ACRIA Joins Community Leaders in Calling on Governor Cuomo to Rescind Mandatory Ebola Quarantine

U.S. & Global Leaders of the HIV/AIDS Response Hold Press Conference to Call on Governor Cuomo to Rescind Policy of Mandatory Home Quarantine for Persons Who Have Been In Proximity to Persons with Ebola Virus Disease

Monday, October 27 - Leaders of the AIDS community and other public health experts held a press conference in front of Bellevue Hospital Center, 462 First Avenue, Manhattan. We will call on NYS Governor Andrew Cuomo to rescind the recently announced policy of mandatory quarantine of persons who have been in close proximity to people with Ebola virus disease (EVD).

On Friday, October 24th, Gov. Cuomo joined New Jersey Gov. Chris Christie to announce a new policy at Port Authority-operated airports, including John F. Kennedy and Newark International Airports—to question each person who has traveled in Liberia, Sierra Leone, and Guinea, and to order immediate mandatory 21-day quarantine of any person who acknowledges having been in proximity to persons with EVD.  At least one person is already confined: a nurse who volunteered with Médicins Sans Frontières to care for EVD patients in West Africa is being held involuntarily at a New Jersey hospital under mandatory quarantine—despite a complete absence of any clinical indicator of EVD.

Governor Cuomo’s subsequent, slight revision to Friday’s announced policy, made Sunday evening under mounting pressure from the White House, public-health experts, and the AIDS community, was characterized by the Governor’s Office as a loosening—to “confinement” at home—but in fact, it remains a mandatory, 21-day quarantine, just at home, not in the hospital. As such, the revised policy still goes against evidence-based, CDC-recommended public health practices grounded in science, and it continues to contribute to ongoing misunderstanding of how the Ebola virus is transmitted and spread as well as to growing stigma and public panic.

Leaders in the HIV/AIDS response have circulated a letter to the Governor calling for rescission of the policy. Since Saturday, the group has collected over 100 signatures, including notable public health leaders such as Chris Beyrer, President at The International AIDS Society; Paul D. Cleary, Dean at Yale School of Public Health; Wafaa El-Sadr, Director of International Center for AIDS Programs; and Paul Farmer, Kolokotrones University Professor at Harvard University and Co-Founder of Partners in Health. In addition, the letter has received support from a diverse array of groups including amfAR, BROADWAY CARES/EQUITY FIGHTS AIDS, Empire State Pride Agenda, and numerous AIDS service and LGBT organizations.

At the 10/27 press conference, the group will address concerns that the new policy has no basis in current evidence on effective disease control. They will also raise the concern that these policies will inhibit medical volunteerism, which is critical to the fight against Ebola in West Africa. They will raise concerns that the policy conveys dangerously incorrect information by implying that Ebola can be easily transmitted by persons who are asymptomatic—a misunderstanding that will inevitably lead to stigma and discrimination. These leaders will also challenge the policy as unenforceable and counter-productive as a public health measure.

Long-time AIDS activist Peter Staley said, “It is unfortunate that the Governor has made such a hasty decision without consulting with leading public health experts. Having seen the stigma that has arisen around HIV/AIDS, I fear that stigma and fear are now going to become significant barriers to addressing Ebola.”

“We need sound science and evidence-based public health policy to address the Ebola crisis. In the United States we need public health policy free of fear, stigma, and discrimination. We must support the African nations heavily impacted by Ebola and the health-care professionals who risk their lives to care for those nations most affected,” stated Guillermo Chacon, President of the Latino Commission on AIDS.

Charles King, President and CEO of Housing Works, said, “If the logic of this new policy were sound, then we would be quarantining all of the New York City-based people, including first responders, nurses, and doctors, who are working directly with Dr. Craig Spencer, the Ebola patient who has been hospitalized since Thursday. Instead, we are imposing this policy only on people coming from Africa, clearly a response to hysteria generated by the media rather than what is in New Yorkers’ best interests.

 

October 26, 2014
 
The Honorable Andrew Cuomo
Governor of New York Albany, New York
 
Dear Governor Cuomo:
 
We write as professionals, activists, and public health researchers who have worked to combat AIDS and other infectious diseases in New York and around the world for over three decades.  We have not forgotten how HIV/AIDS was at first largely ignored while it appeared to affect only marginalized communities or the stigma generated once fear of the virus took hold in the larger population.  We have
watched with growing concern as Ebola virus disease (EVD) was ignored far too long while confined to some of the poorest countries in the world, and how it has now led to hysteria here in the United States, based on only a very small number of cases. As you know, stigma remains our biggest enemy in fighting AIDS and could quickly become the biggest barrier in combatting EVD.  Therefore, we implore you to withdraw the mandatory quarantine requirement for all people entering the United States through Newark Liberty International Airport and John F. Kennedy International Airport who have had direct contact with individuals with EVD in Guinea, Liberia, and Sierra Leone.  
 
This aspect of the procedural plan being put into place to minimize the risk of outbreaks of EVD in the New York metropolitan area is not supported by scientific evidence and will potentially have a profound effect on efforts to recruit U.S.-­‐based health care professionals who are desperately needed to help combat the burgeoning EVD epidemic in West Africa while increasing stigma toward persons who come from those countries. There is no evidence that indicates quarantines are superior to active monitoring for symptoms with respect to preventing transmission of EVD. We urge New Jersey and New York to instead require that all health care workers and others with potential exposure to EVD returning to the U.S. through Port Authority international airports engage in CDC-­‐recommended active monitoring for signs and symptoms of EVD and that they remain in close proximity to a hospital with isolation facilities.  
 
Port Authority-­‐mandated quarantines for all arriving passengers who have had direct contact with individuals with EVD may have consequences that are the antithesis of effective public health policy. Should the New York metropolitan area be the destination of individuals who have contact with people with EVD in West Africa, but they instead travel through multiple hubs (thereby significantly extending their transit time) or deny potential exposure to circumvent these mandatory entry requirements, we will have undermined the most important evidence-­‐based components of breaking EVD transmission chains: prompt diagnosis, isolation of those with bona fide symptoms and clear instructions for those with possible exposure to Ebola. Unnecessary quarantines will also lead to stigma and discrimination directed toward people of West African origin, regardless of their exposure to Ebola.

If we are to effectively prevent additional isolated cases of EVD disease—and with them, public fear and panic—in the New York metropolitan area, and halt the spread of the disease in other parts of the world, the only evidence-­‐based solution is to dedicate the resources required to break chains of transmission in countries where the disease is prevalent. U.S.-­‐based health care workers are critical to this response, through volunteer and paid opportunities. We fear that mandatory quarantines will greatly hinder current efforts to recruit skilled and experienced personnel. Groups such as Médecins Sans Frontières, Partners in Health, and the United Nations have stressed in no uncertain terms that we desperately need more qualified health care providers in Guinea, Liberia, and Sierra Leone to save the lives of those who have been infected, to prevent the ongoing spread of the disease in those countries, and to stem the risk of outbreaks in all other nations.

We urge you to end the mandatory quarantine policy and instead establish a standard protocol, to be developed by the Port Authority in close collaboration with the U.S. Centers for Disease Control, the State of New Jersey Department of Health, the New York State Department of Health, and the New York City Department of Health and Mental Hygiene, for active monitoring and required proximity to a hospital with isolation facilities for all individuals who have had contact with individuals with EVD.

When news of New York City’s first case of EVD broke on Thursday night we were extremely proud of the measured response and high level of preparation described by you and other New York City and State officials. We urge you to continue to provide the leadership that has made New York the model for an evidence-­‐based response to HIV and other health crises.

Respectfully submitted,

ACT UP/NY
Adaora Adimora, MD, MPH, Chair, HIV Medicine Association
AIDS Treatment Activists Coalition American Run to End AIDS, New York
Jeton Ademaj, ACT UP NY
Frederick L. Altice, MD, MA, Professor of Medicine, Epidemiology, and Public
Health; Director of Clinical and Community Research, Yale University School of
Medicine and School of Public Health
Wendy Armstrong, Vice Chair, HIV Medicine Association
Ramin Asgary, MD, MPH, Assistant Professor, Department of Population Health,
New York University School of Medicine
Benjamin Bashein, Executive Director, ACRIA
Chris Beyrer, MD, MPH, President, The International AIDS Society; Professor, Johns
Hopkins Bloomberg School of Public Health
Bernadette Boden-­‐Albala, MPH, DrPH, Associate Dean of Program
Development; Director, Division of Social Epidemiology; Professor of Public Health, Neurology and Dentistry, Global Institute of Public Health, New York University
Elizabeth H. Bradley, Professor of Public Health and Director of Yale Global Health
Initiative
Karen F. Brudney, MD, Assistant Professor of Medicine, Columbia University College of Physicians and Surgeons
Anthony P. Cannella, MD, MSc, Assistant Professor of Medicine, Division of
Infectious Diseases and Global Medicine, Department of Medicine, University of
Florida College of Medicine
Arthur L. Caplan, PhD, Drs. William F. and Virginia Connolly Mitty Professor of
Bioethics; Director Division of Medical Ethics, Department of Population Health
(Med Ethics), New York University School of Medicine
Rea Carey, Executive Director, National LGBTQ Task Force
Guillermo Chacon, President, Latino Commission on AIDS
Eric Cioe, MD Columbia University International Emergency Medicine Fellow;
Instructor of Medicine & Attending Physician, New York-­‐Presbyterian Hospital
Paul D. Cleary, PhD, Anna M. R. Lauder Professor of Public Health (Health Policy); Dean, Yale School of Public Health; Director, Center for Interdisciplinary Research
on AIDS (CIRA)
Rachel M. Cohen, AIDS & Global Health Activist
Ted Cohen, MD, MPH, DPH, Associate Professor of Epidemiology (Microbial
Diseases), Yale School of Public Health
Jim Curran, MD, MPH, Director and PI of Emory Center for AIDS Research
Julie Davids, AIDS Activist
Dr. Sheila Davis, Chief Nursing Officer, Chief Ebola Response, Partners In Health
Patrick Dawson, MPH, Columbia University Department of Epidemiology
Haile T. Debas, MD, Director of the University of California Global Health Institute; Distinguished Professor of Surgery, Emeritus
Carlos del Rio, MD, Chair-­‐Elect, HIV Medicine Association
Hans N. Desnoyers, Director of Operations, Diaspora Community Services
Erin Drinkwater, Executive Director, Brooklyn Community Pride Center
Wafaa El-­‐Sadr, MD, MPH, Director, International Center for AIDS Programs (ICAP)
End AIDS Now, New York
Joel D. Ernst, MD, Professor of Medicine, Pathology, and Microbiology; Acting
Director, Division of Infectious Diseases and Immunology, New York University
School of Medicine
Paul Farmer, MD, Kolokotrones University Professor, Harvard University; Co-­‐ Founder, Partners in Health
Sally Findley, Professor of Population and Family Health, Mailman School of Public
Health, Columbia University
Gerald Friedland, MD, Yale School of Medicine
Eric A. Friedman, JD, O’Neill Institute for National and Global Heath Law, Georgetown University Law Center
Gregg J. Fromell, MD, Vice President, Science Operations, NYU Langone Medical Center
Kevin Frost, CEO, amfAR
Robert E. Fullilove, EdD, Cities Research Group, Columbia University
Jennifer Furin, MD, PhD, Assistant Professor of Medicine, Case Western Reserve University
Joel Gallant, MD, MPH, Immediate Past Chair, HIV Medicine Association
Tracie M. Gardner, Co-­‐Director of Policy, Legal Action Center
Laurie Garrett, Senior Fellow for Global Health, Council on Foreign Relations
Annette Gaudino, ACT UP NY & ACT UP NY Women's Caucus
Shelley Geballe, JD, MPH, Lecturer, Yale School of Public Health, Visiting Clinical
Lecturer, Yale Law School
Toorjo Ghose, Associate Professor, School of Social Policy & Practice, University of
Pennsylvania
GNP+ NA (The Global Network of People Living with HIV, North America)
Lewis Goldfrank, Chairman of Emergency Medicine, New York University and
Bellevue Hospital Center
Gregg Gonsalves, Global Health Justice Partnership, Yale Law School-­‐Yale School of
Public Health
Lawrence O. Gostin, University Professor, Founding O'Neill Chair in Global Health Law,
Georgetown Law; Faculty Director, O'Neill Institute for National and Global Health Law; Director, World Health Organization Collaborating Center on Public Health Law &
Human Rights
Karen Grepin, Assistant Professor of Global Health Policy, New York University
Sally Guttmacher, PhD, Professor of Public Health, New York University
Mark Harrington, Executive Director, Treatment Action Group
Tim Horn, HIV Project Director, Treatment Action Group
Sanjat Kanjilal, MD, Infectious Disease Fellow, Massachusetts General Hospital
William B. Karesh, DVM, Exec. Vice President, EcoHealth Alliance
Salmaan Keshavjee, MD, PhD, ScM, Director, Program In Infectious Disease and Social
Change, Department of Global Health and Social Medicine, Harvard Medical School
Gerald T. Keusch, MD, Professor of Medicine and International Health, Associate
Director, National Emerging Infectious Diseases Laboratory, Boston University
Kaveh Khoshnood, PhD, Associate Professor, Yale School of Public Health
Jacqui Kilmer, COO, Harlem United
Charles King, Chief Executive Officer, Housing Works, Inc.
Michael Kinzer, MD, MPH
Albert Icksang Ko, MD, Professor of Epidemiology (Microbial Diseases) and of
Medicine (Infectious Diseases); Department Chair—Epidemiology of Microbial
Diseases, Yale School of Public Health
Thomas Krever, Chief Executive Officer, Hetrick-­‐Martin Institute
Ann Kurth, PhD, CNM, MPH, Associate Dean for Research, NYU Global Institute of
Public Health
Tim Lahey, MD MMSc, Associate Professor, Infectious Diseases & International Health, Geisel School of Medicine at Dartmouth, Dartmouth-­‐Hitchcock Medical Center
Jay Laudato, Executive Director, Callen-­‐Lorde Community Health Center
Philip Lederer, MD, Infectious Disease Fellow, Massachusetts General Hospital
Jeffrey Levi, PhD, Executive Director, Trust for America's Health
Kelsey Louie, CEO, GMHC
Amanda Lugg, Director of Advocacy, African Services Committee
Hon. Keith Martin, MD, PC, Executive Director, Consortium of Universities for
Global Health
Robert McNamara, Managing Director, Friends In Deed
Peter Meacher, MD, Chief Medical Officer, Callen-­‐Lorde Community Health Center
Suerie Moon, MPA, PhD, Research Director and Co-­‐Chair, Forum on Global
Governance for Health, Harvard Global Health Institute, and Lecturer, Department of
Global Health and Population, Harvard School of Public Health
David Mushatt, MD, Chief, Infectious Diseases Section, Tulane University
Nancy Neveloff Dubler, LL.B, Adjunct Professor, NYU Langone Medical Center
Gbenga Ogedegbe, MD, MPH, Vice Dean & Chief Medical Officer, Global Institute of
Public Health, New York University
Cynthia O’Neal, President, Friends In Deed
David Paltiel, PhD, Professor, Yale School of Public Health Yale School of Management
Melinda Mary Pettigrew, PhD, Associate Professor of Epidemiology (Microbial
Diseases); Associate Dean for Academic Affairs, Yale School of Public Health
Jonathan Platt, MPH, Columbia University Mailman School of Public Health
J. L. Pottenger, Jr., Nathan Baker Clinical Professor of Law, Yale Law School
Gina Quattrochi, Esq., CEO, Bailey House
Miriam Rabkin, MD, MPH, Associate Professor Medicine and Epidemiology,
Columbia University Mailman School of Public Health
Asghar Rastegar, MD, Professor of Medicine; Director, Office of Global Health, Yale
University School of Medicine
Robert H. Remien, PhD, Clinical Psychologist (New York, NY)
Elena Rios, MD, MSPH, President & CEO, National Hispanic Medical Association
Joyce Rivera, Founder & Executive Director, St. Ann's Corner of Harm Reduction
Maria Said, Physician, Board Certified Internal Medicine and Infectious Diseases
Nathan Schaefer, Executive Director, Empire State Pride Agenda
Carl Siciliano, Executive Director, Ali Forney Center
Virginia Shubert, J.D., Shubert Botein Policy Associates
Michael Silverman, Executive Director, Transgender Legal Defense & Education Fund
Prabhjot Singh, MD, PhD, Director of Systems Design, Earth Institute; Assistant
Professor of International & Pubic Affairs, Columbia University
Barbara Smith, PhD, RN, FACSM, FAAN, Associate Dean for Research, Michigan
State University
Kimberleigh Smith, VP, Policy & Advocacy, Harlem United
Samara Soghoian, MD, MA, Assistant Professor of Emergency Medicine, New York
University School of Medicine
Andrew Spieldenner, PhD, Assistant Professor, Hofstra University
Peter Staley, AIDS Activist
Sharon Stapel, Executive Director, New York City Anti-­‐Violence Project
Rev. Moonhawk River Stone, MS, LMHC, RiverStone Consulting
Sean Strub, Executive Director, Sero Project
Dan Suarez, RN, MA, President, National Association of Hispanic Nurses (NAHN)
Glennda Testone, Executive Director, The NYC Lesbian, Gay, Bisexual and
Transgender Community Center
Melanie Thompson, MD, AIDS Research Consortium of Atlanta, HIVMA Board of
Directors
David Tiersten, MD, FCAP, Past President, New York State Society of Pathologists
Francesca Torriani, MD, FIDSA, Professor of Medicine and Director of UCSD Infection Prevention and Clinical Epidemiology and TB Units, Division of Infectious
Diseases, Department of Medicine, UC San Diego
United States People Living With HIV Caucus
Tom Viola, Executive Director, BROADWAY CARES/EQUITY FIGHTS AIDS
Terri Wilder, AIDS Activist
Suzanne Willard, PHD, APN, FAAN
Brian Yablon, MD, Internal Medicine/Pediatric Physician, Anchorage, AK

cc:
Tom Frieden, CDC Director
Ron Klain, Ebola Response Coordinator, Executive Office of the President
Sylvia Burwell, United States Secretary of Health and Human Services
Douglas Brooks, Director of the Office of National AIDS Policy
Cecilia Munoz, Assistant to the President for Domestic Policy
Lisa Monaco, Assistant to the President for Homeland Security and Counterterrorism

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