Although the fervor of domestic news coverage regarding the West Africa Ebola outbreaks has subsided, cases that were treated in the U.S. shed light on a public health infrastructure to which Americans rarely give much thought. Among the discussions of travel bans and increased surveillance, an issue arose of particular legal importance: the quarantine of Kaci Hickox.
Kaci Hickox entered the United States on October 24 after a month of work with Doctors Without Borders treating Ebola patients in Sierra Leone. Per protocols developed by the New Jersey Department of Health (NJDOH), Homeland Security officials detained Hickox upon her arrival at Newark Liberty International Airport. During her detention, her temperature appeared elevated, and, following the protocol, Homeland Security transferred her to a New Jersey hospital for quarantine under the watch of NJDOH. An Ebola test administered at the hospital came up negative. Despite the test results, the NJDOH detained Hickox until October 27, when she threatened legal action against the state. At that point, NJDOH released Hickox, who returned to her home in Maine. After Hickox’s arrival in Maine, the Maine Department of Health (MDOH) sought a court order to enforce a 21-day in-home quarantine against Hickox.
Although the MDOH action was rare, it is hardly unprecedented. Societies reaching back to the middle ages have long sought to isolate citizens in the interest of public health. In the United States, courts have upheld state government efforts to do so, even in certain extreme cases where, in the course of quarantine, citizens have been jailed or had treatment forced upon them.
MDOH moved to exercise its quarantine power over Hickox pursuant to the state’s public health emergency statute. Under that law, MDOH may exercise certain powers—such as supervision or monitoring of a citizens health—if a “public health threat” exists. Such a threat can include “behavior that can reasonably be expected to place others at significant risk of . . . infection with” a communicable disease that is reportable to MDOH.
MDOH grounded its argument for Hickox’s quarantine in the fact that she had been exposed to Ebola while treating patients while in Sierra Leone, that Ebola is a particularly virulent disease, and that, to minimize risk to the public, she needed to be isolated from the public for the balance of the 21-day incubation period during which she might develop symptoms. A day after issuing a temporary order on October 30 granting the MDOH petition, the Court altered its position.
In its October 31 order pending hearing, the Court struck down the quarantine. Citing information presented by MDOH in its petition, the Court noted that, despite her exposure to Ebola, Hickox was not symptomatic and, therefore, did not present a risk of infection to the public; only if she were contagious would the quarantine be justified. With that in mind, the Court permitted Hickox to move freely, but also upheld MDOH’s requests that she submit to direct monitoring for symptoms, coordinate her travel with MDOH, and immediately contact MDOH if symptoms develop. The MDOH monitoring of Hickox ended without fanfare on November 10, the end of the 21-day incubation period. Hickox did not develop symptoms at any point during her monitoring.
As fear about a domestic outbreak of Ebola fades, Hickox’s case serves as useful reminder of importance of providing due process to those whose freedom is restricted during public health crises. Aggressive state action may, at times, be informed by public sentiment and fear a threat to safety; judicial recourse must ensure that such action is properly checked and grounded in sound assessments of any risk to public health.