Travelers to Maryland from three West African countries where Ebola continues to spread could be quarantined at home or barred from public transit, depending on their risk of exposure to the deadly virus, under guidelines Gov. Martin O'Malley announced Monday.
State officials expect about 10 to 20 health care workers and others to come to Maryland each day from Liberia, Guinea or Sierra Leone, and they will closely monitor each traveler for fever and other signs of Ebola.
But officials will not require all of them to stay in quarantine — unlike their counterparts in New York and New Jersey who imposed broader restrictions on travelers, drawing rebuke from White House officials. Quarantines have raised questions about what states can do — ethically and legally — and about the strategies to guard against an outbreak.
Meanwhile, University of Maryland Medical Center officials said Monday night that a potential Ebola patient had been transferred there at the request of state health officials and was isolated. A spokeswoman would not say whether the person had recently arrived in the country, or provide more details.
O'Malley said any plan to protect the public from possible exposure to the virus must be balanced with the ability of U.S. health workers to travel to West Africa to help stem the spread of the disease.
"The only way to really protect ourselves is to stop the spread of the outbreak in West Africa," O'Malley said. "Fear is not of any use to us in these kinds of circumstances."
State health officials plan to monitor travelers using a computer system that helps track a variety of infectious diseases. Anyone who enters the country from the three countries will be placed into one of three groups depending on their possible exposure to Ebola.
The high-risk group includes those who came in contact with an Ebola patient without wearing protective equipment, including health workers who reported a needle stick or other breach of equipment. They will be required to stay home and take their temperature four times a day. They must stay in close contact with health officials who may make unannounced visits.
The group considered at "some risk" includes those who report contact with Ebola patients while using proper protective equipment. They will be asked to avoid public transportation, large gatherings and long-distance travel. They also must take their temperature four times a day and keep in contact with health officials.
These travelers will be required to sign agreements with the state health department. If they don't comply, they could be subject to a public health order requiring them to abide by the guidelines, state health Secretary Joshua Sharfstein said.
Other travelers who report no direct contact with Ebola patients will be considered at "low but not zero risk." They will be required to keep in contact with health officials and take their temperature twice daily.
Hospital officials from John Hopkins Medicine, the University of Maryland Medical System and MedStar Health appeared with O'Malley at a Monday briefing and said they support the measures.
"The need for flexibility, as this is a very dynamic situation, is imperative," said Dr. Trish Perl, senior epidemiologist for Hopkins Medicine.
New York and New Jersey officials on Friday jointly announced plans to require any health workers returning from West Africa to be quarantined in a hospital for 21 days, the maximum amount of time it can take for Ebola symptoms to develop.
But White House officials suggested the policy might do more to incite unwarranted fear of Ebola than prevent its spread, and could discourage health workers from assisting in West Africa.
New York Gov. Andrew Cuomo responded by revising that state's policy to allow health workers to be quarantined at home.
Mark Graber, a professor at the University of Maryland Francis King Carey School of Law, said states have the power to "regulate for the health, safety and general welfare of the population" within their borders. That includes quarantines in cases of a "reasonable perception of danger to public health," he said.
But the federal government could supersede the states if it issues orders regarding travelers from West Africa, because only it has the power to exercise foreign policy, Graber said.
Michael Klag, dean of Johns Hopkins' Bloomberg School of Public Health, criticized New Jersey's policy in a letter to Gov. Chris Christie, posted on the school's website. He wrote on behalf of Kaci Hickox, an alumna and nurse who was placed in isolation after traveling to Newark Liberty International Airport from Sierra Leone on Friday.
Hickox's case drew national attention. Her isolation raised "serious constitutional and civil liberties issues," given that she shows no Ebola symptoms and has not tested positive for the disease, said her lawyer, Norman Siegel.
"While I applaud your concern for the health of the citizens of New Jersey and recognize your responsibility to protect their health, I do not think that this policy does so," Klag wrote to Christie. "Instead, it increases paranoia without materially protecting health."
Hickox was allowed to return to her home in Maine to complete her 21-day quarantine, Christie said Monday.
Christie has defended his state's policy of automatic quarantine for medical workers returning from treating patients in Liberia, Sierra Leone and Guinea. He told reporters he did not reverse the policy in allowing her to be discharged from the hospital.
"We're very happy that she has been released from the hospital," said Christie. "She hadn't had any symptoms for 24 hours and she tested negative for Ebola, so there's no reason to keep her."
For states to fairly use their powers to quarantine and impose other health-related restrictions, actions must respect constitutional rights to equal protections and due process, said Joseph Ali, a research scholar at Hopkins' Berman Institute of Bioethics.
That means treating all people the same when it comes to being placed in quarantine, ensuring they are quarantined in a comfortable setting, and compensating them for their time, he said.
Maryland officials emphasized that their guidelines were developed in consultation with officials from the National Institutes of Health and Centers for Disease Control and Prevention.
"It's based on science and it's based on evidence," said Dr. David Mayer, vice president for quality and safety at MedStar Health.
The state on Thursday designated Johns Hopkins Hospital, University of Maryland Medical Center and MedStar Washington Hospital Center to care for any Ebola patients in Maryland, should federal facilities including the NIH Clinical Center in Bethesda, not be able to admit them.
Federal health officials on Monday called on states to impose voluntary home quarantine for people at the highest risk for Ebola infection but said most medical workers returning from West Africa would only require daily monitoring without isolation.
Baltimore Sun reporter Colin Campbell and Reuters contributed to this report.