Ebola Virus Disease Electron Micrograph

Liberia opens 1 of largest Ebola treatment centers

MONROVIA, Liberia (AP) — Remembering those who have died in the world’s deadliest Ebola outbreak, Liberia’s president opened one of the country’s largest Ebola treatment centers in Monrovia on Friday amid hopes that the disease is finally on the decline in this West African country.

American and U.N. officials as well as Cuban doctors were in the crowd as President Ellen Johnson Sirleaf opened the treatment center, which is set up to hold 200 patients and can eventually treat as many as 300. With the opening of the center, an Ebola treatment unit at JFK Medical Center has been closed. Many people with other diseases had been nervous about going to the nation’s largest referral hospital, and officials hope they will now come back.

The opening of the center, built out of white plastic sheeting with USAID written across it, comes as fewer people are showing up for treatment at various centers. Officials are not sure how to interpret that. Some believe it’s a sign that the Ebola outbreak is finally on the wane in Liberia.

“It is heartening to see that we are finally perhaps catching up with that boulder if not in front of it. It was rolling down the hill at a speed that we were never going to catch, we thought, two months ago, but we’re starting to make progress,” said U.S. Ambassador Deborah Malac.

Others believe Sirleaf’s order that the bodies of Ebola victims in the capital be cremated has led to people with symptoms hiding at home, because cremation violates traditions.

Doctors Without Borders, known as MSF, said that as of Tuesday there were around 80 patients in its 250-bed facility.

“MSF teams are looking into the reasons for this; a widespread aversion to the government’s mandatory cremation policy, poor ambulance and referral systems, changes in behavior, and other factors may play a role,” the aid group said.

Assistant Health Minister Tolbert Nyenswah, who heads the government’s Ebola response, told The Associated Press the JFK Ebola medical team and a team of Cuban doctors will be in charge of the new center, located in Congo Town in eastern Monrovia.

The World Health Organization said this week that the rate of infection in Liberia appears to be falling but warned that the response effort must be kept up or the trend could be reversed.

The international community’s response was late and figures were mostly wrong, Peter Maurer, president of the International Committee of the Red Cross, told reporters in Addis Ababa, Ethiopia. He said he is concerned about the “huge discrepancy” between announcements and the situation on the ground in the Ebola-affected countries.

More than 13,500 people have been sickened by the disease, and nearly 5,000 have died, the World Health Organization said Friday. That toll has about 130 fewer cases than the one released by WHO two days ago, mostly because a number of suspected cases in Guinea were determined to not be Ebola, the agency said.

The outbreak has hit Liberia, Sierra Leone and Guinea hardest and all three countries have resorted to extraordinary measures to combat it.

Sierra Leone has had a state of emergency in place for three months that bans public gatherings and, at one point, the entire country was locked down for three days to seek out hidden cases. There have been rumors that the emergency measures would be lifted, but Attorney General and Justice Minister Franklyn Bai Kargbo told AP on Friday that they are still in force. By law, they can last for 12 months and parliament put no time limit on them, he said.

While the disease is beginning to let up in some of Sierra Leone’s eastern districts, infections are continuing in the capital and surrounding areas.

Despite some signs of hope in Liberia, many officials warn that the fight cannot be let up. Sirleaf said the memory of sick and dying people with no place to go is still too fresh.

“We can all imagine those early days when journalists .. went into the streets and into the communities and took those pictures that were put on all the television screens all over the world of the dying, the sick, the dead who could not be picked up on time,” she said.

Despite those dark days, Liberia health workers fought on, she said.

“To our health workers,” she said, “we owe you a lot for the courage you continue to bring forth.”

___

Clarence Roy-Macaulay in Freetown, Sierra Leone and Elias Meseret in Addis Ababa, Ethiopia contributed to this report.

Ebola Virus Disease Electron Micrograph

Ebola virus disease – Mali

On 23 October 2014, WHO was notified by Mali’s Ministry of Health of a laboratory-confirmed case of infection with Ebola Virus Disease (EVD). This is the first EVD case in Mali.

Details of the case are as follows:

The case is a 2-year-old female who developed symptoms, presumably on 19 October 2014, while in Beuila, Guinea and then travelled across by road to Mali. On 20 October 2014, the patient was admitted to a healthcare facility in Kayes, Mali. On 21 October 2014, she was referred to the Fousseyni Daou Hospital in Kayes. On 22 October 2014, samples for EVD were taken and analysed at the Center for TB and AIDS Research in Mali. Samples came back positive for EVD. Confirmation of test results is being carried out at the Centers for Disease Control and Prevention (CDC) in Atlanta and at Institute Pasteur de Dakar Senegal. The case died on 24 October 2014.

To date, 85 contacts have been identified and are under follow-up.

Public health response

1. Under the leadership of the Government of Mali, WHO, Médecins Sans Frontières, the Alliance for International Medical Action, International Medical Corps, Project Muso, Save the Children and Plan Mali, national and international specialists have been deployed in Bamako and Kayes.

2. In collaboration with WHO, the Ministry of Health is putting in place an incident command structure in order to: (i) mount a coordinated response including surveillance and contact tracing, case management, safe burials, social mobilization and logistics; (ii) accelerate the completion of the isolation facility at the Center for Vaccine Development in Bamako, Mali; and (iii) provide regular communication to the public.

3. WHO convened an EVD Task Force meeting to prioritize actions and to discuss roles and responsibilities with partners.

4. Local authorities are carrying out training activities for the personnel working in the healthcare facilities where the patient was admitted; furthermore, these facilities are undergoing disinfection and equipment replacement. A management plan for EVD cases has been drafted at the Fousseyni Daou Hospital.

WHO and other partners are mobilizing and deploying additional experts to provide support to the Ministry of Health. The necessary supplies and logistics required for supportive management of patients and all aspects of outbreak control are also being mobilized.

Future WHO updates on EVD in Mali will not be posted on the Disease Outbreak News. Further information will be available in WHO’s Ebola Situation Reports which provide regular updates on the WHO response:

WHO does not recommend any travel or trade restrictions be applied by countries except in cases where individuals have been confirmed or are suspected of being infected with EVD or where individuals have had contact with cases of EVD. Contacts do not include properly-protected health-care workers and laboratory staff.

Temporary recommendations from the Emergency Committee with regard to actions to be taken by countries can be found at:

Ebola Virus Disease Electron Micrograph

Africans worst responders in Ebola crisis

JOHANNESBURG (AP) — The head of Africa’s continental body did not get to an Ebola-hit country until last week — months after alarm bells first rang and nearly 5,000 deaths later.

Pledges to deploy 2,000 African health workers have remained largely that — promises.

No African countries are on the United Nations list of contributors to fight the epidemic.

The E-word did not even figure on the agenda of a session on peace and security at the Pan-African Parliament in South Africa last week — more than a month after the U.N. Security Council declared the Ebola outbreak a “threat to international peace and security.”

Angry legislators from Sierra Leone and Liberia got up to protest. “They said as far as they are concerned, nobody wants to talk about Ebola,” said Jeggan Grey-Johnson, a governance expert who watched the session.

“They said countries like Liberia feel totally abandoned by the rest of Africa and shut off from the rest of the continent,” he told The Associated Press.

With few exceptions, African governments and institutions are offering only marginal support as the continent faces its most deadly threat in years, once again depending on the international community to save them.

Ebola “caught us by surprise,” the chairwoman of the 53-nation African Union, Nkosazana Dlamini-Zuma, said this week at a meeting with the U.N. secretary-general and the World Bank president in Ethiopia.

“With the wisdom of hindsight, our responses at all levels – continental, global and national – were slow, and often knee-jerk reactions that did not always help,” she said.

She is a medical doctor from South Africa, where mining magnate Patrice Motsepe Tuesday announced he has donated $1 million to the fight against Ebola in Guinea, where the outbreak started.

Motsepe’s gift, the largest donation by far from any African individual, came after the World Food Program lashed out at China’s billionaires, saying their contributions lagged behind their companies’ huge economic interests in the mineral-rich region. Motsepe’s office said his company has no interests in any of the countries where Ebola is raging out of control — Guinea, Sierra Leone and Liberia. China’s government has sent many health workers and given more than $8 million with a promise of $6 million more to the U.N. Ebola fund.

“Ebola is first and foremost our problem,” the president of the African Development Bank, Donald Kaberuka, told a business forum in Brussels this month. “Before relying on international aid, we must first encourage Africans to take action.”

The African Development Bank is the second largest institutional contributor to the U.N. fund to fight Ebola, second only to the World Bank, having given $45.4 million and promised another $17.4 million. In addition it has given loans and grants individually to the most affected countries.

By contrast, the African Union has made an “uncommitted pledge” of just $700,000. Africa’s equivalent of the Organization of America States, it is the body many believe should have taken the lead from the start.

No finger has been pointed at the Africans, even as rich countries have blamed each other for delays in responding to the crisis and the lack of financing. WHO chief Margaret Chan has said that governments have the first responsibility for taking care of their citizens, including in West Africa.

The WHO identified the first Ebola case in Guinea on March 21; on March 30 the virus crossed the border into Liberia; Sierra Leone reported its first two cases on May 30. On June 20, with some 330 recorded deaths, Doctors Without Borders warned that the outbreak was “totally out of control.”

Yet it was only on Sept. 20 that the first team of 30 military and civilian volunteers were deployed by a newly designated African Union Support to the Ebola Outbreak in West Africa. Most costs for that mission are being paid by the U.S. and other governments.

Jacob Enoh Eben, spokesman for the AU chairwoman, said more than 2,000 volunteers have been pledged to date: 1,000 from Congo, 600 from the East African Community, 500 from Ethiopia and 506 from Nigeria.

But he said they still need to know “when the first of these pledges will materialize.”

Those promised volunteers are only a tiny fraction of the number needed to stem the outbreak. The European Union said this week it is looking to put 40,000 local and European workers into place in the affected countries.

Uganda and Congo, which both have experienced Ebola outbreaks in the past, already have medical teams deployed in Liberia, under contract to WHO and not funded by their governments.

It is difficult to say how many Africans are deployed on the front lines of the Ebola battle.

In Uganda, Dr. Anthony Mbonye, the commissioner for community health services at Uganda’s Health Ministry, said he believes up to 40 Ugandan health workers are on the ground but that most traveled privately. He said the Ministry of Health had officially approved the deployment of about 10 doctors to Sierra Leone, Liberia and Guinea.

South Africa has been the most responsive African country and has budgeted $3.2 million, according to the Department of Health. That includes funding for a mobile testing lab operating in Sierra Leone since August.

The continental body’s lack of a robust response “showed the fragility of our African Union, so heavily dependent on the international community to rescue us from catastrophe,” said Isata Kabia, a Sierra Leonean legislator at the Pan-African Parliament.

“We cannot blame the WHO for their lack of knowledge; we can’t blame the EU for lack of interest,” she told The Associated. “But I think the AU should not only have led the response but also the requests to the international community.”

Associated Press writer Rodney Muhumuza contributed to this report from Kampala, Uganda, and AP medical writer Maria Cheng contributed from London.

Ebola Virus Disease Electron Micrograph

JAL worried about potential impact of Ebola on travel market

 

 

(Reuters) – Japan Airlines Co Ltd CEO Yoshiharu Ueki on Friday expressed worry about the potential impact of the Ebola outbreak on the travel market.

 

“I’m very concerned, the potential impact could be great,” he said at an earnings briefing.

 

(Reporting by Tim Kelly; Editing by Chris Gallagher)

 

Quarantined Ebola nurse Kaci Hickox defies orders to stay at home and goes for a bike ride

  • Nurse Kaci Hickox and her boyfriend Ted Wilbur left their home on Thursday morning with their bikes for an hour-long ride
  • The 33-year-old said: ‘There is nothing to stop me from going for a bike ride in my home town’ 
  • Governor Paul LePage said: ‘I don’t want her within three feet of anyone’ 
  • Demanded that she take a blood test and threatened to arrest her   
  • She spoke to the press outside the home in Fort Kent, Maine, on Wednesday night, saying she will continue to fight the Ebola quarantine 
  • Hickox shook the hand of MailOnline’s reporter at the scene and said: ‘You could hug me. You could shake my hand. I would not give you Ebola’   

By

Martin Gould In Fort Kent, Maine

and
Louise Boyle for MailOnline
Published:
08:43 EST, 30 October 2014

|
Updated:
01:53 EST, 31 October 2014

The Governor of Maine has threatened to arrest Nurse Kaci Hickox after she broke the state’s mandatory Ebola quarantine by saying: ‘I don’t want her within three feet of anyone.’

The 33-year-old, who tested negative for the deadly disease earlier this week, defied the guidelines by going on a bike ride with partner Ted Wilbur.

Later in the day, the pair also had a pepperoni and mushroom pizza delivered to their home in Fort Kent, Maine, before settling down to watch The Avengers film.

Her actions enraged Governor Paul LePage with lawyers from the state going to court to demand the nurse give a blood test.

‘This could be resolved today. She has been exposed and she’s not cooperative, so force her to take a test. It’s so simple’ he told ABC.

He also condemned the nurse for worrying her community by venturing out, breaking the 21-day quarantine period and announced he would ‘exercise the full extent of his authority’ to rein her in.

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Nurse Kaci Hickox went for an hour-long bike ride on Thursday morning because, she said, 'there was nothing to stop her'

Nurse Kaci Hickox went for an hour-long bike ride on Thursday morning because, she said, ‘there was nothing to stop her’

The 33-year-old nurse went on a bike ride with her partner Ted Wilbur this morning as she defied the mandatory Ebola quarantine placed on her by the state of Maine

The 33-year-old nurse went on a bike ride with her partner Ted Wilbur this morning as she defied the mandatory Ebola quarantine placed on her by the state of Maine

Later in the day the pair had a pizza delivered to their home Fort Kent, Maine, and waved to the waiting media as they opened the door

Later in the day the pair had a pizza delivered to their home Fort Kent, Maine, and waved to the waiting media as they opened the door

Governor Paul LePage has said he will 'exercise the full extent of his authority' to rein the nurse in and has insisted: 'I don't want her to be within three feet of anyone'

Governor Paul LePage has said he will ‘exercise the full extent of his authority’ to rein the nurse in and has insisted: ‘I don’t want her to be within three feet of anyone’

Miss Hickox broke her quarantine at 9am and took an ATV trail behind her home for the hour-long ride. A state trooper who had been stationed outside the house followed her in a police cruiser.

‘It’s just good to be out,’ Miss Hickox told MailOnline as she left.

Maine police were monitoring her movements and public interactions but there was no court order to arrest the nurse.

As she returned home, she said: ‘There is no court action against me. There is nothing to stop me from going for a bike ride in my home town.’

I shook Ebola nurse’s hand: The moment MailOnline reporter touched quarantined Kaci Hickox

On Thursday morning I woke to find myself featured in a mini-media firestorm. Why? Because I had shaken the hand of a woman I had just interviewed.

But this wasn’t any woman – it was Kaci Hickox, 33, the nurse who is challenging her 21-day quarantine after returning from treating Ebola victims in Sierra Leone.

Stories were written of our encounter with headlines such as: ‘Nurse breaks quarantine, shakes reporter’s hand’. It was newsworthy because she should not have contact with the public.

I was one of a handful of reporters outside her home in Fort Kent, Maine, when she decided to come outside and talk about her ‘appalling’ confinement.

Under Maine’s official health guidelines she is not supposed to be in public until the three-week period is over. That is not until November 10.

The guidelines are not mandatory but are voluntary. After she made it clear that she doesn’t intend to stick to the rules – which are more stringent than those imposed by the CDC – Maine officials are preparing to secure a court order to force her to stay away from the public.

Defiant Hickox is living with her boyfriend, Ted Wilbur – who has been out and about talking to friends. And on Thursday she went for a bike ride followed by a gaggle of reporters and cameramen.

Despite a state trooper being stationed outside the house, no one tried to prevent people from getting close to her.

Wednesday night’s impromptu press conference was the first time I had been face-to-face with Hickox. Towards the end she bemoaned the fact that despite showing no symptoms of infection, she shouldn’t hug or even shake her hand of people she meets.

On the spur of the moment, I simply said: ‘I’ll shake your hand,’ and I did. It felt like a common courtesy to someone I had just been asking questions of.

It was a brief handshake, nothing memorable, something I have done thousands of times before. She had a firm grip. She looked me briefly in the eye and thanked me.

I turned to leave her property as she and Wilbur went back inside. One local Maine journalist told me he had thought about doing the same but I got there first.

Medical experts say the chances of Hickox falling ill from Ebola are now extremely remote and the risk of transmitting the virus while she is healthy are so slight as to be virtually non-existent – particularly to someone like me who touched her hand so briefly.

President Obama on Wednesday tried to reassure the public that it is safe to touch healthcare workers returning from Ebola ‘hot zones’ when he did the same and shook the hands of doctors and nurses in the 21-day risk period at the White House.

The one question I have been asked repeatedly since is: ‘Did I wash my hands afterwards?’.

Yes I did.

MARTIN GOULD

Hickox said that she had not spoken to her lawyers about the ride and it was her decision to go out and get exercise after a day of being cooped up in her house.

The state trooper who followed them by car said he was just monitoring Miss Hickox’s actions and had no intention of arresting her.

The nurse did not say whether she would venture outside again on Thursday, adding that she had to return home to prepare for her daily temperature check for Ebola symptoms from the state’s Center for Disease Control.

Wilbur said the couple deliberately chose to ride their bikes on a 16-mile trail away from town to minimize their chances of bumping into people who might fear that they could catch Ebola from them.

‘We went the way we did and not through the town. We did not go to the grocery store.

‘We are not trying to get anyone sick — we don’t believe we can get anyone sick — and we are not trying to put anyone at risk,’ he said.

Fort Kent police chief Tom Pelletier called in the house and offered to bring the couple anything they need to lessen the need for them to go into town, Wilbur added.

Wilbur, a nursing student at the University of Maine at Fort Kent pointed out that it is not just aid workers whose lives are turned upside down by the quarantine rules but their families too. ‘I am not able to go to school.

‘If we had children they probably wouldn’t be able to go to school. I have an exam Monday that I am not allowed to take and an assignment I cannot turn in.’

The university said he ‘voluntarily’ agreed not to attend classes, but Wilbur said: ‘It’s voluntary if you count that as people saying “Do you agree you can’t come to class?” and I say “Do I have a choice?” and they say: “No” and I say: “Well I agree then.” ‘

Hickox contends there is no need for quarantine because she’s showing no symptoms.

According to Ebola experts, a blood test for Ebola would only be positive if Hickox was displaying symptoms of the virus – which she says she is not.

The Ebola virus is only detectable in the blood if the disease has significantly progressed.

Miss Hickcox has not made it clear whether she would or would not be agree to taking a blood test.

LePage later added that the nurse was causing a lot of tension and worry in the community of Fort Kent.

‘I don’t want her within three feet of anyone,’ LePage told NBC.

On Wednesday night, Miss Hickox left the home she has been ordered to stay inside for 21 days in order to speak with the press about her ‘frustrating’ situation.

Standing in front of her boyfriend’s house, as the police tasked with watching her looked on from across the street, Miss Hickox told the waiting media contingent that she will continue to fight her quarantine orders, even if she is charged for breaking them.

‘We have been in negotiations all day with the state of Maine and tried to resolve this amicably, but they are not allowing me to leave my house and interact with the public even though I am completely healthy and symptom free,’ Miss Hickox said, according to The Press Herald.

‘I am frustrated by this fact, and I have been told that it is the Attorney General’s intention to file legal action against me. And if this does occur, I will challenge the legal actions.’

Hickox shook the hand of MailOnline’s reporter at the scene and said: ‘You could hug me. You could shake my hand. I would not give you Ebola’.

The Doctors Without Borders nurse believes she flew into New Jersey from treating dying Ebola patients in West Africa on ‘the wrong day’.

She claimed that many other aid workers have entered the country and continue to do so without having to go through what she had.

Hickox said she remains healthy and has not shown any Ebola symptoms and that the measures she’s being forced to comply with are over-the-top.

The nurse and her boyfriend went for a bike ride on Thursday morning and were trailed by a Maine state trooper who said he was monitoring her actions but had no intention of arresting her

The nurse and her boyfriend went for a bike ride on Thursday morning and were trailed by a Maine state trooper who said he was monitoring her actions but had no intention of arresting her

Miss Hickox rides past the unmarked car of a Maine state trooper who followed the nurse but said he had no intention of arresting her 

Miss Hickox rides past the unmarked car of a Maine state trooper who followed the nurse but said he had no intention of arresting her

However residents of Fort Kent, a small rural, logging community, where she is staying have said that ’21 days (of quarantine) is better is better than 21 deaths’ and that it is a necessary precaution.

‘I’m upset that Chris Christie ever let her go from New Jersey,’ said resident Anne Dugal. ‘He should have kept her there longer.

‘She says she only had a temperature of 101 because she got upset. No-one shows a temperature because they’re upset. She should stay inside.’

Ted Wilbur, Miss Hickox’s boyfriend, had walked over to the police parked across the street from their house on Wednesday to check Hickox would not be arrested for leaving the house.

She did not go any further than the driveway and police remained across the street for the press conference.

Nurse Kaci Hickox left her home on a rural road in Fort Kent, Maine, to take a bike ride with her boyfriend Ted Wilbur. Police are monitoring her, but can't detain her without a court order signed by a judge

Nurse Kaci Hickox left her home on a rural road in Fort Kent, Maine, to take a bike ride with her boyfriend Ted Wilbur. Police are monitoring her, but can’t detain her without a court order signed by a judge

 

MailOnline reporter Martin Gould (pictured right) shakes the hand of nurse Kaci Hickox (left) outside her home in Fort Kent, Maine on Wednesday after she stepped outside to defy the state's Ebola quarantine 

MailOnline reporter Martin Gould (pictured right) shakes the hand of nurse Kaci Hickox (left) outside her home in Fort Kent, Maine on Wednesday after she stepped outside to defy the state’s Ebola quarantine

Nurse Kaci Hickox (left) and her boyfriend Ted Wilbur speak to the media on Wednesday. MailOnline reporter Martin Gould (center) shook Miss Hickox's hand following the impromptu press conference

Nurse Kaci Hickox (left) and her boyfriend Ted Wilbur speak to the media on Wednesday. MailOnline reporter Martin Gould (center) shook Miss Hickox’s hand following the impromptu press conference

The nurse made a point of going out on an early morning bike ride on Thursday after describing the decision to keep her under quarantine in Maine as 'appalling'

The nurse made a point of going out on an early morning bike ride on Thursday after describing the decision to keep her under quarantine in Maine as ‘appalling’

Miss Hickox returned to her home on Thursday morning trailed by reporters after she made the decision to break her Ebola quarantine

Miss Hickox returned to her home on Thursday morning trailed by reporters after she made the decision to break her Ebola quarantine

Hickox said she remains healthy and has not shown any Ebola symptoms and that the measures she’s being forced to comply with are over-the-top.

However residents of Fort Kent, a small rural, logging community, where she is staying have said that ’21 days (of quarantine) is better is better than 21 deaths’ and that it is a necessary precaution.

‘I’m upset that Chris Christie ever let her go from New Jersey,’ said resident Anne Dugal. ‘He should have kept her there longer.

‘She says she only had a temperature of 101 because she got upset. No-one shows a temperature because they’re upset. She should stay inside.’

Ted Wilbur, Miss Hickox’s boyfriend, had walked over to the police parked across the street from their house on Wednesday to check Hickox would not be arrested for leaving the house.

She did not go any further than the driveway and police remained across the street for the press conference.

Defiant: Kaci Hickox and her boyfriend Ted Wilbur held a press conference outside their Fort Kent, Maine, home at 7pm on Wednesday night, despite orders by the state to stay indoors

Defiant: Kaci Hickox and her boyfriend Ted Wilbur held a press conference outside their Fort Kent, Maine, home at 7pm on Wednesday night, despite orders by the state to stay indoors

State police troopers were stationed outside the Fort Kent, Maine, home of Kaci Hickox on Wednesday after she threatened to break Maine quarantine guidelines - however they are voluntary at the moment so it is unclear whether they would have the authority to arrest her without a court order

State police troopers were stationed outside the Fort Kent, Maine, home of Kaci Hickox on Wednesday after she threatened to break Maine quarantine guidelines – however they are voluntary at the moment so it is unclear whether they would have the authority to arrest her without a court order

Attacks on Hickox have come thick and fast after she told both NBC’s ‘Today’ show and ABC’s ‘Good Morning America’ that she planned to stay in her home on the outskirts of Fort Kent only for one day after being driven back from New Jersey.

Maine Governor Paul LePage stationed state troopers outside the house that Hickox, 33, shares with her boyfriend Ted Wilbur, setting the stage for a showdown should she decide to leave.

The governor’s office did not say whether the nurse would be arrested if she tried to leave, but said state police were stationed outside the home ‘for both her protection and the health of the community’.

The state’s guidelines are voluntary but Governor LePage wants to make it mandatory and enforceable with a court order.

State Health Commissioner Mary Mayhew told reporters in the capital Augusta: ‘When it is made clear by an individual in this risk category that they do not intend to voluntarily stay at home for the remaining 21 days, we will immediately seek a court order.’

According to NBC the hearing is not likely to be held until Monday – the day before LePage faces re-election and four days after Hickox has vowed to leave her home.

‘If I saw her in the street I wouldn’t go near her,’ said Dugal. ‘Twenty one days is not that long a time.’

Novelist Cathie Pelletier, sitting at the next table to Dugal, agreed. ‘It’s not a case that she can say sorry if she is wrong and dozens of people get infected,’ she said. ‘I can’t understand why she can’t just stay at home those extra few days.’

But both the town’s chief of police, Tom Pelletier — Cathie’s third cousin — and Dr. Michael Sullivan, the chief medical officer at Fort Kent’s hospital the Northern Maine Medical Center, said they wanted to shake Hickox’s hand and thank her for the work she has been doing helping the sick.

The conflicting views go to the heart of the confusion surrounding the approach taken by the federal government, the CDC, and individual states to the Ebola crisis and quarantine rules.

They came as many took to Facebook to slam Hickox for refusing to lock herself away for three weeks – and at the medical center where panicked patients are canceling appointments – even though Hickox has gone nowhere near it, the hospital’s boss said.

Hickox and Wilbur returned to their three-bedroom home on the outskirts of Fort Kent under cover of darkness on Tuesday night after a stopover at his uncle’s house in Freeport, Maine.

Mistake: 'Twenty one days is better than 21 deaths,' said Anne Dugal as she ate lunch with her mother Dolores in the Swamp Buck Restaurant in Fort Kent on Wednesday
Reasonable: 'It's not a case that she can say sorry if she is wrong and dozens of people get infected,' said novelist Cathie Pelletier 

‘Twenty one days is better than 21 deaths,’ said Anne Dugal (left) as she ate lunch with her mother Dolores in the Swamp Buck Restaurant in Fort Kent on Wednesday. Novelist Cathie Pelletier (right) said: ‘It’s not a case that she can say sorry if she is wrong and dozens of people get infected’

They had driven nearly 500 miles from Newark, New Jersey where she had been held in quarantine following her arrival in the U.S. from Africa.

Hickox, 33, had been treating Ebola sufferers in Sierra Leone with the medical charity Doctors Without Borders.

She has shown no signs of the disease but a forehead thermometer showed she had a slight temperature when she arrived at Newark Liberty International airport, which she has put down to being flustered or a faulty thermometer.

I don’t plan on sticking to the (Maine’s) guidelines. I am not going to sit around and be bullied by politicians and forced to stay in my home when I am not a risk to the American public
– Kaci Hickox

Governor Chris Christie departed from national policy and had tried to confine her to a tent inside a hospital for 21 days.

But after she threatened legal action and the White House intervened, she was allowed to travel on the understanding that she would put herself in voluntary isolation in accordance with Maine state guidelines.

Hickox has since declared that she will not be bullied by ‘appalling’ confinement rules and plans to fight for her freedom if restrictions are not lifted by Maine officials on Thursday.

Hickox has said she would abide by all the self-monitoring requirements of the Centers for Disease Control and Prevention. This does not stop people from traveling outside their home, but instead advises them not to go to large gatherings. It also calls on them to take a series of tests twice a day to monitor whether they are developing symptoms.

Doctors insist that the virus is not contagious until symptoms develop.

On Wednesday morning, Hickox, 33, told Today: ‘I don’t plan on sticking to the (Maine’s) guidelines. I am not going to sit around and be bullied by politicians and forced to stay in my home when I am not a risk to the American public.’

Worries: Facebook pages set up protesting the nurse's defiant attitude have been inundated with comments attacking her decision to fight the official Maine health guidelines

Worries: Facebook pages set up protesting the nurse’s defiant attitude have been inundated with comments attacking her decision to fight the official Maine health guidelines

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Life Goes on for Nurse in Standoff Over Ebola

 

Nurse Kaci Hickox, right, and her boyfriend, Ted Wilbur are followed by a Maine State Trooper as they ride bikes on a trail near her home in Fort Kent, Maine, Thursday, Oct. 30, 2014. The couple went on an hour-long ride. State officials are going to… View Full Caption The Associated Press
Nurse Kaci Hickox, right, and her boyfriend, Ted Wilbur are followed by a Maine State Trooper as they ride bikes on a trail near her home in Fort Kent, Maine, Thursday, Oct. 30, 2014. The couple went on an hour-long ride. State officials are going to court to keep Hickox in quarantine for the remainder of the 21-day incubation period for Ebola that ends on Nov. 10. Police are monitoring her, but can’t detain her without a court order signed by a judge. (AP Photo/Robert F. Bukaty) Close The Associated Press
in between going on a bike ride and taking delivery of a pizza, nurse Kaci Hickox and her boyfriend did chores and watched a movie while state officials struggled to reach a compromise in a standoff that has become the nation’s most closely watched clash between personal freedom and fear of Ebola.

The nurse who treated Ebola patients in Sierra Leone and her boyfriend, Ted Wilbur, purposefully rode their bikes away from town on a dirt path to avoid coming into contact with people.

“We’re not trying to push any limits here. We’re members of this community, too, and we want to make people comfortable,” he told reporters Thursday evening.

Hickox, who returned to the U.S. last week, has been under what Maine is calling a voluntary quarantine at her home in this town of 4,300 people.

She has rebelled against the restrictions, saying that her rights are being violated and that she is no threat to others because she has no symptoms. She tested negative last weekend for Ebola, though it can take days for the virus to reach detectable levels.

State officials said that they were seeking a court order to require a quarantine through Nov. 10, the end of the 21-day incubation period for the Ebola virus.

But it was unclear Thursday whether the state had gone to court or whether there had been any progress in negotiations aimed at a compromise.

Gov. Paul LePage said state attorneys and Hickox’s lawyers had discussed a scaled-down quarantine that would have allowed her to go for walks, runs and bicycle rides while preventing her from venturing into populated public places or coming within 3 feet of others.

“I was ready and willing — and remain ready and willing — to reasonably address the needs of health care workers meeting guidelines to assure the public health is protected,” he said.

Hickox stepped into the media glare when she returned from West Africa to become subject to a mandatory quarantine in New Jersey. After an uproar, she was released and traveled more than 600 miles to the small town on the Canadian border where she lives with her boyfriend.

At their home, reporters have been camped out for two days.

Wilbur said he and Hickox spent the day Thursday vacuuming, cleaning, doing laundry and watching a movie, “The Avengers.” He said he also spent four hours attending class via phone. He has agreed to stay away from the University of Maine at Fort Kent for the time being.

During their hour-long bike ride, they were followed by an unmarked state police cruiser. Later, they took delivery of a pizza.

States have broad authority under long-established law to quarantine people to prevent the spread of disease. In Maine, state law allows a judge to confine someone if health officials demonstrate “a clear and immediate public health threat.”

President Barack Obama and humanitarian groups have warned that such measures could cripple the fight against the disease at its source by discouraging volunteers like Hickox from going to West Africa, where the outbreak has sickened more than 13,000 people and killed nearly 5,000 of them.

“The volunteers are heroes to the people they help, and they are heroes to our own countries. They should be treated like heroes when they return,” Samantha Power, U.S. ambassador to the United Nations, said in Brussels.

In other developments:

— Ebola fears infected a medical conference on the subject. Louisiana state health officials told thousands of doctors planning to attend a tropical-diseases meeting this weekend in New Orleans to stay away if they have been to certain African countries or have had contact with an Ebola patient in the last 21 days.

— Liberia is making some progress in containing the outbreak, while Sierra Leone is “in a crisis situation which is going to get worse,” the top anti-Ebola officials in the two countries said.

— The World Bank announced it will give an additional $100 million to help bring in more foreign health workers. That raises the money it has given to the fight to $500 million.

———

Associated Press writers David Sharp and Patrick Whittle in Portland contributed to this story.

Ebola Virus Disease Electron Micrograph

Soldier or civilian, Ebola protocols not the same

WASHINGTON (AP) — A U.S. soldier returning from an Ebola response mission in West Africa would have to spend 21 days being monitored, isolated in a military facility away from family and the broader population. A returning civilian doctor or nurse who directly treated Ebola patients? Depends.

The Pentagon has put in place the most stringent Ebola security measures yet, going beyond even the toughest measures adopted by states such as New York, New Jersey and Maine and much further than the guidance set by the federal Centers for Disease Control and Prevention for travelers returning from the afflicted region.

“I have one responsibility and that is the security of this country,” Defense Secretary Chuck Hagel said Thursday. “And that means the security of our men and women and their families.”

He called the Pentagon’s step a “smart, wise, prudent, disciplined, science-oriented decision.”

Yet, the policy far surpasses federal government standards. The CDC recommends that only people at the highest risk — those who’ve had direct contact with an Ebola patient’s body fluids, for example — avoid commercial travel or large public gatherings for 21 days. Anyone who develops symptoms would be hospitalized immediately.

The differences are partly a function of the military’s unique role, the constitutional authorities granted to individual states and the federal government’s desire not to discourage health care workers from volunteering to help confront the deadly Ebola virus at its source in Sierra Leone, Liberia and Guinea.

But the varying approaches have raised questions about whether and how different levels and agencies of government are coordinating the response to Ebola in the United States.

For now, the questions are mostly academic.

Only one Ebola patient has died in the U.S. and he contracted the disease in Liberia. Two nurses who were infected by that patient have recovered and have been declared Ebola-free. One doctor who recently returned from treating Ebola patients in West Africa has been diagnosed with the virus and is being treated at a hospital in New York.

IN A NUTSHELL, WHAT ARE THE VARIOUS PROTOCOLS?

— The Pentagon: Returning troops would have to undergo a 21-day quarantine even though their jobs do not require them to be in contact with Ebola victims. The military facilities could be in the U.S. or overseas. Already a group of 42 returning soldiers, including a two-star Army general, are in supervised isolation at a military base in Vicenza, Italy.

— The states: Not all have developed responses, but among those who have New York, New Jersey, California, Illinois, Georgia, Florida and Maine are imposing 21-day quarantines for health care workers and other travelers from West Africa who had direct contact with people with the Ebola virus but show no symptoms of the disease.

— The federal government: The CDC recommends 21-day isolation and monitoring for people who show no symptoms but who have had direct contact with an Ebola patient’s bodily fluids, either through exposure or a needle prick, for instance. For those who have been in close contact with patients but have not been directly exposed to a patient’s fluids, the CDC recommends daily self-monitoring for 21 days. Those recommendations are supposed to serve as guidelines for state policies.

WHY IS THE PENTAGON STRICTER?

Defense officials maintain that the Pentagon rules are necessary because even through troops will not treat Ebola patients, they will spend more time in the Ebola hot zone than health care workers.

Gen. Martin Dempsey, chairman of the Joint Chiefs of Staff, said the U.S. troops comprise the largest portion of the U.S. contingent in Liberia and will be staying there for six months at a time, compared with the 30-day to 60-day stays for U.S. civilian health care workers. Pentagon officials also note that the troop presence in West Africa will likely grow to up to 4,000 over time.

“Being in the hot zone is like being in a war zone; the longer you’re there the greater the chances of being injured or killed,” said James G. Hodge Jr., a professor of public health law at the Sandra Day O’Connor College of Law at Arizona State University.

WHY NOT THE SAME POLICY FOR CIVILIANS?

It’s a question some military spouses are certainly asking. Rebekah Sanderlin, a board member of the Military Family Advisory Network, said she hasn’t heard complaints about the 21-day policy for service members. But, she added: “There is a lot of confusion over the quarantine policy because the military and civilian guidelines do not match. I do think if a quarantine period is justified for one group, it is justified for all.”

Hodge, who is western director of the Network for Public Health Law, notes that service members, unlike civilians, can have their liberties curtailed. As White House spokesman Josh Earnest noted this week, “There might be some members of the military who think that the haircut that’s required may not be their best, but that’s a haircut that they get every couple of weeks because it is in the best interest of their unit and it maintains unit cohesion, and that is a policy of the military.”

President Barack Obama has urged states to consider how their policies will affect the willingness of civilian doctors and nurses to volunteer for Ebola work in West Africa. Unlike those civilians, Obama said this week, the troops are not there voluntarily. “It’s part of their mission that’s been assigned to them by their commanders and ultimately by me, the commander in chief,” he said.

HOW MANY PEOPLE ARE AFFECTED?

The biggest Pentagon deployment is in Liberia with 1,000 troops. There are about 120 in Senegal, where they operate a staging base for operations in Liberia. Dempsey said Thursday that the troop presence is intended to grow to about 4,000.

As for civilians, since the CDC began tracking travel from West Africa, it has detected fewer than 100 people a day entering the United States, most of them U.S. citizens or legal permanent residents, according to CDC Director Thomas Frieden. He said about 5 percent have been identified as either health care workers or someone who had been in contact with an Ebola patient, but not exposed to bodily fluids.

Seven out of 10 of those returning civilians go to six states: New York, Maryland, Pennsylvania, Georgia, New Jersey and Virginia.

WHAT HAPPENS IF A SOLDIER CONTRACTS THE DISEASE?

Pentagon officials say any individual diagnosed with the disease would be transferred to the United States for treatment. Right now, however, there is only one aircraft designated to transport a sick individual from West Africa to the U.S. and it can only hold one person at a time and make only four trips a week, according to Maj. Gen. Lariviere, who testified before the House Oversight and Government Reform Committee last week.

He said the Pentagon has a plan for isolation pods that could carry 15 people at a time inside C-17 military transport planes. He said purchase of those pods would not begin until January.

North Korea’s reaction to Ebola makes fears of a zombie apocalypse look rational

Turns out North Korea wasn’t kidding about protecting itself from Ebola. Kim Jong Un’s regime is not taking any chances when it comes to keeping out the virus – despite the fact that it’s happening half a world away and that North Korea is the most closed state in the world.

After last week closing its borders to the few groups of tourists who enter the country, Pyongyang has imposed a 21-day mandatory quarantine period for arrivals from abroad and it also appears to have banned the few citizens who are allowed out of the country from going anywhere.

Plus, they’ve sharply restricted movements inside the country – which already strictly polices who can move around the place even internally.

Even by the standards of the most authoritarian regime out there, North Korea’s Ebola response appears excessive.

Looking at some of the pictures coming out of North Korea, you could be excused thinking that it is Ground Zero for the virus. Korean Central Television this week showed footage of men in hazmat suits spraying the sleeping berths of the Moscow-Pyongyang train.

And a delegation of Japanese diplomats arriving in Pyongyang this week for official talks about a decades-old abduction dispute were greeted at the capital’s Sunan airport by men similar gear.


Medical personnel in protective suits stand by an ambulance at Sunan International Airport. (AP/Wong Maye-E)

First things first: the tourist ban. Last week North Korea abruptly told the handful of travel companies bringing western tourists into the country that all tours would be indefinitely suspended. Most have had all their November tours canceled and are waiting to hear about December. The ban also extends to Chinese tourists, who make up the bulk of visitors to Pyongyang, by far.

Then on Thursday, North Korea announced all foreigners – including diplomats, and regardless of where they’re coming – arriving in the country will be quarantined for 21 days. That’s more than three times the length of the average tour.

“All foreign nationals who are entering from Ebola affected areas are to be quarantined at the Chongchongang Hotel in the city of Anju, North Pyongan Province for a period of 21 days under medical observation,” Uri Tours, one of the agencies operating in North Korea, posted on its Web site.

“Foreign nationals who enter from all other areas will also be quarantined for a period of 21 days but at the hotels in which they originally intended to stay,” Uri Tours said.

Diplomats and foreign aid workers will be quarantined in their missions or residences.

The state-run Pyongyang Radio station said that North Korea was “doubling” its efforts to detect infected patients, according to South Korea’s Yonhap News Agency.

Tourism is considered a major source of foreign currency for North Korea, so the ban underscores the gravity with which they’re viewing the Ebola scare.

But it’s not just foreigners who are considered potential carriers of the deadly virus.

The Daily NK, a news site that carries reports from within North Korea, said that the authorities have placed travel restrictions on those entering Pyongyang.

“In order to prevent transmission of the Ebola virus, a central command office for hygiene and quarantine has been set up,” a source in North Hamgyung Province told the Daily NK. “They have also been placing limits on travel permits for people in regional areas since mid-October to try to curb entry into Pyongyang.”

People wanting to go to Pyongyang on personal business, such as for family events, are being denied entry to the capital, while state officials now have to go through a cumbersome process involving getting an epidemiological certificate from the provincial quarantine office, the site reported.

And then there’s the crackdown on going out into the toxic world.

Only a very select group of North Koreans is allowed to travel outside the country at the best of times – generally only senior apparatchiks, diplomats or businessmen who can make money for the regime – but now even fewer North Koreans being allowed out.

Chosun Exchange, a group that runs training programs for North Korean officials, reports that North Koreans are apparently not allowed abroad. A group that had been set to travel to seminars in Singapore last week was abruptly grounded.

“Is this a misreading of the Ebola threat? Is it a genuine fear that they could not deal with a single case of Ebola? Is it a message for the domestic audience?,” Geoffrey See, founder of Chosun Exchange, wrote in a post on the organization’s  Web site, saying they were still trying to figure out what was going on.

The whole situation recalls a line uttered by Hyungchol Choi, the fictional director of the South Korean intelligence service in Max Brooks’s 2006 dystopian novel World War Z, See wrote.

“No country was better prepared to repel the infestation than North Korea,” Choi said in the book, although he was commenting on a zombie apocalypse outbreak, not Ebola.

“While a complete shutdown of the borders to all travel, even to places with no record of Ebola or Zombieism, is completely within North Korea’s rights, the manner in which these measures were rolled out leaves much to be desired,” See wrote, noting the poor way the clampdown was communicated.

Yes, so bizarre is North Korea’s reaction to Ebola that even zombie apocalypse analogies make sense here.

Anna Fifield is The Post’s bureau chief in Tokyo, focusing on Japan and the Koreas. She previously reported for the Financial Times from Washington DC, Seoul, Sydney, London and from across the Middle East.

Ebola Virus Disease Electron Micrograph

Nurse defies Ebola quarantine with bike ride; negotiations fail

Kaci Hickox (L) and boyfriend Ted Wilbur go for a bike ride in Fort Kent, Maine October 30, 2014.  REUTERS/Ashley L. Conti/Bdn

 

 

(Reuters) – A nurse who treated Ebola patients in Sierra Leone but has tested negative for the virus went for a bike ride on Thursday, defying Maine’s order that she be quarantined in her home and setting up a legal collision with Governor Paul LePage.

 

Attorneys for Kaci Hickox, 33, said they had not yet been served with a court order to enforce the 21-day quarantine – matching the virus’s maximum incubation period – but remained prepared to fight such an order if necessary.

 

LePage’s office said negotiations with Hickox, who worked with Doctors Without Borders in Sierra Leone, “have failed despite repeated efforts by state officials” and that he would “exercise the full extent of his authority allowable by law.”

 

The quarantine showdown between Hickox and Maine has become the focal point of a struggle between several U.S. states opting for stringent measures to guard against Ebola and a federal government wary of discouraging potential medical volunteers.

 

Mandatory quarantines ordered by some U.S. states on doctors and nurses returning from West Africa’s Ebola outbreak are creating a “chilling effect” on Doctors Without Borders operations there, the humanitarian group said on Thursday.

 

A California-based nurses union said it was organizing strikes and other protests against what it views as insufficient protection for nurses caring for patients stricken with the deadly virus.

 

Hickox left her home in the small Maine town of Fort Kent, along the Canadian border, and television news images showed her taking a morning bicycle ride with her boyfriend, Ted Wilbur. Hickox has given the New England state a deadline of Thursday to lift an order that she remain at home until Nov. 10, or she will go to court.

 

“It’s a beautiful day for a bike ride,” said Hickox, wearing a helmet and other bike gear as she headed out for her 3-mile (5-km) ride while police stationed outside her house stood by without trying to stop her, according to local media.

 

LePage’s office said he was open to an arrangement in which she could go for walks, runs or bike rides but not go into public places or come within 3 feet (1 meter) of other people.

 

“I was ready and willing – and remain ready and willing – to reasonably address the needs of healthcare workers meeting guidelines to assure the public health is protected,” said LePage, a Republican locked in a tough three-way re-election battle.

 

President Barack Obama, who has criticized mandatory quarantine policies imposed by some states for returning medical workers like Hickox, flew to Maine on Thursday to campaign in the town of Cape Elizabeth for Democratic candidates, including Mike Michaud, who is trying to unseat LePage in Tuesday’s midterm elections. He did not address the Ebola issue in public remarks at a voter rally.

 

One of Hickox’s attorneys, Norman Siegel, defended his client’s decision to go for a bike ride but noted that she avoided the center of town so as not to “freak people out.”

 

“Since there’s no court order, she can be out in public,” Siegel said. “Even if people disagree with her position, I would hope they respect the fact that she’s taking into account the fear, which is based on misinformation about the way the disease is transmitted.”

 

Medical professionals say Ebola is difficult to catch and is spread through direct contact with bodily fluids from an infected person and is not transmitted by asymptomatic people. Ebola is not airborne.

 

U.S. concern about the disease is high even though there is only one person in the country currently being treated for it, a New York doctor, Craig Spencer, who cared for patients in West Africa. Spencer, 33, remains in serious but stable condition, New York’s Bellevue Hospital said on Thursday.

 

Hickox tested negative for Ebola after returning from Sierra Leone, one of the three impoverished countries at the heart of the outbreak that has killed about 5,000 people there.

 

She previously blasted New Jersey Governor Chris Christie after she was taken from Newark’s airport and put in isolation in a tent before being driven to Maine to spend the rest of her 21-day quarantine at home.

 

Such treatment of returning medics is affecting those still in West Africa, said Sophie Delaunay, executive director of Doctors Without Borders in the United States.

 

“There is rising anxiety and confusion among MSF staff members in the field over what they may face when they return home upon completion of their assignments in West Africa,” said Delaunay in a statement emailed to Reuters. Doctors Without Borders is also known by its French name, Médecins Sans Frontières, or MSF.

 

New York’s tough guidelines are also affecting diplomats. U.S. Ambassador to the United Nations Samantha Power returned to New York on Thursday after a brief visit to West Africa and must report her temperature twice daily to the New York state health department for the next 20 days.

 

Elsewhere, there were happier outcomes for people caught in the crossfire in the battle against Ebola.

 

A 7-year-old girl banned from attending school in Connecticut over fears that she may be carrying the virus after a trip to Nigeria will be allowed back on Friday, according to a joint statement by the school district and the girl’s father, who had filed a lawsuit to get the ban lifted.

 

Dallas nurse Nina Pham, who recovered from an Ebola infection, will be reunited with 1-year-old King Charles Spaniel on Saturday after testing indicated the pet was free of Ebola, a spokeswoman for the city of Dallas said.

 

With elections coming Tuesday, Republicans aiming to take full control of the U.S. Congress have made criticism of Obama’s response to Ebola – which they call inept and too weak – a part of their campaign message.

 

Some U.S. states have imposed automatic, 21-day quarantines on doctors and nurses returning from treating Ebola patients in Liberia, Sierra Leone and Guinea. Obama and other critics say such steps may discourage American doctors and nurses who are desperately needed there from volunteering.

 

Confusion over how to treat potential Ebola carriers in the United States is mirrored across the Americas, according to a meeting of health experts in Havana, Cuba, on Thursday.

 

“Everyone agrees they must be watched. How that is done is up to each country,” said Jorge Perez, director of Cuba’s Pedro Kouri Tropical Medicine Institute. “Every country is sovereign and can adopt the measures they want.”

 

New York City and state officials on Thursday announced a program to encourage healthcare professionals to work in West Africa, an effort to deflect criticism of the state’s mandatory quarantine.

 

The program will provide financial incentives and employment protections similar to the benefits and rights provided to military reservists, New York Governor Andrew Cuomo and New York City Mayor Bill de Blasio said jointly.

 

(Additional reporting by Joseph Ax, Scott Malone, Jeff Mason, Brendan O’Brien, Ellen Wulfhorst, Susan Heavey, Roberta Rampton, Jon Herskovitz, Daniel Trotta, Michelle Nichols and Sharon Bernstein; Writing by Will Dunham and Bill Rigby; Editing by Jonathan Oatis, Grant McCool and Lisa Shumaker)

 

Nurse defies Ebola quarantine with bike ride; negotiations fail

 (Reuters) – A nurse who treated Ebola patients in Sierra Leone but has tested negative for the virus went for a bike ride on Thursday, defying Maine’s order that she be quarantined in her home and setting up a legal collision with Governor Paul LePage.

 

Attorneys for Kaci Hickox, 33, said they had not yet been served with a court order to enforce the 21-day quarantine – matching the virus’s maximum incubation period – but remained prepared to fight such an order if necessary.

 

LePage’s office said negotiations with Hickox, who worked with Doctors Without Borders in Sierra Leone, “have failed despite repeated efforts by state officials” and that he would “exercise the full extent of his authority allowable by law.”

 

The quarantine showdown between Hickox and Maine has become the focal point of a struggle between several U.S. states opting for stringent measures to guard against Ebola and a federal government wary of discouraging potential medical volunteers.

 

Mandatory quarantines ordered by some U.S. states on doctors and nurses returning from West Africa’s Ebola outbreak are creating a “chilling effect” on Doctors Without Borders operations there, the humanitarian group said on Thursday.

 

A California-based nurses union said it was organizing strikes and other protests against what it views as insufficient protection for nurses caring for patients stricken with the deadly virus.

 

Hickox left her home in the small Maine town of Fort Kent, along the Canadian border, and television news images showed her taking a morning bicycle ride with her boyfriend, Ted Wilbur. Hickox has given the New England state a deadline of Thursday to lift an order that she remain at home until Nov. 10, or she will go to court.

 

“It’s a beautiful day for a bike ride,” said Hickox, wearing a helmet and other bike gear as she headed out for her 3-mile (5-km) ride while police stationed outside her house stood by without trying to stop her, according to local media.

 

LePage’s office said he was open to an arrangement in which she could go for walks, runs or bike rides but not go into public places or come within 3 feet (1 meter) of other people.

 

“I was ready and willing – and remain ready and willing – to reasonably address the needs of healthcare workers meeting guidelines to assure the public health is protected,” said LePage, a Republican locked in a tough three-way re-election battle.

 

President Barack Obama, who has criticized mandatory quarantine policies imposed by some states for returning medical workers like Hickox, flew to Maine on Thursday to campaign in the town of Cape Elizabeth for Democratic candidates, including Mike Michaud, who is trying to unseat LePage in Tuesday’s midterm elections. He did not address the Ebola issue in public remarks at a voter rally.

 

One of Hickox’s attorneys, Norman Siegel, defended his client’s decision to go for a bike ride but noted that she avoided the center of town so as not to “freak people out.”

 

“Since there’s no court order, she can be out in public,” Siegel said. “Even if people disagree with her position, I would hope they respect the fact that she’s taking into account the fear, which is based on misinformation about the way the disease is transmitted.”

 

Medical professionals say Ebola is difficult to catch and is spread through direct contact with bodily fluids from an infected person and is not transmitted by asymptomatic people. Ebola is not airborne.

 

U.S. concern about the disease is high even though there is only one person in the country currently being treated for it, a New York doctor, Craig Spencer, who cared for patients in West Africa. Spencer, 33, remains in serious but stable condition, New York’s Bellevue Hospital said on Thursday.

 

Hickox tested negative for Ebola after returning from Sierra Leone, one of the three impoverished countries at the heart of the outbreak that has killed about 5,000 people there.

 

She previously blasted New Jersey Governor Chris Christie after she was taken from Newark’s airport and put in isolation in a tent before being driven to Maine to spend the rest of her 21-day quarantine at home.

 

Such treatment of returning medics is affecting those still in West Africa, said Sophie Delaunay, executive director of Doctors Without Borders in the United States.

 

“There is rising anxiety and confusion among MSF staff members in the field over what they may face when they return home upon completion of their assignments in West Africa,” said Delaunay in a statement emailed to Reuters. Doctors Without Borders is also known by its French name, Médecins Sans Frontières, or MSF.

 

New York’s tough guidelines are also affecting diplomats. U.S. Ambassador to the United Nations Samantha Power returned to New York on Thursday after a brief visit to West Africa and must report her temperature twice daily to the New York state health department for the next 20 days.

 

Elsewhere, there were happier outcomes for people caught in the crossfire in the battle against Ebola.

 

A 7-year-old girl banned from attending school in Connecticut over fears that she may be carrying the virus after a trip to Nigeria will be allowed back on Friday, according to a joint statement by the school district and the girl’s father, who had filed a lawsuit to get the ban lifted.

 

Dallas nurse Nina Pham, who recovered from an Ebola infection, will be reunited with 1-year-old King Charles Spaniel on Saturday after testing indicated the pet was free of Ebola, a spokeswoman for the city of Dallas said.

 

With elections coming Tuesday, Republicans aiming to take full control of the U.S. Congress have made criticism of Obama’s response to Ebola – which they call inept and too weak – a part of their campaign message.

 

Some U.S. states have imposed automatic, 21-day quarantines on doctors and nurses returning from treating Ebola patients in Liberia, Sierra Leone and Guinea. Obama and other critics say such steps may discourage American doctors and nurses who are desperately needed there from volunteering.

 

Confusion over how to treat potential Ebola carriers in the United States is mirrored across the Americas, according to a meeting of health experts in Havana, Cuba, on Thursday.

 

“Everyone agrees they must be watched. How that is done is up to each country,” said Jorge Perez, director of Cuba’s Pedro Kouri Tropical Medicine Institute. “Every country is sovereign and can adopt the measures they want.”

 

New York City and state officials on Thursday announced a program to encourage healthcare professionals to work in West Africa, an effort to deflect criticism of the state’s mandatory quarantine.

 

The program will provide financial incentives and employment protections similar to the benefits and rights provided to military reservists, New York Governor Andrew Cuomo and New York City Mayor Bill de Blasio said jointly.

 

(Additional reporting by Joseph Ax, Scott Malone, Jeff Mason, Brendan O’Brien, Ellen Wulfhorst, Susan Heavey, Roberta Rampton, Jon Herskovitz, Daniel Trotta, Michelle Nichols and Sharon Bernstein; Writing by Will Dunham and Bill Rigby; Editing by Jonathan Oatis, Grant McCool and Lisa Shumaker)