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New Ebola Quarantine Protocol Seen as Barrier to Volunteers

When Dr. Thomas M. Kerkering of Virginia Tech’s Carilion School of Medicine returned in late September after volunteering at an Ebola treatment clinic in Sierra Leone, he adhered closely to the routine established by other medical professionals.

He checked his temperature twice a day and avoided shaking hands with people and hugging even family members. But he also went out for hamburgers with his wife, bought groceries and browsed at a bookstore.

Now, that code of behavior — cautious but hardly constrained — is being second-guessed by elected officials and others as the authorities scramble to respond to news that a New York City doctor contracted the deadly virus while working in Guinea and traveled around the city after his return.

On Friday, in a surprising move, Gov. Andrew M. Cuomo of New York and Gov. Chris Christie of New Jersey imposed a mandatory quarantine on individuals arriving at two area airports who have had direct contact with those infected with Ebola, including health workers.

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Dr. Craig Spencer is being treated for Ebola at Bellevue Hospital Center.Credit...Benjamin Norman for The New York Times

Among medical professionals who have been fighting Ebola in West Africa, the restrictions only intensified the debate. While a few of those interviewed said an overabundance of caution was welcome, the vast majority said that restrictions like those adopted by New York and New Jersey could cripple volunteers’ efforts at the front lines of the epidemic.

Although the federal Centers for Disease Control and Prevention sets the baseline for recommended standards on Ebola, state and local officials have the prerogative to tighten the regimen as they see fit.

 Dr. Rick Sacra, who contracted Ebola in Liberia and was flown back to the United States to be treated in September, said he believed that the new rules in New Jersey and New York would reduce the number of people willing to volunteer their time to treat Ebola patients. 

He said many doctors and nurses who volunteered would spend about three weeks in Africa and then return to their regular jobs. The requirement that they be quarantined at home upon their return “will effectively double the burden on those people, on the loss of productive time,” Dr. Sacra said.

“They are the authorities,” he added. “They have their rationale. They sometimes can’t base their decisions only on the science.”

Part of the issue, several doctors said in interviews on Friday, is that there is no standard protocol for health care workers returning from Ebola-affected countries. Some doctors returned to seeing patients, while others were told to stay away from their hospitals in large metropolitan areas for 21 days, which is believed to be the maximum incubation period for the virus.  

 The group Doctors Without Borders requires all health care workers returning from affected countries to follow a series of instructions, in hopes of identifying the illness as soon as it develops: Returning staff members must take their temperatures twice a day; be on the lookout for symptoms of Ebola; stay within four hours of a hospital with the ability to isolate patients with the disease; and finish their course of preventive malaria treatment, because symptoms of malaria can mimic Ebola’s.

But beyond that, returning workers are permitted to resume their normal activities, since a person without symptoms of the disease cannot transmit it. “Self-quarantine is neither warranted nor recommended when a person is not displaying Ebola-like symptoms,” the organization said in a statement on Thursday.

Doctors Without Borders does ask workers not to return to work for 21 days, however, both because they need to rest and because of the risk of contracting an illness that could generate symptoms easily mistaken for Ebola.

In a statement on Friday, the group said it was still reviewing the New York and New Jersey guidelines.

The International Medical Corps, which has about 300 workers caring for patients in Liberia and Sierra Leone — including 30 who come from outside West Africa — follows similar guidelines. Health care workers are given a thorough medical examination before they leave for West Africa, to ensure they are healthy enough to go. They are closely monitored while they are working, to be sure they follow the proper safety protocols. They are assessed for risk before returning to the United States. Once they are back, the workers are asked to monitor their temperatures and be alert for symptoms for 21 days. But they need not confine themselves to home.

 Some groups have adopted more restrictive measures. SIM USA, a Christian aid group that had two workers who contracted Ebola and survived, has been temporarily housing returning personnel in an RV park on the grounds of its campus in Charlotte, N.C. Three of those workers were quarantined because they had known contact with one of the people who contracted Ebola, but the others — about a dozen — stayed there out of caution.

Kelly Sites, 48, a registered nurse from Central Michigan who does disaster response work for another group, Samaritan’s Purse, is in her second stint in Liberia, helping to open a clinic in the southern part of the country to treat Ebola patients. She came back from her previous trip, working in an Ebola isolation unit in Monrovia, in July.

Ms. Sites, who is married and has 16-year-old twins, said that when she returned from Liberia the last time, she underwent a “mandatory 21-day isolation.” She lived at home and could talk to and even hug family members, but nothing more.

Ms. Sites said she thought a quarantine period was “probably necessary to keep people safe.”

“You don’t mess around with Ebola,” she said in an email.

But Dan Kelly, 33, an infectious disease doctor and a founder of Wellbody Alliance, a nonprofit organization working in Sierra Leone, criticized the governors’ response as knee-jerk.

“I think we are just digging the grave deeper,” he said in a telephone interview from Freetown, the capital. “Come on, that’s exactly the move to push people away from going to Sierra Leone and other affected areas. It’s going to escalate the epidemic and not help solve the crisis.”

He added: “If we’re going to get in front of it, we need health care workers from abroad. They cannot feel shunned or discriminated against.”

Reporting was contributed by Alain Delaquérière, Alan Feuer, Matt Flegenheimer, Denise Grady, Michael M. Grynbaum, Rose Hackman, Eba Hamid, Anemona Hartocollis, Sheri Fink, Annie Correal, Kia Gregory, C. J. Hughes, Corey Kilgannon, Adam Nossiter, Sharon Otterman, Michael Paulson, Liz Robbins, Tatiana Schlossberg, Katie Thomas, Daniel Victor, Karen Workman, Vivian Yee and Kate Zernike.

A version of this article appears in print on  , Section A, Page 1 of the New York edition with the headline: New Protocol Seen as Barrier to Volunteers. Order Reprints | Today’s Paper | Subscribe

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