By Dawn Gagnon and Jackie Farwell, Bangor Daily News Staff
Attorneys for a nurse released from isolation in New Jersey after returning to the U.S. from West Africa say she will not comply with Maine health officials' requirements that she remain under quarantine at home for 21 days.
Kaci Hickox, who treated Ebola patients in Sierra Leone and shows no symptoms of the virus, agreed to refrain from going out in public for two days, said Steven Hyman of the New York law firm McLaughlin & Stern. She traveled to Maine on Monday by private car after her release from New Jersey, where she was isolated against her will in a tent outside University Hospital in Newark after she flew into New York on Friday.
"She doesn't want to agree to continue to be confined to a residence beyond the two days," Hyman said.
Maine health officials have said they expect Hickox to agree to be quarantined at her home until 21 days have passed since her last potential exposure to the virus. Twenty-one days is the maximum incubation period for the Ebola virus.
Local officials in Fort Kent, where Hickox lives with her boyfriend, said Tuesday that she was not heading back to town right away. On Tuesday morning, vehicles from about a dozen national and state media outlets lined the road near the house in town, though no one appeared to be home.
Early Tuesday evening, Maine Department of Health and Human Services Commissioner Mary Mayhew noted at a hastily called news conference that the state has the authority to seek a court order to compel quarantine for individuals deemed a public health risk.
She did not address Hickox's case directly, saying the state has not filed a court order.
Another attorney representing Hickox, New York civil rights lawyer Norman Siegel, said she would contest any potential court order requiring her quarantine at home.
"The conditions that the state of Maine is now requiring Kaci to comply with are unconstitutional and illegal and there is no justification for the state of Maine to infringe on her liberty," he said.
Hickox will abide by daily monitoring, as recommended the by updated guidelines released Monday by the federal Centers for Disease Control and Prevention, Hyman said. She has been in regular contact with state health officials, Siegel said.
U.S. CDC Director Tom Frieden called for isolation of people at the highest risk for Ebola infection but said most medical workers returning from the three African nations at the center of the epidemic — Sierra Leone, Liberia and Guinea — would require daily monitoring without isolation.
The new guidelines recommend considering isolation only for individuals exposed to Ebola who show symptoms. Those with no signs of illness should be monitored for 21 days after the last potential exposure, with symptom-free individuals at the highest risk subject to "restricted movement within the community" and no travel on public transportation, according to the guidelines.
The federal CDC's guidelines serve only as recommendations. States have leeway to develop their own protocols.
Both of Hickox's attorneys declined to comment on where she was staying, who she was with or her travel plans, saying only that she had arranged housing in Maine.
"She understands the nature of the disease, she treated it," Hyman said. "She understands the nature of the risk."
Hickox's boyfriend, Ted Wilbur, a University of Maine at Fort Kent nursing student, plans to join her and will not return to campus for the next 21 days, according to Raymond Phinney, associate dean of student life and development at the university.
Mayhew reinforced the state's intent to prevent people who have been exposed to Ebola from contact with others during the news conference at the department's offices in Bangor late Tuesday afternoon.
"The way that goes right now is that anybody who remains at home with an individual that is placed at risk, who's had exposure, if that patient does become symptomatic, all family members must agree to go into quarantine for a 21-day period," Mayhew said.
She acknowledged that the state's protocols "may go slightly beyond the federal guidelines," but described them as a common-sense approach to guard against a public health crisis.
"As we've indicated, the intent is to minimize public contact if they have family members who have become exposed to them and they later develop symptoms, those individuals would be subject to the 21-day quarantine."
"If they had visitors, those visitors would be subject to the quarantine if the individual under quarantine develops symptoms," Mayhew said.
Though they declined to get into specifics on Tuesday, officials from the Maine Department of Health and Human Services provided an update on the state's efforts to prevent the spread of Ebola to Maine.
Federal health officials have said the risk of an outbreak in the U.S. is very low. Contracting Ebola requires direct contact with the bodily fluids of someone who is both infected and exhibiting symptoms. The virus is not spread through the air.
State health officials do have some mechanisms for handling situations in which individuals refuse to comply with quarantines and other safeguards.
"We will proceed with a court order to seek legal authority as provided under Maine law," Mayhew said. "We expected that the Maine attorney general's office will represent the Department of Health and Human Services in this avenue of pursuing a court order," she said, later, adding, "No court order has been filed at this time."
Asked if there were any plans to take such an action, Mayhew said, "We are evaluating appropriate steps to ensure that our protocol is complied with and if necessary, will be enforced."
Also during the Bangor news conference, Maine CDC Director Dr. Sheila Pinette described how people who come to Maine from places in which Ebola is present.
"We have an active monitoring program for low-risk patients, where with active monitoring there's a phone call that is between the epidemiologist and the individual on a twice-a-day basis. For direct active monitoring we do have the epidemiologist go to the home to speak to the individual, assess the individual's status and observe the patient taking the temperature, looking at the temperature and then recording that. So we are in continuous contact.
"And I do want to comment a little bit on the science here," Pinette said, referring to reports that the nurse had not tested positive for Ebola.
"The problem we're faced with here is that this is a blood-borne pathogen," Pinette said. "We don't know a lot about this virus but we do know from the experiences learned in Texas that they had some equivocal tests within the first 72 hours of testing their health care workers and we need to go based on the facts.
"The fact of the matter is that it has a 21-day incubation period. This individual was tested within the first 24 to 48 hours and the federal CDC was in agreement with retesting the patient should she develop symptomatology," she said, adding, "But they wanted to wait 72 hours and they wanted to continue to keep the individual under 21-day incubation period for monitoring because as the viral load increases, that is how you can develop a positive Ebola test.
"So we believe that she may have been tested too early and therefore that is the reason why we continue to monitor this individual. So I have to say, in my own clinical opinion, to protect the health and safety of even one Mainer, it is extremely important for us to be very, very cautious," Pinette said.
In a Monday editorial, the New England Journal of Medicine criticized mandatory quarantines for health care workers returning from West Africa, imposed in states including New York and New Jersey.
"This approach … is not scientifically based, is unfair and unwise, and will impede essential efforts to stop these awful outbreaks of Ebola disease at their source, which is the only satisfactory goal," the editorial said. "The governors' action is like driving a carpet tack with a sledgehammer: it gets the job done but overall is more destructive than beneficial."