In California, it is local health officers who have the authority to order a quarantine. They are to review each person on a "case-by-case" basis, the state says. Quarantine may involve "isolation at home," but can also be tailored to allow people who are at lower risk fewer restrictions, such as "observation and monitoring."
San Francisco health officer Dr. Tomas Aragon drew a distinction between the quarantine order in California and those being implemented in New York and New Jersey. "There's always the ethical balance between the good of the community and individual rights, so we try to select the least restrictive option that achives that public health goal," he said.
"That’s what they didn’t do back East. They jumped to the most restrictive option, and the problem with jumping to the most restrictive option is that’s hard to defend legally, especially if there’s a less restrictive option."
The order should "protect the health and safety of Californians," Chapman said. He also seemed to acknowledge the tension between protecting the health of Californians at home -- and not posing an unfair burden on returning health care workers, whom he called "great humanitarians," who are caring for Ebola patients in Africa.
"They will be treated with respect and dignity when they come home as these important public health actions are taken," Chapman said.
Guidelines from the Centers for Disease Control were updated earlier this week and recommend that anyone returning from one of the three countries should be monitored for 21 days after they arrive in the U.S. The CDC guidelines also call for a "case-by-case" review for those it categorizes as being at "some risk." This includes health care workers who have directly cared for Ebola patients.
These workers may be subject to "additional restrictions," the CDC guidelines say, "such as controlled movement, workplace exclusions, or restrictions on other activities."
The California Department of Public Health says that its guidelines are "consistent with CDC" and called its order today "supplemental operational guidance for California local health departments."
The New England Journal of Medicine published an editorial earlier this week criticizing the governors of New York and New Jersey for imposing mandatory 21-day quarantines of health care workers returning from West Africa who have cared for Ebola patients.