(Reuters) - Federal health officials on Monday revamped guidelines for doctors and nurses

returning home to the United States from treating Ebola patients in West Africa, stopping
well short of controversial mandatory quarantines being imposed by some U.S. states.
Dr. Thomas Frieden, director of the U.S. Centers for Disease Control and Prevention
(CDC), called for voluntary home quarantine for people at the highest risk for Ebola
infection but said most medical workers returning from the three countries at the center of
the epidemic would require daily monitoring without isolation.
New York and New Jersey are among a handful of states to impose mandatory
quarantines on returning doctors and nurses amid fears of the virus spreading outside of
West Africa, where it has killed nearly 5,000 people in the worst outbreak on record.
The Obama administration's new guidelines are not mandatory and states will have the
right to put in place policies that are more strict. Some state officials, grappling with an
unfamiliar public health threat, had called federal restrictions placed on people traveling
from Ebola-affected countries insufficient to protect Americans and have imposed tougher
measures.
With thousands already dead from Ebola in Liberia, Sierra Leone and Guinea, concerns are
high in the United States about stopping its spread. In New York City on Monday, a 5-yearold boy who arrived in the United States from Guinea and was in hospital for screening for
fever, tested negative for Ebola.
The CDC's Frieden, on a conference call with reporters,
warned against turning doctors and nurses who are striving to tackle Ebola in West Africa
before it spreads more widely into "pariahs."
Under new CDC guidelines that spell out four risk categories, most healthcare workers
returning from West Africa's Ebola hot zone would be considered to be at "some risk" for
infection, while healthcare workers tending to Ebola patients at U.S. facilities would be seen
as "low but non-zero" risk.
In other Ebola-related developments, the U.S. military said it was isolating troops returning
from their mission to help West African countries curb Ebola even though they showed no
sign of infection. And a nurse who treated patients in Sierra Leone was released to go to her

home state of Maine after New Jersey had forced her into quarantine. The nurse had been
kept in quarantine for two days after testing negative for the Ebola virus.
There has been a growing chorus of critics, including public health experts, the United
Nations, medical charities and even the White House, denouncing mandatory quarantines
as scientifically unjustified and an obstacle to fighting the disease at its source in West
Africa.
"At CDC, we base our decisions on science and experience. We base our decisions on what
we know and what we learn. And as the science and experience changes, we adopt and adapt
our guidelines and recommendations," Frieden said.
Medical professionals say Ebola is difficult to catch and is spread through direct contact
with bodily fluids from an infected person and not transmitted by asymptomatic people.
Ebola is not airborne.
Frieden said high-risk people include healthcare workers who suffer a needle stick while
caring for an Ebola patient or who tend to a patient without protective gear.
He said returning health workers at some risk would have their health monitored daily by
a local health department official who would check their temperature, look for signs of
fatigue and review their daily activity plans to determine what activity makes sense for that
individual, at that time.
President Barack Obama's spokesman, Josh Earnest, made clear Monday that the White
House was not thrilled that individual states had implemented quarantines viewed as unfair
to returning healthcare workers, though he acknowledged the states' rights to set them.
"We want to make sure that whatever policies are put in place in this country to protect the
American public do not serve as a disincentive to doctors and nurses from this country
volunteering to travel to West Africa to treat Ebola patients," Earnest said.
MAJOR GENERAL ISOLATED
The Pentagon move went well beyond previously established military protocols. The U.S.
Army has already isolated about a dozen soldiers at part of a U.S. base in Vicenza, Italy,
including Major General Darryl Williams, who oversaw the initial response to the Ebola
outbreak, the worst on record with nearly 5,000 dead.

Dozens more will be isolated in the coming days as they rotate out of West Africa, where the
military has been building infrastructure to help health authorities treat Ebola victims, the
Pentagon said.
"We are billeted in a separate area (on the base). There's no contact with the general
population or with family. No one will be walking around Vicenza," Williams told Reuters in
a telephone interview.
"Nobody is symptomatic. No Army soldier came in contact with Ebola-stricken patients,"
Williams said, calling the move precautionary.
The case of nurse Kaci Hickox, put into quarantine on Friday under a New Jersey policy that
exceeded precautions adopted by the U.S. government, underscored the dilemma that
federal and state officials are facing.
New Jersey Governor Chris Christie, who has defended his state's policy of automatic
quarantine for medical workers returning from treating patients in Liberia, Sierra Leone
and Guinea, told reporters he did not reverse the policy in allowing her to be discharged
from the hospital and to return to Maine.
"We're very happy that she has been released from the hospital," said Christie, who Hickox
had criticized for making comments about her health that she said were untrue while calling
her quarantine unjust.
"She hadnt had any symptoms for 24 hours and she tested negative for Ebola so theres no
reason to keep her," said Christie, a potential Republican Party 2016 U.S. presidential
candidate known for his combative style.
Christie said he sees no reason to talk to her and expressed "goodwill" toward Hickox, who
had worked with the medical charity Doctors Without Borders in Sierra Leone. "But she
needs to understand that the obligation of elected officials is to protect the public health of
all the people," Christie said.
Christie said his state was providing transportation for her to Maine, whose health officials
"will take over her care and monitoring from there" as she completes a 21-day quarantine at
home. The quarantine matches the incubation period of the virus.

U.N. Secretary-General Ban Ki-moon on Monday became the latest to criticize quarantines,
saying through his spokesman these create difficulties for medical workers risking their lives
in the battle against the deadly disease.
"Returning health workers are exceptional people who are giving of themselves for
humanity," said Ban's spokesman, Stephane Dujarric. "They should not be subjected to
restrictions that are not based on science. Those who develop infections should be
supported, not stigmatized."
Four people have been diagnosed with Ebola in the United States, with one death - a
Liberian man visiting Texas. The only patient now being treated for Ebola in the country is a
New York doctor, Craig Spencer, who was diagnosed last Thursday. He had worked with
Doctors Without Borders treating Ebola patients in Guinea.
(Additional reporting by David Morgan, Jeff Mason, Steve Holland, Phil Stewart, David
Alexander, Roberta Ramptom and Susan Heavey in Washington, Louis Charbonneau, Laila
Kearney and Joseph Ax, Bill Berkrot in New York, and Steve Scherer in Rome; Writing
byWill Dunham; Editing by Lisa Shumaker and Grant McCool)

http://www.reuters.com/article/2014/10/27/us-health-ebola-usa-newyorkidUSKBN0IG12920141027