New Jersey Mandatory Quarantine and Screening Protocols for Ebola

New Jersey Mandatory Quarantine and Screening Protocols for Ebola

PO Box 360 Trenton, NJ 08625-0360 For Release: 10/31/2014

Mary E. O'Dowd, M.P.H. Commissioner For Further Information Contact: Office of Communications (609) 984-7160

New Jersey Mandatory Quarantine and Screening Protocols

TO:  
Col. Rick Fuentes, Superintendent, State Police
David Hespe, Commissioner, Department of Education
John Jay Hoffman, Acting Attorney General
Chris Rodriguez, Director, Office of Homeland Security and Preparedness
Jennifer Velez, Commissioner, Department of Human Services
FROM:
Mary E. O’Dowd, MPH, Commissioner, Department of Health
Chair, Ebola Virus Disease Joint Response Team (EVD-JRT)
SUBJECT:  New Jersey Mandatory Quarantine and Screening Protocols
On October 22, 2014, pursuant to Executive Order No.164 (2014), Governor Chris Christie created an Ebola Virus Disease Joint Response Team (EVD-JRT) to coordinate the efforts needed to appropriately prepare for and respond to the Ebola Virus Disease public health hazard.  The New Jersey Department of Health (NJDOH) and its state, local, and federal health care and public health partners are taking a comprehensive approach in responding to Ebola through coordinated steps to prevent potential exposure, ensure the health care system’s preparedness, and provide community education.
This memo is intended to provide guidance to our partners by formally documenting the quarantining and screening protocols previously implemented in New Jersey pursuant to statutory authority to “maintain and enforce proper and sufficient quarantine, wherever deemed necessary.” 
I.         Christie Administration Staffing at Newark Liberty International Airport 
As Governor Christie indicated on Wednesday, October 22, 2014 in a public briefing on Ebola preparedness, the following New Jersey State officials have been and will continue to be deployed at Newark Liberty International Airport.
These officials are there to supplement Centers for Disease Control and Prevention (CDC) and Customs and Border Protection (CBP) staffing in order to provide real-time information and decision-making.

• New Jersey Department of Health (NJDOH) epidemiologists and physicians remain in regular communication with the CDC officials at the airport and responding hospitals to collaborate on management of passenger evaluation and follow up protocols.
• Office of Homeland Security and Preparedness (OHSP) will continue to lead coordination efforts with Newark Liberty International Airport for passengers identified for enhanced screening.
• The Office of the Attorney General (OAG) is providing legal staff at Newark Liberty International Airport and counsel to OHSP and the NJDOH regarding coordination with our federal partners on all necessary actions, including quarantining.

II.         Protocols For Passengers Traveling From Ebola Affected Country Exhibiting Symptoms During Flight
If a passenger exhibits symptoms during a connecting flight to Newark Liberty International Airport, originating from one of the three West African nations that have been identified with widespread transmission of Ebola (Guinea, Liberia, and Sierra Leone), CDC notifies NJDOH.  Following this notification:        

• Immediate transport to a designated Tier 2 hospital for medical evaluation and treatment accompanied by pre-designated Emergency Medical Services personnel.  Emergency Medical Services personnel will wear appropriate personal protective equipment (PPE).
• The symptomatic individual is placed in isolation at a designated Tier 2 hospital and infection prevention measures are implemented.
• The individual is subject to NJDOH mandatory quarantine order based on risk assessment.
• Ebola testing is conducted as necessary after consultation with NJDOH and CDC, based on clinical symptoms and possible exposure.
• If an alternate diagnosis is identified (such as malaria), the individual remains in isolation as clinically appropriate. Depending upon evaluation of the risk factors the individual may still be subject to a mandatory quarantine order.

III.         Protocols For Passengers Traveling From Ebola Affected Country Exhibiting Fever During Non-Contact Fever Check
If a passenger arrives in Newark Liberty International Airport from a flight originating from one of the three West African nations that have been identified with widespread transmission of Ebola (Guinea, Liberia, and Sierra Leone), a non-contact fever check is conducted by the U.S Coast Guard. If the passenger exhibits a temperature, CDC notices NJDOH. Following this notification:

• Immediate transport to a designated Tier 2 hospital for medical evaluation and treatment accompanied by pre-designated Emergency Medical Services personnel.  Emergency Medical Services personnel will wear appropriate personal protective equipment (PPE).
• The symptomatic individual is placed in isolation at a designated Tier 2 hospital and infection prevention measures are implemented.
• The individual is subject to NJDOH mandatory quarantine order based on risk assessment.
• Ebola testing is considered in consultation with NJDOH and CDC, based on clinical symptoms and possible exposure to the Ebola Virus.
• If an alternate diagnosis is identified (such as malaria), the individual remains in isolation as clinically appropriate. Depending upon evaluation of the risk factors, detailed below, the individual may still be subject to a mandatory quarantine order.

IV.        Protocols For Passenger Traveling From Ebola Affected Country Exhibiting No Fever During Non-Contact Fever Check
If a passenger arrives in Newark Liberty International Airport from a flight originating from one of the three West African nations that have been identified with widespread transmission of Ebola (Guinea, Liberia, and Sierra Leone), they are evaluated for symptoms and a non-contact fever check is conducted.
All passengers who exhibit no fever at the non-contact fever check must still complete a traveler declaration form providing all pertinent contact information, an Ebola Virus Risk questionnaire and an interview. The passenger’s risk is then determined by evaluating travel history and potential exposure.  This assessment includes a determination of credibility or lack of credibility based on the consistency, responsiveness, and accuracy of the documentation and interview questions as factors in the evaluation of risk.
A. Low Risk:
If the individual traveled to one of the three affected West African nations, but had no known exposure to anyone with the Ebola Virus, the individual is considered Low Risk and the following actions will be taken:

• If the individual is a New Jersey resident, Division of Global Migration and Quarantine (DGMQ) send the individual’s contact information to NJDOH.
  • CDC provides the individual with an Ebola Care Kit and a 24/7 phone number for NJDOH.
  • NJDOH contacts the individual’s local health department for active monitoring for 21 days from the date of their departure from the affected country.
  • Local health department provides the individual contact information for area hospitals and Emergency Medical Services.
• If the individual is a non-New Jersey resident, they are released and NJDOH sends the individual’s contact information to the Department of Health in their home state.

If the passenger is determined to have had some risk following the questionnaire and oral interview, the passenger completes a more detailed exposure and risk assessment. Following the more detailed exposure and risk assessment, the passenger is moved into one of two other risk categories:

B. Some Risk:
If the individual traveled to one of the three affected West African nations, and for example, was a health care worker who treated an Ebola patient with active symptoms while wearing PPE, the individual is considered to have Some Risk and the following actions will be taken in such a case:

• Individual is subject to NJDOH mandatory quarantine order.
• No commercial conveyance or movement by the individual is permitted.
• NJDOH will contact the individual’s local health department for active monitoring for 21 days        from the date of their last exposure.
• The local health department will provide the individual contact information for area hospitals and Emergency Medical Services.

C. High Risk:
If the individual traveled to one of the three affected West African nations and had direct contact with the body fluids of an individual with the Ebola Virus, he/she is considered to have High Risk and the following actions will be taken:

• Individual is subject to NJDOH mandatory quarantine order.
• No commercial conveyance or movement by the individual is permitted.
• NJDOH will contact the individual’s local health department for active monitoring for 21 days from the date of their last exposure.
• The local health department will provide the individual contact information for area hospitals and Emergency Medical Services.  

All other scenarios will be addressed on a case-by-case basis for possible mandatory quarantine, with the following additional measures as appropriate:   

• CDC provides an Ebola Care Kit with 24/7 phone number for NJDOH.
• NJDOH sends information to local health department.
• NJDOH limits or prohibits commercial conveyance or movement of the individual.
• Local health departments will contact the individual for direct active monitoring for symptoms for 21 days and provide contact information for area hospitals and Emergency Medical Services.
• Controlled movement and conditional release based upon person’s compliance and adherence to local health department’s instructions.

V.        Housing and Transportation For Residents and Non-Residents Subject to a Mandatory Quarantine Order
As the EVD-JRT announced on Wednesday, October 22, 2014, New Jersey will make every reasonable effort to ensure New Jersey residents subject to a mandatory quarantine order are able to do so in their home. This policy was first explained by EVD-JRT member DHS Commissioner Jennifer Velez on October 22nd: “Travelers who are New Jersey residents will quarantine in their own homes.”
Governor Christie reiterated this on Friday, October 24th at a joint briefing with New York Governor Andrew Cuomo:  “We will make those judgments and the Department of Health will make those judgments where need be, what the most appropriate location for that is, if the person is not a resident of our state already. Obviously if they’re already a resident of New Jersey then they can quarantine in their own homes under a quarantine order.”

• Residents will be transported from Newark Liberty International Airport to home quarantine location with a NJ State Police escort.
  • Arrangements include provisions for day-to-day necessities and comfort, as necessary.
  • As permitted by law, the State will provide assistance to quarantined individuals if they are being denied compensation for lost time at work.

• NJDHS is working to designate and support suitable housing locations in New Jersey for the quarantine of asymptomatic individuals should the need arise, such as in the event a non-resident cannot safely be transported to their home state. DHS is working with State and local health officials, as appropriate.
• Travelers or their families can call 877.294.HELP (877-294-4357) for phone support, and DHS will make available crisis counselors, as needed.

As members of the EVD-JRT, I understand you will be implementing these protocols through your own efforts and internal guidelines. As previously stipulated at our briefing on Wednesday, October 22nd, OHSP will be taking the lead on coordinating these efforts.