Life Inside the Ebola Bubble: Porta Potties and an iPhone

For some Ebola-exposed travelers coming home to New York, New Jersey and Illinois, life under state-enforced quarantine won’t be the preferred way to avoid going to work.

In New York, under a revised policy announced yesterday, people who come to the U.S. after being in contact with Ebola patients and don’t show symptoms will be confined at home for 21 days, though they can have family and visitors. New Jersey set a starker example of close monitoring, confining a nurse to a tent outside a Newark hospital over her public protests.

“I have a porta-potty type restroom, no shower facility and no connection with the outside world except my iPhone, which I insisted I bring,” Kaci Hickox, a nurse who recently returned from volunteering with aid group Doctors Without Borders in Sierra Leone and is now in quarantine in New Jersey, said yesterday in an interview with CNN.

As quarantine orders from the three states are enforced in coming days, hundreds of people may soon find themselves in lockdown, according to estimates from state health departments on arriving passengers. The measures have spurred debate about whether the rules are ethical or useful in stopping a disease that isn’t spread by casual contact, and about the logistics of such an intensive monitoring effort.

As of yesterday, Hickox couldn’t go outside, have visitors or touch another human for 21 days -- all while waiting to see if she develops symptoms of a deadly virus that’s killed about half of those it infects, according to the World Health Organization.

U.K. Skepticism

President Barack Obama’s administration has expressed concerns about the quarantines ordered by Governors Chris Christie of New Jersey and Andrew Cuomo of New York, a senior administration official said yesterday. The official, who asked not to be named because the discussions are private, said policies not grounded in science may deter people from volunteering in West Africa. Cuomo stuck by his state’s quarantine in a press conference later in the day.

U.K. health officials also expressed doubts about quarantining people returning from Ebola aid work.

“While the U.K. might see cases of imported Ebola, there is very low risk of it spreading to the general population,” the nation’s Department of Health said in an e-mailed statement yesterday. “England has a world class health care system with robust infection control systems and processes and disease control systems.”

Protecting Citizens

State health officials say the rules are about protecting their citizens. In Dallas, a Liberian national named Thomas Eric Duncan had the run of the city for days while he had symptoms of Ebola, before being isolated Sept. 28. Two nurses who treated Duncan before he died Oct. 8 were infected. Both have recovered.

Craig Spencer, the first New Yorker to be diagnosed with Ebola, visited a Brooklyn bowling alley, rode public transportation, and ate at a meatball shop before developing a fever and getting rushed to Bellevue Hospital Center on Oct. 23.

State officials have cited both cases as examples of why forcing people to stay inside for the longest amount of time Ebola can incubate in the body is necessary, even though doctors say it’s impossible to infect someone while asymptomatic.

Voluntary Ineffective

“I don’t believe that when you’re dealing with something as serious as this that we can count on a voluntary system,” Christie said yesterday in an interview with Fox News. “This is the government’s job.”

Cuomo, who jointly announced the quarantine policy with Christie for travelers arriving at New York airports from West Africa, said quarantining people at home will keep them from spreading Ebola if they are ill.

Illinois Governor Pat Quinn called his state’s quarantine a “common-sense step that will help ensure people across Illinois are protected.”

Hickox, the nurse detained after arriving in the U.S. from Sierra Leone, told CNN she doesn’t understand the logic behind forced quarantines because returning health-care workers know to isolate themselves immediately if they fall ill.

An initial test showed Hickox was negative for Ebola and she is still symptom-free. She is now staying in a tent outside a Newark hospital, she told CNN. She said she doesn’t know when she’ll be released.

“I have not been communicated a clear plan” by public health officials, she said on CNN. “No one has told me how long it will last.”

Pizza, Exercise

New Jersey state health commissioner Mary O’Dowd and University Hospital officials said in a statement yesterday that Hickox’s tent is temperature controlled. Hickox has access to magazines and newspapers and has received take-out food and drink, they said.

“Our primary concern is ensuring the health of the patient and the public,” the statement said.

Three people who had close contact with Spencer, a 33-year-old physician who also volunteered with Doctors Without Borders in West Africa, are under quarantine in New York.

Someone will deliver food and needed supplies to their homes, though other details remain unclear, such as what mental health assistance is available or how the people will exercise.

“Our health department person will be making sure that all of her health needs are clearly met,” Jay Varma, deputy health commissioner at New York City Department of Health and Mental Hygiene, said yesterday while standing outside the apartment of Spencer’s fiancee, who is quarantined.

Safe Houses

A case manager “will be making sure that every other thing she needs, whether it’s food or other supplies, that we address this and make her as comfortable as possible,” Varma said.

The quarantine for the three in New York will end on Nov. 14 if they remain healthy and don’t develop Ebola symptoms.

Jennifer Velez, New Jersey’s human services commissioner, said her department is coordinating transportation and temporary housing for those subject to quarantine rules who have no place to stay. State officials are also working with food banks to arrange for grocery delivery.

New Jersey and Illinois officials haven’t said whether they will pay workers for the three weeks, as Cuomo pledged yesterday, or if they’ll ensure they don’t get fired because of their long period away from the office.

Franklin Graham, president and chief executive officer of Samaritan’s Purse, said he puts everyone with his charitable organization who returns from working in West Africa in a “safe house” within an hour from one of the four high-level U.S. biocontainment hospitals.

‘It’s Sad’

People can come and go, though they cannot come within 3 feet (1 meter) of anyone until the 21-day incubation period has passed. At the end, Graham gives them a $1,000 bonus.

“If a person goes to Liberia for three weeks, they’ve got to get in their minds it’s a six-week trip,” Graham said in a telephone interview. “It’s a nice place to go, not jail.”

States should provide comfortable quarantines or reverse the decisions to put them in tents or keep them at home, Graham said.

“Governor Cuomo and Governor Christie have done a great disservice to all of us in relief,” he said. “They just did this for the cameras and it’s sad. It needs to be reversed.”