TIME ebola

Nurse Defies Ebola Quarantine in Maine

Nurse Kaci Hickox and her boyfriend Ted Wilbur address the media during an informal meeting with the news media outside their home in Fort Kent, Maine, Oct. 29, 2014.
Nurse Kaci Hickox and her boyfriend Ted Wilbur address the media during an informal meeting with the news media outside their home in Fort Kent, Maine, Oct. 29, 2014. Ashley L/ Conti—Reuters

"I'm not willing to stand here and let my civil rights be violated when it's not science-based"

FORT KENT, Maine — A nurse who vowed to defy Maine’s voluntary quarantine for health care workers who treated Ebola patients followed through on her promise Thursday, leaving her home for a bike ride.

Kaci Hickox and her boyfriend stepped out of their home Thursday morning and rode away on bicycles, followed by state police who were monitoring her movements and public interactions. Police couldn’t detain her without a court order signed by a judge.

Hickox contends there’s no need for quarantine because she’s showing no symptoms. She’s also tested negative for the deadly disease.

State officials were going to court in an effort to detain Hickox for the remainder of the 21-day incubation period for Ebola that ends on Nov. 10

It was the second time Hickox broke quarantine. She left her home Wednesday evening briefly to speak to reporters, even shaking a hand that was offered to her.

“There’s a lot of misinformation about how Ebola is transmitted, and I can understand why people are frightened. But their fear is not based on medical facts,” Norman Siegel, one of her attorneys, said Wednesday.

Hickox, who volunteered in Sierra Leone with Doctors Without Borders, was the first person forced into New Jersey’s mandatory quarantine for people arriving at the Newark airport from three West African countries. Hickox spent the weekend in a tent in New Jersey before traveling to the home she shares with her boyfriend, a nursing student at the University of Maine at Fort Kent.

“I’m not willing to stand here and let my civil rights be violated when it’s not science-based,” she told reporters Wednesday evening.

Generally, states have broad authority when it comes to such matters. But Maine health officials could have a tough time convincing a judge that Hickox poses a threat, said attorney Jackie L. Caynon III, who specializes in health law in Worcester, Massachusetts.

“If somebody isn’t showing signs of the infection, then it’s kind of hard to say someone should be under mandatory quarantine,” he said.

Ebola, which is spread through direct contact with the bodily fluids of an infected person, has killed thousands of people in Africa, but only four people have been diagnosed with it in the United States. People can’t be infected just by being near someone who’s sick, and people aren’t contagious unless they’re sick, health officials say.

Guidelines from the federal Centers for Disease Control and Prevention recommend daily monitoring for health care workers like Hickox who have come into contact with Ebola patients. But some states like Maine are going above and beyond those guidelines.

The defense department is going even further. On Wednesday, Defense Secretary Chuck Hagel ordered military men and women helping fight Ebola to undergo 21-day quarantines that start upon their return — instead of their last exposure to an Ebola patient.

President Barack Obama warned that overly restrictive measures imposed upon returning health care workers could discourage them from volunteering in Africa.

But Maine Gov. Paul LePage, who canceled campaign events to keep tabs on the situation, maintained that the state must be “vigilant” to protect others.

State law allows a judge to grant temporary custody of someone if health officials demonstrate “a clear and immediate public health threat.”

The state’s court filing was expected Thursday, officials said.

If a judge grants the state request, then Hickox will appeal the decision on constitutional grounds, necessitating a hearing, Siegel said.

Siegel said the nurse hopes her fight against the quarantine will help bring an end to misinformation about how the Ebola virus is transmitted.

“She wants to have her voice in the debate about how America handles the Ebola crisis. She has an important voice and perspective,” he said.

TIME Mental Health/Psychology

4 Ways Being Lonely Can Affect Your Health

Getty Images

Research consistently shows that lonely people have a higher risk of heart disease

When you’re lonely, you may look for friends in all sorts of unexpected places. At least, that’s the conclusion of a recent study in Psychological Science that found that folks who felt socially disconnected—aka lonely—were more likely to view a doll’s face as human.

But the health implications of being lonely go much further. “People who are lonely have more physical and mental health problems than those who feel connected to others,” explains Bruce Rabin, MD, director of the University of Pittsburgh Medical Center Healthy Lifestyle Program. Here, four ways loneliness affects your health:

You’re more likely to be down in the dumps

The more lonely you feel, the more likely you are to have depressive symptoms, according to research at the University of Chicago.

“When you’re lonely, brain hormones associated with stress such as cortisol become active, which can cause depression,” Rabin explains. “In fact, for mild and moderate depression social interaction is even more effective at alleviating symptoms than a prescription antidepressant.” One 2009 Colorado State University study found that the more positive social interactions people with depression had, the more improvement in symptoms they experienced.

HEALTH.COM: Foods That Make You Feel Better

You’re less likely to take care of yourself

Research shows you’ll eat less healthful fare if you frequently dine solo: Single and widowed men and women 50 and older, for example, eat fewer veggies daily than married or cohabiting counterparts. “If you’re cooking for other people, you’re more likely to prepare a healthier meal that contains a range of foods—a meat, a starch, a vegetable—than if you’re just throwing together something for yourself,” Rabin points out.

Folks who are lonely are also more likely to be physically inactive, according to a 2009 study published in the journal Health Psychology.

HEALTH.COM: 18 Habits of the Happiest Families

You may be more susceptible to heart disease

Middle aged adults who live alone have a 24% increased risk of dying of heart disease, according to a 2012 Harvard study. “Research has consistently shown lonely people have a higher risk of heart disease, and it’s for many reasons,” Rabin says. “Since they don’t have social support, they’re more susceptible to the effects of stress, which increases the likelihood of getting heart disease. We know elevated stress hormones increase the accumulation of cholesterol deposits in the heart. Secondly, if they’re lonely they’re less likely to be physically active or eat properly. And finally, if they don’t feel well, they’re much less likely to confide that in someone who will insist that they go to the doctor to get checked out.”

HEALTH.COM: 12 Signs You May Have an Anxiety Disorder

You could have a weaker immune system

Loneliness can strain the immune system, according to Ohio State University research presented in 2013. People who were lonely produced more inflammation-related proteins in response to stress than folks who felt more socially connected. Inflammation is linked to numerous health conditions including heart disease, Type 2 diabetes, arthritis, and Alzheimer’s disease.

What to do about it

Joining a bevy of social groups isn’t necessarily the best way to combat loneliness. “It’s important to note that someone can be alone, or have only a handful of close friends, and not be lonely,” Rabin stresses. “Or you can be a social butterfly and out with friends every night of the week and still feel isolated.” His advice? Volunteer. Doing good deeds for others will lift your mood, and you’ll most likely meet kindred spirits that you can cultivate a real connection with—which in turn will leave you feeling less lonely.

HEALTH.COM: 12 Ways We Sabotage Our Mental Health

This article originally appeared on Health.com

TIME Education

Skin Cancer U? Students Tan on Campus at Top Colleges

A woman lies in a tanning booth in Anchorage, Alaska on Dec 15, 2005.
A woman lies in a tanning booth in Anchorage, Alaska on Dec 15, 2005. Al Grillo—AP

America’s top universities may be teaching a dangerous lesson about tanning.

Twelve percent of the nation’s top colleges and universities have tanning beds on campus, and nearly half have them either on campus or in off-campus housing, according to a report published online Wednesday in JAMA Dermatology.

Students can even use “campus cash” debit cards loaded up by parents for tanning at 14 percent of the 125 top colleges and universities compiled by U.S. News & World Report. And when tanning beds were offered in off-campus housing, it was free to tenants 96 percent of the time, the study found…
TIME ebola

Maine to Seek Court Order to Force Ebola Quarantine on Nurse Kaci Hickox

After she said she'd defy it

Maine officials will seek a court order to force Kaci Hickox, a nurse who recently returned from treating Ebla patients in West Africa, to self-quarantine at home after Hickox said she wouldn’t voluntarily quarantine herself.

Hickox, who is holed up in a house in the town of Fort Kent, gave the state until Thursday to let her move freely and threatened to take the matter to court otherwise. But Maine Health Commissioner Mary Mayhew said at a news conference Wednesday afternoon that “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 immediate see a court order.”

Read the rest of the story from our partners at NBC News

TIME #TheBrief

#TheBrief: Ebola Quarantines Get Political

While the federal government works to contain Ebola in the U.S., states are taking matters into their own hands—and butting heads with the White House and the CDC in the process.

The attempt to contain the spread of Ebola in the United States is becoming political, with governors imposing varying, stringent, and sometimes unclear quarantine rules that are hard to enforce across state lines.

President Barack Obama spoke out against these policies Wednesday, saying, “We don’t want to discourage our health care workers from going to the front lines. They are doing God’s work over there, and they are doing it to keep us safe.”

Here’s your brief on the science and politics of Ebola.

TIME ebola

Here’s What Scientists Know About Ebola in Sierra Leone

An Ebola screening tent outside the Kenema government hospital in Kenema, Sierra Leone, Aug. 6, 2014.
An Ebola screening tent outside the Kenema government hospital in Kenema, Sierra Leone, Aug. 6, 2014. Tommy Trenchard—Redux/The New York Times

Rare, reliable data about Ebola from inside a treatment center in Sierra Leone

Everything we know about Ebola since the disease’s two dozen or so outbreaks since 1976 comes not from a rich, deep database of scientific evidence that’s been carefully collected and recorded. With few formal health care systems in the areas hardest hit by the disease, there were no medical records, no charts and no standardized ways to document patients’ symptoms, vital signs, treatment regimens and whether or not they survived. Instead, much of our knowledge comes from the haphazard scrawl of doctors’ notes and their recollections about treatment and survival rates.

But for the past 10 years at Kenema Government Hospital in Sierra Leone, the country’s Ministry of Health has been working with a group of international researchers to establish a meticulous medical records system—originally for patients with Lassa fever, another common infection in the region. So when the first Ebola patient walked through the door on May 25, the same procedures for documenting vital signs and treatment information stayed in place. Now, for the first time, doctors have a robust record of the first Ebola patients in the current outbreak treated at Kenema beginning in May—and the results of that record-keeping appear in the New England Journal of Medicine.

MORE: Ebola Tests Fast Tracked By FDA

The new records were a challenge to collect, since infection control rules meant that the paper charts could not be transferred back and forth between the ward where patients were treated and other areas of the hospital. “The nurses’ station was separated from the patient rooms by essentially a chicken wire window, so the nurses would talk to each other through the chicken wire—the nurse inside, in personal protective equipment, would tell the nurse outside what to write down,” says paper co-author Dr. John Schieffelin, an assistant professor of clinical pediatrics and internal medicine at Tulane University who has been serving stints at the hospital for the last four and a half years. Even that rudimentary system was state of the art for the region, where most health clinics do not keep medical records. “In most of Sierra Leone, the hospital chart is one of those little composition books that we used to write essays in during high school,” says Schieffelin. “There was no structure to it; the physician would just write daily notes and most hospitals don’t have a charting system.”

MORE: See How Ebola Drugs Grow In Tobacco Leaves

The new documents confirm what previous health workers knew about Ebola from experience. Of 106 patients with Ebola, 44 had complete medical charts in paper form (the rest were destroyed because health officials feared they had been contaminated with the virus), and the findings supported some basic tenets of Ebola infection: that the incubation period for Ebola virus is about six to 12 days, that 74% of those infected died, that younger patients were more likely to survive infection than those over age 45, and that people with less virus in their blood when diagnosed were more likely to survive.

“It affirms our understanding of how to treat Ebola patients,” says Schieffelin. “We need to treat them aggressively with IV fluids and monitor their blood chemistries. The study also gives us a good solid baseline for understanding the disease, so we can build on it in a lot of different ways. It’s a foundation for doing further studies for optimizing treatment. It provides a great foundation for studies looking at novel treatment methods. Now that we understand how Ebola affects patients, can we improve symptoms and outcomes with novel therapies? We can start to ask and answer those questions.”

MORE: 12 Answers to Ebola’s Hard Questions

Turning those answers into new treatment strategies, however, might be a daunting task—especially in the context of the current outbreak. On most days, the Kenema hospital would see about 90 Ebola-related patients, some of whom were suspected to have the disease but still needed to be tested, and others with confirmed infections who needed to be immediately assigned to a bed and given IV fluids. “There are a lot of confused Ebola patients,” says Schieffelin. “These people are wandering around the ward, often going from one bed to the next, and they are scared so often not very cooperative. To top that off, a lot of people didn’t speak English, so that made it even more challenging.”

He admits to often tossing patient confidentiality concerns aside by asking other patients who were feeling well to translate critical information to their peers, who either didn’t need to be in the hospital any longer because they tested negative, or needed to be immediately transferred to another ward if they were infected.

MORE: Learning From Past Viral Epidemics, Asia Readies for Possible Ebola Outbreak

At Kenema, the health care workers did not use the full-coverage hazmat suits that Medecins Sans Frontieres uses in its clinics. Instead, they wore Tyvek suits that covered their front and back, a mask, face shield, double gloves and a head covering. That left some skin in the front and back of the neck exposed. The reason was partly for practical reasons—Schieffelin was often the only health care worker on his part of the ward where patients were triaged, and frequently had to spend four to four and a half hours at a time suited up. The full coverage suits become uncomfortable and unbearable after about 45 minutes.

“But I was personally okay with our equipment,” he says. “Because my biggest concern was getting a needle stick. My mucous membranes—my eyes, nose and mouth—were pretty well covered.”

After about four hours, he and whoever else was working on the wards with the infected patients would get sprayed with a bleach solution from the shoulders down, in order to avoid splashing any potentially contaminated material onto their face and neck. Then they would take each piece of equipment off and wash their hands in bleach after each step. After a break of an hour or so, they would suit up again.

MORE: Ebola Quarantines ‘Not Grounded on Science,’ Say Leading Health Groups

When Schieffelin returned from his work in Sierra Leone in August, he was told by the World Health Organization, U.S. Centers for Disease Control and the Louisiana state health department (he lives in the state) to monitor his temperature twice a day for 21 days, which he did. He was also told not to use mass transportation. He worked at home for a couple days, only because he was exhausted after his trip, and when he returned to work he didn’t see patients for a few weeks—mostly out of a scheduling coincidence, not intentionally.

Given public concerns about Ebola potentially coming to the U.S. and spreading here, however, he says, “Perhaps we should say that in terms of physicians and nurses, maybe direct patient care for a couple of weeks would not be in anyone’s best interest.”

But while he recognizes that hospital organizations and the general pubic have legitimate concerns about being protected against an agent as deadly as Ebola, Schieffelin is against mandatory self-isolation or quarantine, measures the states of New York and New Jersey recently decided to require for all health care workers returning from the three countries affected by Ebola. “I think self-isolation is completely unnecessary if you are not symptomatic. In my mind, that enhances hysteria. I have young children. If their dad were in self isolation away from everybody for three weeks, that would adversely affect them and would be telling the community and the schools the wrong message: that I need to be a pariah and an outcast for three weeks,” he says. “In my mind, that’s not the right message. If I have no symptoms, I am not a threat to anybody—I’m not a threat to my children, nor are my children a threat to other children at their school.” Such mandatory quarantines could also deter health workers from contributing to the effort to control the epidemic, and that will only prolong it, he says.

Schieffelin says that if he had recorded a fever at any point during this 21 day monitoring period, he would have immediately reported to the Louisiana health department and gone into isolation. He knows how deadly Ebola can be from personal and professional experience: seven of Schieffelin’s co-authors on the paper have died of Ebola infection since the data were collected over the summer.

TIME ebola

California Orders Ebola Quarantine for Some Travelers

The state describes it as a "flexible, case-by-case approach"

California ordered a 21-day quarantine Wednesday for travelers who have had contact with confirmed Ebola patients.

The state said the quarantine order requires local counties to individually assess people at risk for Ebola and assign an “appropriate level of quarantine.” Those who are at a high risk, defined by the state as people who had contact with an Ebola patient, will be put in a 21-day quarantine.

“Although quarantine can involve isolation at home, it may be tailored to allow for greater movement of individuals who are deemed to be at lower risk,” the California Department of Public Health said.

California’s move follows similar quarantine orders from New York, New Jersey and Illinois, measures that have been criticized by health experts—and by President Barack Obama—as putting fear over science and potentially hampering efforts to contain the outbreak that has killed thousands in West Africa by making it harder for aid workers to travel there and back.

The state said local health officials have the authority to order the quarantine of people who may have an infectious disease that’s a public health threat.

“This flexible, case-by-case approach will ensure that local health officers throughout the state prevent spread of the disease,” the department said, “while ensuring that individuals at risk for Ebola are treated fairly and consistently.”

TIME ebola

Ebola’s Decline in Liberia Prompts Fears of Complacency

A host of new evidence suggests the number of Ebola cases in Liberia has declined, but health care workers in the country treating the disease warn that it remains a grave threat, particularly in rural areas where a lack of awareness remains problematic.

“If we should be able to end this nightmare in our country, we must remain fully engaged and even more engaged in what we are doing individually and collectively to defeat this virus,” Fayiah Tamba, head of the Liberia National Red Cross Society, said in a presentation this week.

News that the Ebola outbreak might be weakening in Liberia began percolating in local media reports last week and has been reinforced by statements from international health officials. Health workers on the ground confirmed the downward trend to TIME. A local Red Cross branch recovered 175 bodies of deceased Ebola patients last week, down from more than 300 in mid-October. Burial numbers hit the lowest point since August. Many of the country’s Ebola-dedicated hospital beds remain empty, an International Medical Corps doctor said.

But the numbers don’t tell the whole story, health care workers said. While the number of Ebola cases in the country’s capital of Monrovia has declined, it’s difficult to assess the situation in rural regions. In some areas, large majorities of the population are “stuck with their beliefs” and still don’t understand the basics of the virus, according to Emmett Wilson, a program manager at FACE Africa in Liberia. Those regions remain at high risk without continued efforts to spread awareness, he said.

Pranav Shetty, an International Medical Corps doctor in Liberia, described the decline in cases as “one frame in an entire movie,” and said the nature of the disease means that improvements may only be temporary.

“Every single case has the potential has the potential to restart the epidemic,” he said.

A focus on rural areas is essential to preventing such a reoccurrence, and many health care workers said the lull in cases has allowed them to refocus their efforts outside the city. Shetty said free hospital beds have allowed health workers to reach residents of far-out regions.

“We have to concentrate our efforts and energy to the communities especially in rural communities more so that we don’t have a reoccurrence,” Tamba said.

In urban areas with higher levels of awareness, health care workers said it’s important that residents don’t grow complacent. A few weeks ago everyone was sanitizing their hands and following hygiene instructions carefully, Wilson said, but now, they’re “slacking.”

“We are involved in a fight,” he said. “When people start to get the impression that there’s a reduction in the number of cases, it sends a mixed signal.”

The concerns of health care workers on the ground have not escaped the attention of officials at international health groups. On Wednesday, World Health Organization assistant director general Bruce Aylward was careful to warn that much work remains to eradicate Ebola in Liberia, even as he made a bold statement that aid efforts were “getting an upper hand on the virus.”

“A slight decline in cases in a few days versus getting this thing closed out is a completely different ball game,” he said on a conference call. “It’s like saying your pet tiger is under control.”

TIME ebola

Ebola Brings Another Fear: Xenophobia

Amadou Drame, 11, and brother Pape Drame, 13, right, listen as their father, Ousmane Drame, responds to questions during a news interview on Oct. 28, 2014, in New York.
Amadou Drame, left, 11, and brother Pape Drame, right, 13, listen as their father Ousmane Drame responds to questions during a news interview on Oct. 28, 2014, in New York City Frank Franklin II—AP

A father's claim that his two boys were beaten and called "Ebola" raises concern among Africans

The father says the bullying began soon after his two sons arrived at their New York City school from Senegal almost one month ago. They were called “Ebola” by other students, taunted about possibly being contagious and excluded from playing ball. Ousmane Drame says the baiting finally erupted into a physical fight on Oct. 24 when 11-year-old Amadou and his 13-year-old brother Pape were pummeled by classmates on the playground of Intermediate School 318 in the Bronx.

“It’s not just them,” Drame said at a press conference. “All the African children suffer this.”

The brothers’ experience is an extreme example of the backlash felt by some Africans in the U.S. since the Ebola virus arrived from West Africa. Many others tell of facing subtler, but no less hurtful, forms of discrimination at work, in school and as they commute as fear of the little-known but often deadly disease has spread among the public.

In Staten Island, the largest Liberian community outside of Africa, one woman says she was forced to take temporary, unpaid leave from her job because of her nationality. Liberians in Minnesota have been told to leave work after sneezing or coughing. In New Jersey, two elementary school students from Rwanda were kept out of school after other parents pressured school officials. At Navarro College, a public community college in Texas, officials mailed letters rejecting international applicants from African countries, even ones from countries without confirmed Ebola cases. (The school has since apologized for sending out “incorrect information.”)

“This is a larger problem,” says Charles Cooper, president of the New York City–based African Advisory Council, an advocacy group. “People are on the train and they sneeze and hear, ‘I hope you don’t have Ebola. I hope you don’t give me Ebola.’ Xenophobia is growing around this, but many people are afraid to come out publicly.”

The spread of previously unknown, contagious diseases in the U.S. has often led to these sorts of overreactions. For Ebola, those fears appear driven by the circumstances of the virus — its high mortality rate, its gruesome symptoms, its origins on a continent often misunderstood by Americans — even though the odds of contracting it in the U.S. remain exceedingly low. A recent poll from the Harvard School of Public Health found that more than half of adults worry there will be a large Ebola outbreak inside in the U.S. over the next year, while over a third are worried that they or a family member will be infected.

While fears erupted around people diagnosed with polio in the 1940s and SARS in the 2000s, public-health experts point to the start of the AIDS epidemic in the early 1980s as the last time Americans attached a similar stigma to people even loosely associated with the virus. At the time, many Americans refused to be near those suspected of having HIV, unaware of how it was actually transmitted.

“A lot of what I’m seeing today was present at the very beginning of the AIDS epidemic,” says Robert Fullilove, a Columbia University professor of sociomedical sciences, who has been researching HIV since the mid-1980s. “It’s this tendency to separate between two different groups, when somebody’s ‘otherness’ is associated with a deadly disease. It’s like déjà vu all over again.”

That toxic brew of fear and misinformation led to discrimination against gays — the disease was unfairly yet colloquially known as the “gay plague” for its disproportionate toll among homosexual men — and people from Haiti, which was the first country in the western hemisphere with confirmed cases of HIV.

“Haiti itself became stigmatized,” says Dr. Joia Mukherjee, a Harvard Medical School associate professor. “The same thing is happening now with Liberians, and indeed all of Africa.”

In both cases, the driving forces are the same: a general lack of understanding about the disease, how it is transmitted and where it’s been concentrated.

“The average American doesn’t even recognize how big Africa is,” Fullilove says of the Ebola stereotypes.

The bullying allegedly faced by the Drame brothers is a case in point. The vast majority of Ebola cases are in Liberia and Sierra Leone. Senegal had only one confirmed case and is now considered free of the disease by the Centers for Disease Control and Prevention (CDC).

Countering such misinformation has been central to the messaging strategy of the CDC and government officials. It’s no coincidence that President Obama hugged Nina Pham after the Dallas nurse was declared free of the virus. And the image offensive may be paying off. According to a new ABC News/Washington Post poll, the people least worried about catching the disease or a larger U.S. outbreak were the ones who knew the most about how Ebola is transmitted.

Your browser, Internet Explorer 8 or below, is out of date. It has known security flaws and may not display all features of this and other websites.

Learn how to update your browser