WASHINGTON – The Spanish flu pandemic a century ago prompted the last large-scale quarantines in this country. Now the Ebola outbreak is raising new questions about whether ordering quarantines is an effective way to fight deadly disease in the U.S.
Health experts say putting people into quarantine can be appropriate on a case-by-case basis. In a high-profile case in 2007, an Atlanta man believed to have a rare, extremely drug-resistant form of tuberculosis was ordered into federal quarantine after returning to the country from his wedding overseas. Later tests found a less dangerous form of TB.
Experts have criticized Govs. Andrew Cuomo of New York and Chris Christie of New Jersey for announcing quarantines for health workers returning from West Africa, where the Ebola virus is raging. The Centers for Disease Control and Prevention has announced less restrictive guidelines with different recommendations aimed at different groups.
Meanwhile, the Pentagon announced plans to go further than the CDC guidelines and put troops returning from Ebola response missions in West Africa in quarantine for 21 days - the incubation period for Ebola.
WHAT ARE THE LATEST FEDERAL RECOMMENDATIONS?
The CDC now recommends that people who are at highest risk for coming down with Ebola avoid commercial travel or attending large public gatherings, even if they have no symptoms.
Its updated advice to state and local officials separates people who've been around Ebola into categories. Those at highest risk are anyone who's had direct contact with an Ebola patient's body fluids, including health care workers who suffer a needle-stick injury during a patient's care.
Active monitoring is also recommended for people at some risk - those who've been in close contact with an Ebola patient - or low risk - those who've been in a country with widespread transmission.
WHAT ARE STATES DOING?
There's a range of responses from states, and some have yet to announce their approaches since the updated CDC guidelines were announced Monday.
New York, New Jersey, California, Illinois, Georgia, Florida and Maine are among those announcing 21-day quarantines for health care workers and others at risk arriving from Ebola zones in West Africa. Details of the quarantine procedures vary.
Connecticut has announced plans to quarantine people on a case-by-case basis.
The state approaches face a test from Kaci Hickox, the nurse who was confined to a tent in New Jersey after returning from West Africa. New Jersey officials discharged her home to Maine. She is fighting the home quarantine procedures there.
WHAT IS THE MILITARY DOING?
Defense Secretary Chuck Hagel on Wednesday announced a 21-day quarantine period for troops returning from West Africa, where nearly 1,000 of them have deployed to support efforts to combat the virus. Details were still being worked out.
Hagel said the policy had been sought by communities and families of members of the military. Although the move goes beyond CDC guidelines, President Barack Obama has made clear he feels the military's situation is different in part because troops are not in West Africa by choice.
WHEN HAVE QUARANTINES BEEN USED BEFORE IN THE U.S.?
Large-scale quarantines were used frequently during disease outbreaks in the 19th and early 20th centuries, including the influenza pandemic in 1918. Experts say it's not clear such quarantines were very effective.
In some cases, entire populations were isolated, such as a quarantine of Chinatown in San Francisco in 1900 in response to the bubonic plague. The quarantine order was struck down by a court after an outcry by residents.
Such large-scale quarantines have largely fallen into disuse with the rise of modern medicine, vaccines and antibiotics.
More recently, the spread of tuberculosis led authorities to quarantine individuals to make sure they were taking their medicine and following other protocols. More than 100 TB patients were detained in New York City between 1993 and 1995.
WHAT ABOUT ELSEWHERE?
The SARS epidemic led to large-scale quarantines in Asia and Canada in 2003, including around 30,000 people quarantined in Toronto, mostly at home. There's disagreement about whether the quarantine in Toronto was effective. Some believe it did limit the spread of the outbreak, while others say it was ineffective and inefficient and noncompliance was a problem.
WHAT ARE EXPERTS' CONCERNS ABOUT QUARANTINES FOR EBOLA?
Experts note that unlike SARS and the flu, Ebola is not easily spread to others by coughing or sneezing. Instead it requires direct contact with a sick person's bodily fluids while they are showing symptoms of the disease. So they question the need to quarantine people who are not showing symptoms.
Health officials also agree that the best way to protect the U.S. from the disease is to end the outbreak in West Africa. Doctors, nurses and other health workers are badly needed there, and experts worry that imposing quarantines here at home could discourage those volunteers.
"Being overbroad, being draconian is not necessarily the best way to keep us safe," said Wendy Parmet, a health policy expert at Northeastern University School of Law.