CT to handle quarantine decisions on case-by-case basis

Connecticut will require all travelers from the West African countries most affected by the Ebola virus to be actively monitored, require those who meet certain risk factors to be quarantined, and will decide each case individually, according to a statement released by Gov. Dannel P. Malloy’s office Monday evening.

The stated policy appears less stringent than one the Malloy administration issued Oct. 16, which said all asymptomatic people who come to Connecticut from Liberia, Sierra Leone or Guinea, or who have been in contact with someone with Ebola, would be quarantined. But an administration spokesman said the procedures outlined Monday are in line with what the state has implemented in the past week. Public health officials said last week that they could use discretion in handling individual cases.

State policies for addressing people possibly exposed to the deadly virus have received significant scrutiny in recent days following the diagnosis of Ebola in a New York City physician who had recently returned from volunteering in Guinea with the group Doctors Without Borders.

Soon after, the governors of New York and New Jersey announced mandatory quarantine policies for returning medical workers last week, triggering a backlash from public health experts. They warned that mandatory quarantines for medical providers showing no symptoms were not scientifically justified and could reduce the willingness of health care workers to volunteer to fight the outbreak in West Africa.

New York Gov. Andrew Cuomo issued a less stringent policy Sunday. And the Centers for Disease Control and Prevention issued revised guidance Monday for monitoring and restricting the activities of people exposed to Ebola, based on their level of risk.

For people without symptoms who are considered at “some risk,” including health care workers who provided direct care to Ebola patients in countries with widespread transmission of the virus, the guidance calls for direct active monitoring — meaning their state or local public health authority would be responsible for checking them daily to assess for symptoms and fever. Public health authorities could issue additional restrictions if warranted based on individual cases, but the guidance doesn’t call for people who are not at high risk or showing symptoms to be homebound or otherwise quarantined.

People with Ebola are not infectious until they show symptoms, and the virus can only be transmitted by contact with the blood or body fluids of a person with symptoms, according to the Association for Professionals in Infection Control and Epidemiology, which condemned mandatory quarantines for medical providers who are not symptomatic as being out of line with scientific evidence.  The organization supports active monitoring of people who were potentially exposed to the virus, and said mandatory quarantines should only be considered for people who don’t adhere to monitoring.

Connecticut’s quarantine policy hasn’t received the attention that the policies in New York and New Jersey have, although the state chapter of the American Civil Liberties Union raised questions last week.

Eight people are currently in quarantine in Connecticut, including a family of six from West Africa that had agreed to voluntarily quarantine themselves in West Haven. A quarantine order involving a ninth person was rescinded following a review of information related to the person’s travel activities, according to the Malloy administration.

On Monday, the Malloy administration released a statement saying all travelers arriving in Connecticut after visiting Guinea, Sierra Leone or Liberia are required to undergo 21 days of active monitoring, in which local health directors contact them daily to find out their temperature and determine if they have developed any symptoms.

The state health department also reviews each case to determine if additional steps are warranted. Staff from the local or state health departments interview each traveler to determine more about the person’s travel and whether he or she could have been exposed to the virus. The information is reviewed by epidemiological experts at the state health department. Based on a review of the information gathered, Mullen could require the person be quarantined.

A person who shows symptoms would be isolated.

The procedures outlined Monday don’t include quarantining all asymptomatic travelers returning from the three West African countries, as the written guidance Malloy and Mullen released Oct. 16 did.

That guidance — released while a Yale graduate student was hospitalized in New Haven with Ebola-like symptoms; tests for Ebola were negative — said that people who are not sick but who traveled to Guinea, Sierra Leone or Liberia, or who were in contact with an infected person, would be required to stay home for 21 days and take their temperatures twice daily.

But since then, state health officials indicated that they could use discretion in handling cases.

Asked whether the information reflected a change in policy, Malloy spokesman Andrew Doba said the procedures described were in line with what has been implemented. “We believe the public has a right to know in detail exactly how the protocols are operating,” he said.

In the statement Monday, Malloy said it’s important to look at each case individually. “DPH will continue to err on the side of caution in each and every circumstance,” he said.

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