California health officials on Wednesday ordered people returning from Ebola-stricken areas who have had contact with infected patients to be monitored for the disease, and left it up to county officers to decide how, including a 21-day quarantine.
While there are no reported or confirmed cases of Ebola in California, 19 people in the state are being monitored for symptoms because those people recently traveled to an Ebola-affected country.
San Diego County Public Health Officer Wilma Wooten said three people in San Diego are in the low risk category. They are not under quarantine or any other restrictions.
“We call individuals twice a day," Wooten said. "We ask them to report whether or not they’ve had a fever, and report any other symptoms associated with Ebola virus disease.”
Those at low risk, as defined by the U.S. Centers for Disease Control and Prevention, could include someone who has been in a country in the past 21 days where the Ebola virus is widespread but had no known exposure. It also could be someone who had brief, unprotected contact with a person who exhibiting Ebola symptoms.
Dr. Ron Chapman, the state's health officer, said California is establishing a statewide standard to protect the public. Chapman said the extent of quarantines will be determined by county health officials on a case-by-case basis. That means some people could be isolated at home while others deemed lower risk are free to move about while being monitored.
Riverside County's health department announced Tuesday that two people who have recently returned from West Africa were being monitored for 21 days by having them take their temperatures twice a day. They are considered low risk.
Orange County health officials are monitoring two recent travelers as well, according to the Orange County Register.
A person who traveled to an Ebola-affected area as identified by the U.S. Centers for Disease Control and Prevention but did not come into contact with a person with Ebola will not be quarantined.
"Not everyone who has been to an Ebola-affected area should be considered high risk," Chapman said in a statement. "This order will allow local health officers to determine, for those coming into California, who is most at risk for developing this disease, and to contain any potential spread of infectious disease by responding to those risks appropriately."
The active Ebola areas listed by the CDC are Guinea, Liberia and Sierra Leone.
Health officials said a number of California health care workers have volunteered to help combat the epidemic in West Africa. The California Department of Public Health has not said how many people, if any, have been quarantined.
California is adopting the risked-based quarantines after New Jersey Gov. Chris Christie and New York Gov. Andrew Cuomo were criticized by medical experts for ordering mandatory quarantines for health care workers, including a nurse who has shown no symptoms of Ebola. Cuomo has since relaxed the policy by allowing medical workers who showed no symptoms to remain at home.
The Pentagon announced this week that troops returning from Ebola missions will be isolated for 21 days.
California Medical Association spokeswoman Molly Weedn said the group representing doctors doesn't have a policy on quarantines. And California Nurses Association spokesman Chuck Idelson said the nurses union has no comment on California's quarantine standard.
The union on Tuesday said five California hospitals that say they are ready to treat the Ebola virus lack proper training and equipment. The contention was part of an ongoing effort to call attention to what the union says is inadequate preparation at University of California hospitals in Los Angeles, San Francisco, San Diego, Davis and Irvine.
Last week the hospital UC system told the California Department of Public Health that those facilities were ready for patients.
Gov. Jerry Brown also has held meetings with state agency heads, labor unions and leaders in the health care industry to address Ebola preparedness at hospitals and other medical facilities throughout California.
On Monday, the Democratic governor was asked by a reporter whether he was considering measures similar to those taken by Christie and Cuomo.
Without mentioning the governors by name, Brown said he is not inclined "to make a political decision on something as dangerous as Ebola," according to the San Francisco Chronicle.
Ebola Risk Levels
High risk:
• A needle puncture or mucous membrane exposure to blood or body fluids of a person with Ebola while the person is showing symptoms of the virus.
• Exposure while not wearing personal protective equipment () to the blood or body fluids (including feces, saliva, sweat, urine, vomit, and semen) of someone with Ebola while the person was showing symptoms of the virus.
• Processing blood or body fluids of a person with Ebola while the person was symptomatic without appropriate PPE or standard biosafety precautions.
• Direct contact with a dead body without appropriate personal protective equipment in a country where Ebola virus infections are widespread.
• Having lived in a household and provided direct care to a person with Ebola while the person was symptomatic.
Some risk (applies to people who have been in countries with widespread Ebola virus transmission):
• Direct contact while using appropriate PPE with a person with Ebola while the person was symptomatic.
• Close contact in households, health care facilities or community settings with a person with Ebola while the person was symptomatic.
• Close contact is defined as being within about 3 feet of a person with Ebola while the person was symptomatic. The contact needs to be for a prolonged period of time while not wearing appropriate protective equipment.
Low risk:
• Having been in a country with widespread Ebola virus transmission within the past 21 days and having had no known exposures.
• Having brief direct contact, such as shaking hands, while not wearing appropriate protective equipment, with a person with Ebola while the person was in the early stage of disease.
• Brief proximity, such as being in the same room for a brief period of time, with a person with Ebola while the person was symptomatic.
• In countries without widespread Ebola virus transmission, having direct contact while using appropriate protective equipment with a person with Ebola while the person was symptomatic.
• Traveled on an aircraft with a person with Ebola while the person was symptomatic.
No identifiable risk:
• Contact with an asymptomatic person who had contact with someone with Ebola.
• Contact with someone with Ebola before the person developed symptoms.
• Having been more than 21 days previously in a country with widespread Ebola virus transmission.
• Having been in a country without widespread Ebola virus transmission and not having any other exposures as defined above.
