Last week, a nurse returning from West Africa was quarantined by the state of New Jersey in a tent adjacent to a hospital. Yesterday, Governor Chris Christie announced she was free to travel home to Maine, but the policy remains in place. And several other states now have similar quarantines for people who have been exposed to the Ebola virus. Civil rights advocates say quarantines aren’t medically necessary and discourage healthcare workers from volunteering. But supporters argue federal guidelines don’t go far enough—they say tougher measures are necessary to protect the public. Diane and guests debate the legal, ethical and public health implications of mandatory, Ebola quarantines.

Guests

  • Michael Shear White House correspondent, The New York Times
  • Donna Lieberman Executive director, New York Civil Liberties Union
  • Dr. Anthony Fauci Director, National Institute of Allergy and Infectious Diseases at the National Institutes of Health.
  • Bruce Fein Principal, Bruce Fein & Associates and author of "Constitutional Peril: The Life and Death Struggle for Our Constitution and Democracy."

Transcript

  • 10:06:53

    MS. DIANE REHMThanks for joining us. I'm Diane Rehm. The Centers For Disease Control announced new guidelines yesterday for travelers exposed to the Ebola virus, but governors of several states say they don't go far enough. They're leaving mandatory quarantines in place. Joining me to talk about the legal, ethical and public health debate over Ebola quarantines, Michael Shear of the New York Times, and constitutional scholar Bruce Fein.

  • 10:07:28

    MS. DIANE REHMJoining us from the NPR bureau in New York City, Donna Lieberman of the New York Civil Liberties Union and by phone from his office in Bethesda, Maryland, Dr. Anthony Fauci of the National Institutes of Health. Do join us. Your questions, comments, 800-433-8850. Send an email to drshow@wamu.org. Follow us on Facebook or send us a tweet. And welcome to all of you.

  • 10:08:03

    MR. MICHAEL SHEARThank you, Diane.

  • 10:08:04

    MR. BRUCE FEINGood to be here.

  • 10:08:05

    MS. DONNA LIEBERMANThanks.

  • 10:08:05

    DR. ANTHONY FAUCIGood to be with you, Diane.

  • 10:08:07

    REHMDr. Fauci, tell us about these new CDC guidelines. What do they say, how different are they from current protocol?

  • 10:08:20

    FAUCIWell, Diane, what they've done when it comes to people coming into the country from the involved West African countries is that they matched the stratification of the risk to which the person entering the country has been in, be that a healthcare worker or perhaps someone from Liberia, Sierra Leone, taking care of or coming into contact with an Ebola patient.

  • 10:08:46

    FAUCIThey match that stratification of risk with the degree and the intensity of the monitoring of that person after they arrive and then they use that to make a determination as to what is the level of restriction that you would put on that person so that you have the fundamental scientific evidence and data dictate whether or not you're gonna severely restrict someone or let someone go out without any issue.

  • 10:09:16

    REHMBut give me an example of what you mean. Are you talking about an accidental needle stick? What are you talking about?

  • 10:09:25

    FAUCIOkay. So there are four fundamental risk categories, Diane. One is called a high risk and an example of that is either a healthcare worker who has a needle stick or has a splash of bodily fluid from an infected person or maybe not a healthcare worker, someone who's living with and caring for a person or someone who's touched a dead body. That's one level of risk.

  • 10:09:50

    FAUCIThe monitoring and restriction of that person is much more stringent than the next level, which is called some risk, namely you're in a country with widespread Ebola transmission and even though you've had the right equipment on, if you're a healthcare worker, but you've come into direct contact with that person or you're not a healthcare worker and you have close contact with someone, you're put into the next one which is called some risk.

  • 10:10:18

    FAUCIAnd then, you go way down. The next is low, but no zero risk, namely you just happened to be in the country that has Ebola transmission, but you don't have any known risk. And then, there's something called low risk. So that's a new way of looking at things. Don’t put everybody in the same bucket. Stratify them according to what their risk of getting infected is and match the kind of restriction and monitoring based on that risk.

  • 10:10:47

    REHMAll right. So say an individual has just come back from helping to care for other patients with Ebola. Would those individuals, if they were designated high risk, would they be banned from flying? Would they be banned from going to public places or getting on a bus? What would happen?

  • 10:11:22

    FAUCIWell, it depends. If they're there, we're talking about -- first of all, you have to distinguish, Diane, between a symptomatic person and an a-symptomatic person. A person who's symptomatic, even if, let's say, pick out your high risk person. Let's say it's someone that has gotten -- touched a dead body or living with a person carrying. That person likely would not even get on the plane.

  • 10:11:46

    FAUCIWhat the American people are concerned about mostly is someone who gets on a plane, doesn’t have any symptoms and then gets here. What are we gonna do with them? What kind of monitoring? So, for example, let's say someone who is a healthcare worker is in a country that has a high, widespread Ebola transmission and they've had direct contact and they've actually warned the right equipment.

  • 10:12:12

    FAUCIThey're called some risk. That person would have, when they come here, direct active monitoring so there would be not only just saying I'm gonna measure my own symptoms or temperature and I'll let you know. They're gonna actually have someone directly, every day, come and make sure that person doesn't have symptoms and doesn't have a fever.

  • 10:12:34

    FAUCIAnd if they do, then that person would be restricted.

  • 10:12:37

    REHMAll right. So all of what you've just said still falls short of what the governors of several states want. Is that correct?

  • 10:12:51

    FAUCIWell, when you talk about a quarantine, what you do is that you put sort of everyone in the same category and you quarantine them for 21 days. And what the CDC guidelines tries to do, and I believe successfully, is not put everyone in the same bucket of either complete restriction or no restriction. And they -- yeah.

  • 10:13:13

    REHMAnd how do you feel about a mandatory quarantine?

  • 10:13:18

    FAUCIRight. Well, first of all, I think it's important that I say this, Diane, because there's been a lot of, I think, misrepresentation of opinion. The governors who've done that, I believe, in good faith have been trying to do what they feel is the best for their constituency. So there's no criticism there. There's nothing that I can say against them. The only thing I can say is that based on the scientific data and experience we have, that a person who doesn't have any symptoms is not going to transmit Ebola to anyone.

  • 10:13:54

    FAUCIThe person needs to have contact directly with bodily fluids. And that's the reason why the CDC is doing these stratified risk and matching the kind of restriction to the risk in a a-symptomatic -- if a person is symptomatic, there's no doubt. They're not going anywhere. They're not going to be able to interact in the community. But I wanted to underscore, Diane, the idea -- we've got to get away from this criticism back and forth.

  • 10:14:20

    FAUCII understand why governors may have done that. They're trying to do the best for their constituencies.

  • 10:14:25

    REHMAll right. And that is Dr. Anthony Fauci of NIH. Turning to you, Michael Shear, how many states now have some kind of quarantine policy in place?

  • 10:14:42

    SHEARWell, the ones that we know of, there's about a half dozen that appear to have taken a kind of different or modified approach to what the CDC has done so that you have, for example, in Virginia and Maryland, they both adopt a similar approach to CDC, but with some tweaks so that they ask people to sign a document when they come in, promising that they will not be going to mass events or places that are crowded.

  • 10:15:11

    REHMPromising.

  • 10:15:12

    SHEARPromising, but not being, you know, sort of physically restrained or quarantined. You have New York and New Jersey who have said for that category that Dr. Fauci described of the some risk, those people would be mandatorily asked to stay at their homes. They would have somebody check in, a health worker check in with them twice a day, but unannounced so a surprise visit so that you would be there.

  • 10:15:40

    SHEARAnd the governor of New York has said, look, if they're not there, we're gonna enforce the fact that they're there, although he hasn't said how they'll do that. You had the governor of Georgia yesterday say that the people in that -- that have direct contact with a patient, which would seem to be in that second, some risk, category for the CDC, those people would be quarantined in a government facility, though he didn't say what that government facility would be.

  • 10:16:04

    SHEARAnd then you have the army, which late yesterday announced that all of the soldiers that are gonna be coming back are going to be quarantined on base with no access to their family members for 21 days and that's irrespective of whether or not, as I understand it, irrespective of whether or not they've been in touch with a patient or not. So a lot of those folks are just building hospitals and doing that kind of thing and they're not actually caregivers.

  • 10:16:30

    SHEARSo there's been a kind of, you know, and largely it's a definitional thing, right? Like, all of them are doing different things. But what's unclear, I think, to a lot of us, and I've been trying to follow this pretty closely for the last couple of weeks, is what the nation -- which category do people fall in and each governor is kind of taking a different approach.

  • 10:16:51

    SHEARAnd, you know, what I think Dr. Fauci and others in the federal government have said is, look, we don't have the authority to mandate that all the states do what we want them to do, that our guidelines -- perhaps, you know, Dr. Fauci can talk about that a little bit some.

  • 10:17:04

    REHMBut tell me what the White House response has been to all of this.

  • 10:17:11

    SHEARWell, I think you heard Dr. Fauci at the end there talk about, you know, we don't want to blame people. And I think there has been, over the last couple of days, 24, 48 hours, a sort of backing off of what people perceived as this direct criticism. But I will tell you that my reporting suggests that the folks at the White House and in the administration since Saturday or Sunday, after the governors of New York and New Jersey announced their policy, that there was a lot of concern, what I described in one of my articles as deep concern among the administration folks at how far New York and New Jersey had gone in an effort to try to convince them to sort of pull back on that and come to a place that's more like what the CDC has proposed.

  • 10:17:52

    SHEARI think there has been a lot of, in the last 24 hours, like, okay, let's calm down. Let's not be in such a political fight. But at the end of the day, this is a difficult thing. And you saw Governor Christie and Governor Cuomo yesterday say, look, they can -- CDC can do what they want. We're gonna protect our people and that's gonna cause some conflict.

  • 10:18:09

    REHMAnd what about the reaction to the joint chiefs of staff in regards to the military?

  • 10:18:17

    SHEARYou know, it's interesting. That happened late last night and I reached out to the White House to Josh Earnest, the press secretary, and said, look, how do you square the fact that you've got the military doing one thing and the administration and the CDC doing another and he referred me back to the DOD and didn't want to say, so.

  • 10:18:33

    REHMMichael Shear of the New York Times. When we come back, we'll talk about civil liberties, Constitutional rights, lots of in betweens. We'll be right back.

  • 10:20:02

    REHMAnd welcome back. I am talking here in the studio with Michael Shear of the New York Times from whom you've just heard and earlier with Dr. Anthony Fauci of the NIH. Also with us from New York is Donna Lieberman. She is executive director of the New York Civil Liberties Union, and constitutional scholar Bruce Fein. He is principal of Bruce Fein and Associates.

  • 10:20:44

    REHMNow Bruce Fein, are these quarantines that have been put in place by New York and New Jersey and other states considered legal?

  • 10:21:02

    FEINI think the answer would be yes, based upon our existing framework of case law. The Supreme Court has repeatedly held you create a danger to yourself or to others -- and someone with a contagious disease certainly does -- can be restrained. And let me just give you some examples. Children can be required to be vaccinated to attend school so that they don't create risk to other students. The Supreme Court has held if you're a sex offender and you have a mentally abnormal condition that could be dangerous, you can be detained beyond your prison term.

  • 10:21:33

    FEINThey've suggested in other cases that if you're mentally ill, of a drug addiction or alcohol addiction, you can be detained and treated indefinitely to try to cure your illness as long as it created a threat to yourself or to others. So it seemed to me in this situation, especially whereas Dr. Fauci said, those who are a-symptomatic are the ones who are quarantined. That is they also have the symptoms that could be passed onto someone else that clearly would pass constitutional muster.

  • 10:22:02

    FEINAnd I think there are a couple other elements that work in favor of legality here on the constitutional plane. One, you don't have a situation where a particular minority group is being singled out. You have sort of neutral criteria here. The length of the quarantine be 21 days and it's not as though you're put in shackles. I'm not trying to understate the amount of irritation that comes with the restraints on your liberty. But if you can't go to a ballgame or to a concert or something, that's not as oppressive as if you're detained in a jail or something of that sort.

  • 10:22:32

    FEINAnd even with regard to non-liberty issues, with regard to if you have a diseased crop, it could be destroyed if it threatens other diseased crops. A case called Millergen Shoni (sp?) makes that clear. So I don't think this is a question of constitutional dimension. It's a policy question. And the last thing I'd say with regard to uniform federal standard, I think that if Congress wished, it certainly could empower the CDC to impose a national standard under the theory that the quarantines, if they're over-expansive, they could deter international travel and it could deter health care workers from traveling on their discretion.

  • 10:23:08

    FEINNow unfortunately the congress is typically invertebrate on these issues they think as politically combustible. And so they run away and hide. And I don't think it makes sense. If anything I think the conversation today would awaken anxiety in your listeners because how can there be so many different protocols if they really know what they're doing?

  • 10:23:25

    REHMAnd turning to you, Donna Lieberman, did Governor Christie go too far in the quarantine of nurse Kaci Hickox?

  • 10:23:39

    LIEBERMANOh yes, absolutely. But I want to return to the question of, you know, sort of whether the protocols in place, the quarantine policies in place generally are in -- comport with the constitution. I think that the policy of the CDC certainly does comport with the constitution. As it turns out, good public health policy is good civil liberties policy because it matches the level of the restraint and the imposition on liberty with the level of the risk. But the policies in place in New York and New Jersey in fact do not match the level of the restraint and the imposition on liberty with the level of the risk.

  • 10:24:30

    REHMWhy not?

  • 10:24:31

    LIEBERMANMr. Fein talks about, you know, the case law about people who are contagious being appropriately deprived of their freedom, detained to protect the rest of us. But people are being detained under these policies who don't pose a risk, who the CDC and all the public health experts tell us are not a threat to the public health. So while we understand that the governors are really trying to do the best, you know, and Governor Cuomo has said many, many times, better safe than sorry, you know, that's fine when it comes to shutting down the subways before Sandy. But it's not okay to go so far overboard and put people under the harshest quarantine conditions when we're dealing with people's liberty and when it doesn't serve a public good.

  • 10:25:24

    LIEBERMANI think that we have to talk about the collateral consequences of these sweeping quarantine policies because it discourages health workers from doing the good heroic work like Kaci Hickox, even if they're confined in conditions that are not as abysmal and offensive and horrific as she was confined in. And they instill fear where we shouldn't be afraid.

  • 10:25:52

    REHMDonna, I know that Dr. Fauci wants to get in but I want to ask you one more question. Do you think that the governors have the legal right to place people in quarantines in their homes just to remain in their homes for 21 days?

  • 10:26:20

    LIEBERMANI think that when people are contagious then they can be quarantined. When people are not contagious, then I think that there are other measures that are fine that Dr. Fauci outlined that the governors can impose. But it can't be the most extreme level of restraint which is quarantine. Public health doesn't call for it but Dr. Fauci's a better person to talk about that than I am.

  • 10:26:46

    REHMAll right. Dr. Fauci, you're up.

  • 10:26:50

    FAUCIWell, Diane, as Donna said, that's really the fundamental basis of what the CDC recommendations are as I tried to articulate in the beginning of the program.

  • 10:27:00

    REHMBut they're confusing, Dr. Fauci. Suppose -- let me just give you a what-if. Suppose somebody gets on a plane declaring he or she has had no contact, no exposure, nothing and arrives here in the United States and declares exactly the same thing, has no temperature. But suppose that person in private develops symptoms, goes to a bowling alley and then throws up all over the place?

  • 10:27:45

    FAUCIOkay. So, Diane, you can do a lot of what-ifs based on what-ifs, you know.

  • 10:27:50

    REHMSure.

  • 10:27:50

    FAUCIAnd what you're asking for is a completely risk-free world. But putting that aside for a second, let me just say that when a person comes in, even if they deny that they have had contact -- you're talking not about a health care worker. You're talking about just a normal person from Liberia or Sierra Leone.

  • 10:28:08

    REHMSure. Right.

  • 10:28:11

    FAUCINow the restraints are now that when someone gets off the plane they are questioned and their temperature is taken.

  • 10:28:21

    REHMRight.

  • 10:28:21

    FAUCISo even if they're infected and still without symptoms, they now have active monitoring. So they have to report in now with their symptoms. They have to have their temperature taken each time, reported back in and report on symptoms. If they don't do that, they have to give a contact information of where they are. They have to give a telephone number, email address, where they're going to be geographically. And if they don't report in, that's called active monitoring, then they are subject to being restrained.

  • 10:28:54

    REHMBut couldn't they simply disappear into the population?

  • 10:29:00

    FAUCIDiane, again, anything is possible like that, but you've got to really be careful. If you do what-if based on a what-if, based on a what-if, you're going to make yourself -- tie yourself into a pretzel. You can't be...

  • 10:29:11

    REHMBut I think that's what an awful lot of people are beginning to do, Dr. Fauci, because the outlines, as you put them, are somewhat hazy.

  • 10:29:25

    FAUCIOkay. Well, Diane, let's just put a fact on the table. Since the beginning of this epidemic in March, two American's have gotten infected in the United States.

  • 10:29:38

    REHMRight.

  • 10:29:38

    FAUCIBoth of them have been taking care of a very drastically-ill person, Mr. Duncan, who died.

  • 10:29:48

    REHMRight.

  • 10:29:49

    FAUCIThose were the only people who got infected. One more thing, Diane. Mr. Duncan was in the United States and was exposing himself to his family and others. None of those people have gotten infected.

  • 10:30:03

    REHMRight.

  • 10:30:03

    FAUCIThat's what we're talking about, taking evidence-based and data, not a zero zero risk but look at what has happened.

  • 10:30:12

    REHMAll right. Bruce Fein.

  • 10:30:14

    FEINI think those points are well taken but I think it's not unreasonable to not get an absolute risk-free system but try to minimize that. And what I think the equation that's been discussed so far neglects is, what is the nature of the burden if you're in your home for 21 days? Is it really so drastic that that little extra increment of safety isn't worth it? Reasonable people can disagree. And to suggest that it's illegal or unconstitutional seems to me very flawed because you identified, Diane, many of the places where the effort to monitor could fail because of dishonesty or otherwise. And maybe it's not even dishonesty. It's just inefficiency. That's part of what bureaucracies are about.

  • 10:31:00

    FEINWhen I came back from abroad , traveled to Africa several weeks ago, I was just asked, well, did you come from Liberia, Sierra Leone or Guinea? I did not because I hadn't visited there but that was the scope of the inquiry. Now they may have increased it since that time but I don't think that for the reasons that you articulated that it's unreasonable, again indicating that the so-called home arrest, if you will, for 21 days is such a huge burden that an increment of public safety isn't justified.

  • 10:31:29

    REHMMichael Shear, how do you gauge the public reaction to what the CDC is saying and what the potential risks as outlined have been?

  • 10:31:46

    SHEARI mean, I think that's one of the things that we don't have a really clear picture about. I saw a poll coming in this morning that suggested that something like 54 percent of the people thought that they had confidence in the way the government was handling Ebola. So that would go, I think, to give some greater sense of confidence than I think you maybe pick up from the anecdotal watching the cable news shows you would think that everybody's in a, you know, complete panic.

  • 10:32:10

    SHEARI'm not sure that's the case. On the other hand, to your point that you made earlier, I do think people look at the patchwork of differences that have been -- you know, that are out there. And they do wonder, given the sort of faith that they started with in the CDC as a sort of rock solid institution in the country, how come it seems to herky jerky.

  • 10:32:34

    SHEARAnd I think from the beginning -- and Dr. Fauci knows this a lot better than I but, you know, when the Dallas situation started happening, there were all these questions that seemed to be -- the government seemed to be playing catch up. And I think that undermines a sense of confidence that the government is on top of this. And that's what, I think, the effort yesterday by putting out these national standards was about.

  • 10:32:55

    REHMAnd you're listening to "The Diane Rehm Show." And Michael, we now have several different recommendations from obviously the CDC, several of the governors. They're conflicting to a certain degree. And what kind of a problem is this for the Obama Administration?

  • 10:33:23

    SHEARWell, so I think there's a couple of different levels on that. One is that I don't know that we want to get down this rabbit hole, but there is an election in a week from today and so there -- you know, there are all sorts of potential implications for how this has kind of dominated the conversation at a time when the Obama Administration and the Democrats, you know, would have liked to have been talking about something else.

  • 10:33:44

    SHEARI do think, and it's a good question for Dr. Fauci and I wonder -- and this is a legal question that maybe the lawyers can talk about as well but, you know, is there any way short of asking congress to pass new laws that the government can encourage more of these states to adopt their policy. In other words, putting aside the fighting and the back and forth. I wonder if Dr. Fauci knows, is there an effort inside the White House, inside the administration to try to sell this internally to all these other governors to go to the governor of -- Governor Deal in Georgia and say, look, you know, you've got to do it our way. This is really the better way in the hopes of coming up with a more consistent package.

  • 10:34:25

    REHMDr. Fauci.

  • 10:34:27

    FAUCIWell, the CDC is very, very much involved in interacting at the state level. The CDC is a federal organization that deals in a very collaborative way with the state and local health authorities. They can set a bar beneath which you can't go. The states can go over that, which we're seeing in some circumstances now.

  • 10:34:50

    FAUCIBut in direct answer to the question, certainly the CDC is very actively reaching out with their partners at the state and local level trying to get some sort of an agreement. Not necessarily everyone's going to agree but to try and articulate why they feel that this matching of the stratification of risk and matching that with the kind of monitoring and restriction you ultimately do, is something that's science-based and that will work. So direct answer, they are reaching out to the states.

  • 10:35:23

    REHMSo if they federal government comes up with some sort of executive protocol on Ebola, would that preempt what some of the states have done in terms of prescribing their own quarantines, Bruce Fein?

  • 10:35:46

    FEINWell, I think that congress clearly could empower the CDC to preempt the state laws. Now, the issues would be, Diane, whether under existing laws if congress does nothing that an executive order is something that could be reasonably implied as authorized by the existing immigration legislation. I'm assuming the answer probably is no. Otherwise it seems to me quite impolitic for President Obama to have this sort of Tower of Babel from all the different states outstanding, which create anxiety without a doubt. Because the idea of the public would be if they know how to deal with this, there'd only be one protocol.

  • 10:36:24

    FEINYou know, when you go and you get treated for a disease or pneumonia there's one protocol. They don't have 15 different ones. So my belief is that unless the president simply doesn't want to take on a federal burden where if there was a problem that's all, you know, on his shoulders, you could assign it to the governor. I think probably it doesn't have the legal authority the executive branch to act now unilaterally.

  • 10:36:48

    REHMDonna Lieberman, what about the so-called home quarantines? Are they okay or do you feel they go too far in stepping on individual rights?

  • 10:37:04

    LIEBERMANI think that quarantines at home are okay depending on the conditions. If they are extreme quarantines where people cannot leave their homes, cannot have family members with them or visitors and they're asymptomatic, not contagious, then they don't serve the public health need.

  • 10:37:27

    REHMAll right.

  • 10:37:28

    LIEBERMANPeople need to be subjected to the least restrictive possible intrusions that serve the public health.

  • 10:37:33

    REHMDonna Lieberman is executive director of the New York ACLU. Stay with us.

  • 10:40:00

    REHMAnd welcome back. We're talking again about Ebola. This time the various quarantines put in place by certain governors. We have many callers, many emails. Here's an email from John, in Missouri, who says, "It's better to be over cautious then too liberal with our measures, otherwise you can count on some misguided, self-centered person pushing the limits and infecting others in this country." How do you react to that, Bruce Fein?

  • 10:40:48

    FEINWell, what I think it shows is that science is misplaced when it doesn't also incorporate how human beings can lie and misrepresent and bureaucracies can become inefficient and not have a scheme come off exactly as you wish. And as we were pointing out earlier, the idea of self-reporting and monitoring and relating accurately the exposure is something that depends upon honesty and truth. And that is something we applaud, but surely that's not characteristic of everyone.

  • 10:41:20

    FEINAnd when we go back at the level of the danger -- and plus, I think -- I don't necessarily -- I think I would agree with Donna, that, you know, home detaining for 21 days, given the fact that you're doing it in the public interest is such an onerous burden, that these measures that are taken by the governors are -- provide an ample, but not an unreasonable amount of comfort level.

  • 10:41:40

    REHMDr. Fauci?

  • 10:41:42

    FAUCIWell, I think one of the things we have to put into the equation, and again, getting back to that not in any criticism of anyone because I believe everyone is trying to act in good faith for the best, for example, governors for the best of their constituents. But one of the issues -- let's concentrate for a moment just on health care workers. So if you have a health care worker who goes over there, at great sacrifice to themselves, remember the best way to make Americans safe is to completely suppress this epidemic in West Africa.

  • 10:42:12

    FAUCIThen we don't have to worry about anything. The only way we're going to do that is by the kinds of resources that are being put in, of which volunteer health care workers are a major, major component of that effort. If they go over there, do everything right, at great sacrifice, putting themselves at risk, come back here and are without symptoms, and are having direct, active monitoring -- which the new CDC guidelines call for -- direct means somebody takes their temperature, somebody makes a clinical judgment whether they can go out into society.

  • 10:42:46

    FAUCIIf they are not allowed to do that, but have to be another 21 days out of commission, I know from talking to many of my colleagues that would be a major disincentive for people to go over there and to do the kind of work that they're doing. And we need them. That's one of the considerations that you really have to put on the table.

  • 10:43:09

    REHMAll right. Let's open the phones first to Daytona Beach, Fla. Hello, Brendan, you're on the air.

  • 10:43:18

    BRENDANThank you for the great conversation, Diane.

  • 10:43:20

    REHMThank you.

  • 10:43:21

    BRENDANIt seems to me like what's not being recognized is that because this is so public and people are -- I can't imagine someone traveling to and for West Africa -- that being a small decision. Depending on them to come in and reveal all the details of things that they may or may have not done, and then making a decision based on that, doesn't account for the risk of them possibly misrepresenting something, just to be able to get on with their lives. That's my comment.

  • 10:43:52

    FEINYeah, if I -- I think that's accurate. And I want to go back to another point that Dr. Fauci made. And I think I'd part company with him on how great a deterrent, you know, a 21-day house quarantine would be. The military, unilaterally, has done this. And I don't know whether people in the military are saying, well, I'm going to resign from the military because I've got 21 days quarantine if I'm gone to Africa.

  • 10:44:15

    FEINI think there's an understatement of the willingness of people in good faith to say, I'll take 21 days, you know, it's an irritant, yes. But, you know, I can survive there. This is something that's needed to calm fears and as an extra precaution of risk. So this idea that no one would go to perform health care in Guinea or in Sierra Leone or Liberia I think is vastly overstated.

  • 10:44:37

    REHMDonna?

  • 10:44:38

    LIEBERMANYeah, I think, you know, easy for us to say. We're not subjected to this 21-day stay-at-home quarantine. It's not quite that un-onerous. And I think we have to understand and really respect what Dr. Fauci has said, which is that we're not saying that people should be just sent out into the world to go about their business. We're saying that anybody who is at a level of risk that warrants active monitoring is going to be actively monitored.

  • 10:45:14

    LIEBERMANSo we're not saying go home and go, you know, touch everybody and shower with people or whatever people are going to do to create risk of infection. We're saying when you're asymptomatic we're going to check on you every day, twice a day. There's nothing vague about that. There's nothing -- shedding responsibility for monitoring people. Yet you're not telling people you can't go out for a walk in the park.

  • 10:45:39

    LIEBERMANYou're not telling them -- and in New York City, you know, where you don't have a backyard -- if you're quarantined in your house, you're quarantined sometimes in one room. It's like, you know, I guess it's solitary confinement, you know. And I think that, you know, fear is like -- we're all worried about the dangers from Ebola. But we have to listen to the medical experts and we have to drive our policy based on the risk minimization that they are calling for.

  • 10:46:09

    LIEBERMANAnd I think that, you know, human life is complicated and the situations that are going to arise are complex and complicated. We can't predict all of them. But what the CDC guidelines do is create levels of restrictions, based on levels of risk. And there are responses that we can take as a society if somebody is noncompliant. That's what we did with TB, you know. And I think that it's what promises to work without imposing a terrible discouragement on health care workers.

  • 10:46:46

    LIEBERMANYou know, are we going to start discouraging the EMT workers from dealing with people who might be infectious? Are we going to discourage the health care workers in our own country? You know, they take precautions, but what if? No, of course not. We need to be kind of reasonable about this. And I think respect the CDC guidelines.

  • 10:47:08

    REHMAll right.

  • 10:47:08

    LIEBERMANWhich, as I said before, respect civil liberties as well.

  • 10:47:11

    REHMAll right. Here's an email from Deb, Michael Shear. She's in Ohio. She says, "Who's paying for the cost of these quarantines?" She says, "I know the parents of the journalist treated in Nebraska have said their son did not have any health insurance. His total costs were close to $500,000. Will he be responsible for that debt?"

  • 10:47:46

    SHEARYou know, that's a really good question. I don't know the answer. There's a couple of different levels of costs and perhaps Dr. Fauci knows how the -- and some of the insurance works. Clearly, there's going to be people with insurance and without insurance. The one issue -- kind of side issue on cost came up in New York City, in terms of people's salaries.

  • 10:48:05

    SHEARIf you tell somebody that they have to quarantine themselves -- as New York has done -- at home for two or three weeks, what do you do to the people whose bosses say, well, then you're not going to get paid, right, for those three weeks. And the governor has said that they will make up the salary for those.

  • 10:48:21

    REHMThe state will make -- I see.

  • 10:48:22

    SHEARThe state will, right. But that's a good question. If, you know, if this was a federal policy or if it extends to other states, you know, will other governors make that same choice? I don't know about the question on the insurance and who ends up paying for some of this highly specialized care, as Dr. Fauci provided to that nurse, Nurse Pham.

  • 10:48:39

    REHMAll right. Let's go to Miriam, in Arlington, Va. Hi there.

  • 10:48:46

    MIRIAMHi, Diane. Thanks so much for taking my call.

  • 10:48:48

    REHMSure.

  • 10:48:49

    MIRIAMFirst, for Dr. Fauci, my question as a parent always protecting my children from disease, I know the first line of defense is the human skin. I understand that covering yourself, entirely is what they're doing, but if the hand and the face are covered and there are no open wounds, then wouldn't a person in essence be protected after they took a shower? I'm just talking about the workers. That's just a technical question.

  • 10:49:17

    MIRIAMOn the other side, I really do believe that the CDC and the Department of Education should get together now. And in everyone's little trick or treat bag we should be talking about exposures and we should be talking about protection. And this could get us way ahead on what could come and get out of hand down the road. Thank you.

  • 10:49:36

    REHMAll right. Dr. Fauci? I'm sorry. Dr. Fauci, I'm not hearing you.

  • 10:49:46

    FAUCII'm sorry, Diane. I was on mute so not to…

  • 10:49:47

    REHMOkay.

  • 10:49:49

    FAUCIOkay. The answer to the question about protection, someone can be in a situation where they're taking care of someone who is seriously ill and they have the right personal protective equipment on and there's no real exposure that they know of, sometimes because of fatigue or because of the stress of the situation when they are in that environment, particularly in the West African country, that sometimes that when they take their material off, all of the protective material, they can sometimes accidentally contaminate their skin, which likely has happened on one or more occasion.

  • 10:50:24

    FAUCIAnd which is the reason why someone can't identify what the risk is. They haven't stuck themselves with a needle. They haven't got anything obviously on bare skin. It's likely something that has to do with when you -- what's called doffing. When you take off your protective equipment. That's what we think happens in those situations.

  • 10:50:41

    REHMAll right. And let's go to Louisville, Ky. Hi, Jimmy.

  • 10:50:50

    JIMMYHi. Thank you for taking my question.

  • 10:50:51

    REHMSure.

  • 10:50:52

    JIMMYIt's a three-part question. First of all, with the new CDC regulations that have come out, what would have the nurses that have contracted this fallen under? And what will the caretakers fall under that are taking care of them now? And even that they were infected, have they pinpointed or do they have an idea of when that risk -- when it was contracted? Do the two people that have it, do they have an idea of when and where they contracted it in the process of caring for them?

  • 10:51:26

    REHMDr. Fauci?

  • 10:51:29

    FAUCIWell, the person that -- there were two nurses. One of whom I've had the privilege of taking care of. When they were first seeing Mr. Duncan, they clearly, first of all, didn't have the real drill type training. So they were at risk on the basis of a number of reasons. When she was finished taking care of the person, right now, having taken care of someone in that situation, she would have been on direct active monitoring -- when she was without symptoms.

  • 10:52:01

    FAUCISo at the time that she had no symptoms someone would have been directly monitoring, taking her temperature, asking her about symptoms under the current guidelines. That's what we call direct active monitoring. Now, the situation is that once she got infected, that that proves that the environment she's in was a high-risk environment. So under those circumstances, if she had no symptoms, she would have had restriction of movement into crowded places.

  • 10:52:32

    FAUCIBecause even without symptoms, when you are in a high-risk situation you have restriction of movement, in addition to direct active monitoring. So if the guidelines had been in place at the time, that's what would have happened. And remember, those two nurses, to this point, have not infected anyone. The only two people -- the only two Americans in this country who've gotten infected were those who put themselves knowingly at risk to take care of another human being.

  • 10:53:04

    REHMAnd you're listening to "The Diane Rehm Show." Michael Shear, we have not heard one word from Ron Klain, since he took over as Ebola czar. What explains his silence and what is he doing?

  • 10:53:29

    SHEARWell, I think that's a good question that those of us in the White House press corps have asked repeatedly of the White House folks. They have said that while Mr. Klain has been in the past a sort of very, sort of visible public person at times, that they envisioned his role as much more -- in this case, much more behind the scenes, as a coordinator person. Somebody that would be at these meetings that I'm sure Dr. Fauci is part of, kind of coordinating all the different agencies and parts of government to make all of this work.

  • 10:54:00

    SHEARYou know, I assume that at some point Mr. Klain may actually emerge as more visible public role. Let's remember he just started last Wednesday, I think, officially. They announced him a few days earlier, but it takes a little time to get the clearances and all that. So…

  • 10:54:13

    REHMDo you understand clearly what he is supposed to do?

  • 10:54:18

    SHEARYou know, I've got to say nothing about this story seems 100 percent clear to me. You know, the best description that I've gotten is the comparison to the previous person who they said was coordinating all of this, which is Lisa Monaco, who is the president's Homeland Security advisor. And the best way it was explained to me was, look, she was trying to be the person, be the glue between all of these different agencies.

  • 10:54:41

    SHEARBut the problem was she had so many other responsibilities, taking care of the Yemen situation and the -- and all of Homeland Security efforts, terrorism here and abroad and ISIS and all of that. And it was just impossible for her to devote the kind of time. So that's what it's been described to me as.

  • 10:54:56

    REHMAnd finally to you, Bruce Fein, will so-called home quarantine stand up in court?

  • 10:55:07

    FEINYes. I think it clearly will. And I also want to make an observation about that. I do think that generally under the constitution, when the government takes your property or opportunity to make income, they ordinarily pay just compensation if the purpose of the taking is the public health or welfare. And I do think it makes a lot of sense in this circumstance where somebody -- because they're under home quarantine -- is deprived of the opportunity to work and losing money, that they may have a claim for just compensation, if it's not voluntarily forthcoming.

  • 10:55:34

    REHMAnd I think Dr. Fauci wants to make one last comment.

  • 10:55:37

    FAUCIYeah, Diane, please don't get confused about what Ron Klain's doing. He's playing a very active role. He is the Ebola response coordinator. There are multiple agencies involved because just because you haven't seen him on television or on the airwaves, he's playing a very important coordinating role. And as was said correctly, that was formerly done by Lisa Monaco and to some extent Susan Rice.

  • 10:56:00

    FAUCIThey have other very, very important day jobs, as you know. So what Ron is doing is something important and active. So just because you don't hear about it, that doesn't mean he's not actively involved.

  • 10:56:11

    REHMDr. Anthony Fauci, he joined us from his office at the NIH, in Bethesda. Donna Lieberman, executive director of the New York Civil Liberties Union, Bruce Fein, constitutional scholar, author of "Constitutional Peril: The Life and Death Struggle for our Constitution and Democracy." And Michael Shear, White House correspondent for the New York Times. Let's hope all of this simply quiets down. Thank you all so much.

  • 10:56:55

    SHEARThank you, Diane.

  • 10:56:55

    FEINThanks, so much.

  • 10:56:56

    FAUCIThank you.

  • 10:56:56

    REHMAnd thanks for listening all. I'm Diane Rehm.

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