognizing the heroic work they are doing, they may be less likely to disclose their health worker status,” Frieden said. “They may be less likely to help stop it as the source in Africa. If we can’t control it there, the risk to us would increase.”
