A nurse who treated Ebola patients in Sierra Leone has criticized her treatment under a mandatory 21-day quarantine policy implemented by three US states, in an article written in a New Jersey hospital where she remained in isolation despite testing negative for the virus on Saturday.

Kaci Hickox was placed in quarantine under a policy announced on Friday by New Jersey governor Chris Christie and New York governor Andrew Cuomo, which requires anyone flying into the states after having contact with Ebola sufferers in west Africa to be subject to mandatory isolation for 21 days, thought to be the disease’s maximum incubation period.

The mayor of New York, Bill de Blasio, told reporters on Saturday that Cuomo had not informed city officials before announcing the new quarantine plans. He declined to offer an opinion on the new rules, but said the city would co-operate with them. The Illinois department of public health imposed similar restrictions.

Cuomo and Christie acted after a New York doctor, Craig Spencer, who worked with Ebola patients in Guinea, tested positive for the disease. He remained in stable condition at Bellevue hospital in New York on Saturday.



As officials sought to allay public concerns about the disease, Barack Obama used his presidential address to urge Americans to base their response to domestic Ebola cases on “facts, not fear”.

The restrictions imposed on health workers returning from Africa exposes a dilemma for authorities who are keen for American experts to help staunch the disease in Africa but mindful of public concerns at home.

In a first-person account published by the Dallas Morning News, Hickox had sharp criticisms of the additional restrictions. She wrote: “This is not a situation I would wish on anyone, and I am scared for those who will follow me.”



Hickox, a volunteer nurse with Doctors Without Borders, was stopped at Newark airport in New Jersey, where she told an immigration official she had travelled from Sierra Leone. She endured several hours of questioning from officials wearing protective coveralls, gloves, masks and face shields. Her temperature was taken, and registered 98F. Then, she said, her temperature was taken a second time.

“Four hours after I landed at the airport, an official approached me with a forehead scanner. My cheeks were flushed, I was upset at being held with no explanation. The scanner recorded my temperature as 101,” she wrote.

Hickox said she was left alone in a room for another three hours before being taken to the hospital, where her temperature was again recorded. This time it was 98.6F.

“I sat alone in the isolation tent and thought of many colleagues who will return home to America and face the same ordeal,” she wrote. “Will they be made to feel like criminals and prisoners?”

The New Jersey department of health said Hickox would remain in isolation for the time being. Speaking on Friday, Christie said the state’s health department had determined a quarantine order should be issued; it was not clear on Saturday if it would be issued in New York, where Hickox was traveling to, or New Jersey, where she is in hospital. Hickox is not from the area, Christie said.

Civil liberties activists raised concerns about the constitutionality of the new rules, warning they could discourage health workers from volunteering to fight Ebola in Africa.

“We understand the importance of protecting the public from an Ebola outbreak,” the American Civil Liberties Union said in a statement reported by the New York Times, adding that the mandatory orders for isolation “raise serious constitutional concerns about the state abusing its police powers by detaining people who are exhibiting no Ebola symptoms”.

Aid groups have expressed concerns about the effect of the new rules on a region where more doctors and nurses are desperately needed to fight a virus that the World Health Organisation said on Saturday has now infected more than 10,000 people. Almost 5,000 people, mostly in Guinea, Liberia and Sierra Leone, have died.



The restrictions imposed by New York, New Jersey and Illinois go beyond recommendations from the Centers for Disease Control and Prevention (CDC), the agency managing the federal response to Ebola in the US. The CDC said in a statement that it “sets the baseline recommended standards, but state and local officials have the prerogative to tighten the regimen as they see fit”.

On Friday night Mary Bassett, New York City’s health commissioner, sounded a cautious note. “People who go and volunteer, we have to look at how the new quarantine policy would impact them,” she said on Twitter.

People who go and volunteer, we have to look at how the new quarantine policy would impact them --@chrislhayes #inners — Dr. Mary Bassett (@DrMaryTBassett) October 25, 2014

Doctors Without Borders, known internationally as Médecins Sans Frontières (MSF), has warned against a mandatory quarantine on medics returning from Ebola-stricken countries, saying it would be an “excessive measure”.



The Obama administration is understood to be considering the effectiveness of imposing a nationwide policy of quarantining health workers returning from west Africa. Josh Earnest, the White House press secretary, declined to rule it out during a briefing on Friday.



Tom Skinner, a spokesman for the CDC, told Reuters: “There are a number of options being discussed pertaining to the monitoring and mobility of healthcare workers who are returning to the United States from affected countries.”

Spencer, 33, finished his work in Guinea on 12 October and left the country on 14 October, flying home to John F Kennedy airport in New York via Europe. He arrived in New York on 17 October. He checked his temperature twice a day, but despite feeling fatigued, visited the High Line park on Tuesday, and on Wednesday took a three-mile jog and went bowling in Brooklyn. As soon as he recorded a fever on Thursday, he contacted MSF in New York.

Guidelines set out by MSF state that returning medics should stay within four hours of a hospital with isolation facilities, but do not require that they avoid crowds so long as they do not display symptoms.

“As long as a returned staff member does not experience any symptoms, normal life can proceed,” the organisation says. “Family, friends, and neighbors can be assured that a returned staff person who does not present symptoms is not contagious and does not put them at risk. Self-quarantine is neither warranted nor recommended when a person is not displaying Ebola-like symptoms.”

At a Friday press conference, Bassett, the New York health chief, praised Spencer’s actions in volunteering to help Ebola victims in west Africa and said he had followed protocols on his return. “There’s this young guy who went over there, really doing the right thing, the courageous thing, and he handled himself really well,” Bassett said. “I don’t want anyone portraying him as reckless.”

De Blasio told the same press conference that American medical professionals helping to tackle the outbreak in west Africa “are the people who will end this crisis”. He said: “We have to make sure that that flow of medical personnel can continue.”

On Saturday, Obama urged calm. “We have to be guided by the science – we have to be guided by the facts, not fear,” the president said in his weekly address to the nation.



“Yesterday, New Yorkers showed us the way. They did what they do every day – jumping on buses, riding the subway, crowding into elevators, heading into work, gathering in parks. That spirit – that determination to carry on – is part of what makes New York one of the great cities in the world.

“And that’s the spirit all of us can draw upon, as Americans, as we meet this challenge together.”

In a conspicuous attempt to allay public fear, on Friday Obama was photographed hugging Nina Pham, the first of two Texas nurses to recover from the disease after treating Thomas Eric Duncan, who contracted Ebola in Liberia and died in Dallas earlier this month. Pham returned home shortly before midnight on Friday, accompanied by her mother and sister.



Before the latest Ebola case in New York, the CDC had tightened its monitoring requirements for those arriving in the US from the three west African countries hardest hit by the outbreak. The new monitoring system goes into effect on Monday in six states – New York, Pennsylvania, Maryland, Virginia, New Jersey and Georgia – and will eventually be expanded across the country.



The new guidelines will require anyone who flies from Liberia, Sierra Leone or Guinea ­– regardless of whether they are exhibiting symptoms ­– to check in daily with state and local health officials. They will be required to report their temperatures and the any appearance of Ebola-like symptoms, such as severe headaches, fatigue and diarrhoea. They will also be required to consult with health officials if they need, or want, to travel.



If an affected individual fails to check in, the CDC said health officials would take immediate action to track the person down and ensure the proper monitoring is carried out. Concern has been raised over the feasibility of such proposed action.