Oct 31, 2014 3:15 AM

Soldier or civilian, Ebola protocols not the same

The Associated Press

WASHINGTON (AP) A U.S. soldier returning from an Ebola response mission in West Africa would have to spend 21 days being monitored, isolated in a military facility away from family and the broader population. A returning civilian doctor or nurse who directly treated Ebola patients? Depends.

The Pentagon has put in place the most stringent Ebola security measures yet, going beyond even the toughest measures adopted by states such as New York, New Jersey and Maine and much further than the guidance set by the federal Centers for Disease Control and Prevention for travelers returning from the afflicted region.

"I have one responsibility and that is the security of this country," Defense Secretary Chuck Hagel said Thursday. "And that means the security of our men and women and their families."

He called the Pentagon's step a "smart, wise, prudent, disciplined, science-oriented decision."

Yet, the policy far surpasses federal government standards. The CDC recommends that only people at the highest risk those who've had direct contact with an Ebola patient's body fluids, for example avoid commercial travel or large public gatherings for 21 days. Anyone who develops symptoms would be hospitalized immediately.

The differences are partly a function of the military's unique role, the constitutional authorities granted to individual states and the federal government's desire not to discourage health care workers from volunteering to help confront the deadly Ebola virus at its source in Sierra Leone, Liberia and Guinea.

But the varying approaches have raised questions about whether and how different levels and agencies of government are coordinating the response to Ebola in the United States.

For now, the questions are mostly academic.

Only one Ebola patient has died in the U.S. and he contracted the disease in Liberia. Two nurses who were infected by that patient have recovered and have been declared Ebola-free. One doctor who recently returned from treating Ebola patients in West Africa has been diagnosed with the virus and is being treated at a hospital in New York.


The Pentagon: Returning troops would have to undergo a 21-day quarantine even though their jobs do not require them to be in contact with Ebola victims. The military facilities could be in the U.S. or overseas. Already a group of 42 returning soldiers, including a two-star Army general, are in supervised isolation at a military base in Vicenza, Italy.

The states: Not all have developed responses, but among those who have New York, New Jersey, California, Illinois, Georgia, Florida and Maine are imposing 21-day quarantines for health care workers and other travelers from West Africa who had direct contact with people with the Ebola virus but show no symptoms of the disease.

The federal government: The CDC recommends 21-day isolation and monitoring for people who show no symptoms but who have had direct contact with an Ebola patient's bodily fluids, either through exposure or a needle prick, for instance. For those who have been in close contact with patients but have not been directly exposed to a patient's fluids, the CDC recommends daily self-monitoring for 21 days. Those recommendations are supposed to serve as guidelines for state policies.


Defense officials maintain that the Pentagon rules are necessary because even through troops will not treat Ebola patients, they will spend more time in the Ebola hot zone than health care workers.

Gen. Martin Dempsey, chairman of the Joint Chiefs of Staff, said the U.S. troops comprise the largest portion of the U.S. contingent in Liberia and will be staying there for six months at a time, compared with the 30-day to 60-day stays for U.S. civilian health care workers. Pentagon officials also note that the troop presence in West Africa will likely grow to up to 4,000 over time.

"Being in the hot zone is like being in a war zone; the longer you're there the greater the chances of being injured or killed," said James G. Hodge Jr., a professor of public health law at the Sandra Day O'Connor College of Law at Arizona State University.


It's a question some military spouses are certainly asking. Rebekah Sanderlin, a board member of the Military Family Advisory Network, said she hasn't heard complaints about the 21-day policy for service members. But, she added: "There is a lot of confusion over the quarantine policy because the military and civilian guidelines do not match. I do think if a quarantine period is justified for one group, it is justified for all."

Hodge, who is western director of the Network for Public Health Law, notes that service members, unlike civilians, can have their liberties curtailed. As White House spokesman Josh Earnest noted this week, "There might be some members of the military who think that the haircut that's required may not be their best, but that's a haircut that they get every couple of weeks because it is in the best interest of their unit and it maintains unit cohesion, and that is a policy of the military."

President Barack Obama has urged states to consider how their policies will affect the willingness of civilian doctors and nurses to volunteer for Ebola work in West Africa. Unlike those civilians, Obama said this week, the troops are not there voluntarily. "It's part of their mission that's been assigned to them by their commanders and ultimately by me, the commander in chief," he said.


The biggest Pentagon deployment is in Liberia with 1,000 troops. There are about 120 in Senegal, where they operate a staging base for operations in Liberia. Dempsey said Thursday that the troop presence is intended to grow to about 4,000.

As for civilians, since the CDC began tracking travel from West Africa, it has detected fewer than 100 people a day entering the United States, most of them U.S. citizens or legal permanent residents, according to CDC Director Thomas Frieden. He said about 5 percent have been identified as either health care workers or someone who had been in contact with an Ebola patient, but not exposed to bodily fluids.

Seven out of 10 of those returning civilians go to six states: New York, Maryland, Pennsylvania, Georgia, New Jersey and Virginia.


Pentagon officials say any individual diagnosed with the disease would be transferred to the United States for treatment. Right now, however, there is only one aircraft designated to transport a sick individual from West Africa to the U.S. and it can only hold one person at a time and make only four trips a week, according to Maj. Gen. Lariviere, who testified before the House Oversight and Government Reform Committee last week.

He said the Pentagon has a plan for isolation pods that could carry 15 people at a time inside C-17 military transport planes. He said purchase of those pods would not begin until January.


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