The debate over government-imposed Ebola quarantines has arrived in Maine, with the LePage administration saying it will take “appropriate action” if a Fort Kent nurse who treated patients in West Africa doesn’t comply with an in-home quarantine.

LePage spokeswoman Adrienne Bennett would not specify what action the state would take, but said that nurse Kaci Hickox, who has tested negative for Ebola and does not have any symptoms of the disease, is expected to abide by a 21-day quarantine.

Hickox, who was traveling to Maine on Monday, has spoken out against her treatment in New Jersey, where she was quarantined against her will in a tent at a hospital soon after New Jersey Gov. Chris Christie announced mandatory quarantines for aid workers returning from countries hit hard by the disease. The virus has killed thousands in Africa and one man in Texas, who infected two Dallas health care workers. Hickox’s quarantine came soon after a doctor returning to New York from Guinea tested positive for Ebola.

Bennett, when asked whether a 21-day quarantine was mandatory or voluntary for Hickox, at first told the Portland Press Herald early Monday afternoon that it was “voluntary.” Later in the afternoon, she wrote in an email that Hickox was expected to follow the quarantine.

“We fully expect individuals to voluntarily comply with an in-home quarantine. If an individual is not compliant, the state is prepared to take appropriate action,” Bennett wrote. She was asked repeatedly by the Press Herald to clarify what “appropriate action” was, but did not respond.

Whether Hickox, who worked in Sierra Leone for Doctors Without Borders, would abide by a quarantine is unknown. Her New York attorney, Steven Hyman, emphasized her civil rights.

“There is no basis (for her) to be kept in quarantine or isolation,” Hyman said. “We are prepared to establish that in a court of law.”

Gov. Paul LePage, in a news release, lauded health care workers who combat Ebola in Africa, but added that the state must be “vigilant in our duty to protect the health and safety of all Mainers.”

“Additionally, we will work with the health care worker to establish an in-home quarantine protocol to ensure there is no direct contact with other Mainers until the period for potential infection has passed,” he said. “We will help make sure the health care worker has everything to make this time as comfortable as possible.”

The Maine Attorney General’s Office declined to comment. Dr. Dora Anne Mills, a former director of the Maine Center for Disease Control and Prevention, said she does not believe the state could impose a quarantine without a court order.

Dr. Sheila Pinette, Maine’s current CDC director, did not respond to requests for comment Monday.

Hyman questioned whether the state’s proposed quarantine was truly voluntary. The attorney said he worries that the state’s protocols were being promoted as voluntary, but that once Hickox arrived, they would be enforced as mandatory.

“All she wants to do is resume a normal life,” he said. “Hopefully, Maine will let her do it.”

Hyman said Hickox is “definitely asymptomatic,” and a quarantine is inconsistent “with medical needs and Kaci’s civil and human rights,” but “she wants to work with the government of Maine to ease this situation.”

Hyman said he expected Hickox, who couldn’t be reached for comment Monday, to remain in seclusion for the “next day or so” while he works with state health officials, according to The Associated Press. He believes the state should follow federal CDC guidelines that require only monitoring, not quarantine, for health care workers who show no symptoms after treating Ebola patients.

The developments in Hickox’s case came as the federal CDC released new guidelines Monday saying that even if people have no symptoms and are not considered contagious they should stay away from commercial transportation or public gatherings if they have been in direct contact with the bodily fluids of someone sick with Ebola – say, by touching their fluids without protective gear or by suffering an injury from a contaminated needle.

Absent that direct contact, simply caring for Ebola patients or traveling in West Africa doesn’t warrant quarantine conditions, the public health agency said.

But quarantines are determined state by state in the U.S., and the CDC is empowered only to issue guidelines.

The 21-day period is used because someone who has been infected with Ebola will show symptoms within that time.

Hickox wrote an op-ed for the Dallas Morning News on Saturday that criticized New Jersey’s policies and spoke out against Christie on CNN, causing a media frenzy.

Hickox has been driven for years to help the world’s poorest people cope with disease outbreaks and other public health problems.

She grew up in Texas and graduated in 2002 from the University of Texas at Arlington, where she majored in nursing.

“I always felt a strong desire to work overseas with vulnerable populations, and nursing seemed to be a perfect avenue,” she told the school’s alumni magazine in 2012.

She started her overseas work in 2004 with the International Medical Corps after a tsunami hit Indonesia. After being turned down by Doctors Without Borders, she obtained a Tropical Nursing degree in London and later earned dual master’s degrees in public health and science of nursing from Johns Hopkins University, the magazine said.

She eventually was enlisted by Doctors Without Borders in 2007 to manage three rural health care clinics in an impoverished section of Myanmar.

“We used what I have come to call the ‘bridge or barefoot’ approach to primary health care in a unique rural setting … be prepared to walk barefoot through the rain and mud when the bridges are broken,” she wrote for a Doctors Without Borders publication.

She was then sent to the deserts of Nigeria during a measles epidemic affecting 2,000 new children every week, she wrote in a field journal for Doctors Without Borders. In 2012, she enrolled in a two-year fellowship in applied epidemiology with the federal CDC in Las Vegas.

She lives with her boyfriend, Theodore Wilbur, in Fort Kent. Wilbur also is studying nursing and told the New York Daily News that, despite the ordeal, he expects Hickox will return to work with Doctors Without Borders.

Hickox, upon arriving in New Jersey, tested positive for a fever by a person using a forehead thermometer, but she told the media that she was flushed and angry. Her body temperature was later at normal levels, according to news reports.

The New Jersey Health Department said in a statement Monday that Hickox had been symptom-free for 24 hours and would be taken to Maine.

She was the first person forced into a mandatory quarantine in New Jersey. Speaking at a campaign event Monday morning in Florida, Christie said when Hickox “has time to reflect, she’ll understand” the quarantine.

Christie and New York Gov. Andrew Cuomo jointly announced the quarantine policy on Friday, but Cuomo has since backed off the policy.

Over the weekend, the Obama administration condemned the mandatory quarantines, and both states announced some modifications Sunday night. Christie’s office said that the state’s protocol was clear that New Jersey residents with no symptoms but who had come into contact with someone with Ebola would be subject to a mandatory 21-day quarantine at their home. Non-residents who landed in the state would be taken home if feasible, or otherwise quarantined in New Jersey.

Meanwhile, LePage on Monday reiterated that the state’s travel policies hew closely to the federal CDC guidelines. New Jersey’s policy is stricter than those of the federal CDC.

Mills, Maine’s former CDC director and now vice president for clinical affairs at the University of New England, said Maine has struck a better balance than New Jersey between patient rights and public health.

“I do think New Jersey, with the blanket quarantine, has gone way beyond what the CDC is recommending, and it’s not supported by the science,” she told the Press Herald.

Mills did point to differences between the federal CDC’s guidelines and Maine’s, as the state goes a step further than federal guidelines by having a 21-day voluntary quarantine for those who treated Ebola patients. The federal guidelines call for monitoring and “controlled movements” for such individuals.

Mills said that in Maine, to quarantine someone against their will would require a court order or a declaration by the governor of a public health crisis. Even if a public health crisis is declared, a court review of mandatory quarantines would be required within 48 hours of such actions being taken, Mills said.

“Maine, as a state, has really tried to balance civil liberties and public health,” she said.

State Rep. Anne Graham, D-North Yarmouth, said Maine’s lack of a state epidemiologist is hurting Maine’s response to Ebola. State epidemiologist Stephen Sears left in May, and Pinette’s office is interviewing candidates to replace him.

“What is the factual basis for the Maine CDC’s decisions?” Graham said. “Let’s make decisions based on data and not fear.”

At Northern Maine Medical Center in Fort Kent, spokeswoman Joanne Fortin said the hospital has an Ebola protocol and would be able to isolate and treat a patient for the virus. She said the federal CDC has contacted the hospital and would help transfer a patient to another hospital if necessary.


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