Philadelphia imposes a mandatory quarantine three or four times a year for uncooperative people with tuberculosis and is planning to automatically seek a court order as a precaution if a patient is confirmed with Ebola, officials said.
The city is monitoring about 40 travelers from West Africa who arrived at five designated airports in other parts of the country. An additional 20 or so, including 11 in Burlington County, are being followed at least daily in surrounding counties in Pennsylvania and New Jersey. About 100 are being monitored in Pennsylvania and a similar number in New Jersey, two of the six states that are the destination for most travelers from Guinea, Liberia, and Sierra Leone, where the epidemic rages.
All have been cooperative and no travel restrictions or quarantines have been imposed, officials said, because none have known exposure to Ebola - the trigger that has caused a rift between the federal and several state governments. The restrictions have also infuriated a nurse who was quarantined in Newark under Gov. Christie's order and has been challenging a similar mandate in Maine since being transported home.
Caroline Johnson, disease control director for the Philadelphia Department of Public Health, said that city health workers were in daily contact with nearly all the travelers from West Africa that have been referred to them after airport screening by federal authorities.
The number is fluid - about five to 10 additional cases a day are expected - and the city projects it will end up tracking 100 to 200 people as new travelers arrive and others reach the end of the 21-day period of incubation for the virus.
Nearly all are in contact by phone, and must report any symptoms of disease, which are similar to the flu, along with their temperatures from two readings. This follows recommendations from the U.S. Centers for Disease Control and Prevention. Some have been visited at home, most to deliver thermometers; in at least two cases, workers went in-person so that they could bring French translators.
Tuberculosis is passed through the air and is up to 20 times more likely to be transmitted than Ebola, which requires direct contact with body fluids. TB cases usually are handled through voluntary isolation.
Several times a year, however, the city goes to court - either to force treatment or to keep the patient away from others.
"They may not like the process. They may not like the way they are being treated," said Lynda Moore, a chief deputy city solicitor who handles health cases for the city. "Either you are going to comply," she said, "or we are going to court." The Common Pleas Court almost always agrees with the city.
Pennsylvania law gives county health department directors, along with the governor and the state health secretary, the authority to order a mandatory quarantine, but they must get a judge's approval to have it backed up by law enforcement.
County health directors in New Jersey said that they had the power to enforce quarantines on their own, although a patient who objects could take the issue to court. It was unclear whether they would use their own authority to enforce Christie's mandatory quarantine of travelers who were exposed to Ebola in West Africa, although they said that they planned to carry out the order regardless.
Whether that would be a good idea continued to depend on who was doing the talking, with the public health community overwhelmingly opposed.
Sarah Bass, an associate professor in public health at Temple University, surveyed Pennsylvanians' attitudes toward voluntary isolation and mandatory quarantine in a hypothetical avian influenza pandemic for a 2010 journal article headlined "If You Ask Them, Will They Come?"
"As coerciveness increased, the willingness [to comply] decreased," she said, suggesting that a mandate might actually backfire. Men and people with higher incomes were more likely to be uncooperative; regular churchgoers were most willing.
Besides limiting the spread of disease, quarantines are meant to calm the public. Done too broadly, however, like a national state of emergency, "is the kind of thing that can scare people," said law professor Kimberly Mutcherson, who teaches health law and bioethics at Rutgers University-Camden.
"The biggest problem with excessive 'caution' " said Scott Burris, a Temple law professor and director of the Public Health Law Research project, "is that they are saying it is not dangerous, but they are acting like it is."
With Ebola, Burris said, "the chances are zero of getting it from an asymptomatic person, and near zero in early [stages of symptoms]." Calls for widespread quarantines, he said, are reminiscent of the early days of AIDS, when some schools refused to educate children with HIV - moves overturned by the courts.
Misplaced fear distracts from the most important actions needed to contain the disease at its source, said David Barnes, an associate professor of history and sociology of science at the University of Pennsylvania, who is writing a book about the Lazaretto, the oldest surviving quarantine station in the Western Hemisphere, in Tinicum Township.
"This is the most obvious and tragic lesson of Ebola," Barnes said. "Individual cases can occur anywhere, but epidemics are impossible wherever health centers or hospitals are capable of diagnosing and isolating cases quickly."
Public health workers are in daily contact with about 100 travelers from West Africa in New Jersey and another 100 in Pennsylvania.
None has known exposures to Ebola, which would trigger quarantine in New Jersey and some travel restrictions in Pennsylvania.
The breakdown by county on Thursday:
Philadelphia: About 40.
Delaware: Not given*.
* Delaware County is covered by the Pennsylvania Department of Health, which would not release local numbers.
SOURCE: State and local health departments