TIME ebola

Here’s How Suspected Ebola Patients Can Be Restricted

Ebola precautions in the Netherlands
A man tries on special Ebola gear in Berkel en Rodenrijs, The Netherlands, on Oct. 17, 2014. Remko De Waal—EPA

And other Ebola quarantine questions answered

About 100 Dallas healthcare workers who treated Thomas Eric Duncan, who died of Ebola Oct. 8, have been asked by the Texas state health agency not to go to public places or travel by plane or bus. The voluntary requirements are designed to halt the disease’s spread, which continue to concern Americans this weekend as a cruise ship quarantined a health worker and an airline attempts to contact passengers who flew with an infected Dallas nurse.

But as health officials try to contain the spread of the disease, the restrictions by federal and state agencies as well as private businesses like cruise lines are increasingly bumping up against civil liberties, raising a number of questions about who can officially order a quarantine and whether someone can be kicked off a plane for having Ebola-like symptoms.

Who can order a quarantine?

State, local and federal authorities can all issue quarantines, which separate and restrict the movement of people who were exposed to a communicable disease. But it’s often state authorities that order them. Those health agencies often have significant powers to issue a quarantine if they suspect someone has come into contact with a disease like Ebola, says Wendy Parmet, a Northeastern University law professor. Texas, for instance, has strong policing powers in the case of a public health emergency to quarantine those the state believes to have come in contact with the disease. For example, the state can destroy property it believes may have come into contact with a contagious disease.

The Centers for Disease Control and Prevention (CDC) also issues quarantines, with its powers deriving from the Public Health Service Act and the Commerce Clause of the U.S. Constitution. But the CDC is generally focused on issues at the border: flights and passenger ships coming into the U.S., for example. But it has jurisdiction over interstate flights as well.

Who can order someone to be isolated?

Local, state and federal agencies can issue an isolation order, which separates people with a contagious disease from those who are not infected.

What do those agencies have to prove to order a quarantine or an isolation?

Health agencies have an epidemiological checklist that helps them determine if someone showing symptoms of a disease is actually carrying it, says Indiana University law professor David Fidler. Those health agencies are generally required to be as unrestrictive as possible when issuing those orders. For example, the CDC can’t order a quarantine for longer than the general incubation period for Ebola, which is normally 21 days. If it does, an individual could theoretically take the health agency to court over the matter.

What happens if someone suspected of Ebola resists a state or federal order?

Because of the substantial powers given to the CDC and state and local health agencies, someone resisting a quarantine or isolation could be made to comply involuntarily. In Texas, it’s a criminal offense to resist a quarantine order.

“Most health agencies would certainly have the authority to send police in moon [hazmat] suits to physically put them somewhere in isolation or back in their house,” says Robert Field, a Drexel University professor of law and health policy.

What if you resist voluntary compliance, like the kind being asked of Dallas’s healthcare workers?

If healthcare workers resist signing the voluntary quarantine or defy its recommendations after agreeing to it, Emory University law professor Polly Price says that it’s likely an official quarantine would be ordered. “They could go and get a court order to formalize it, possibly even after the fact,” Price says. “But they would likely seek a formal quarantine.”

Can the CDC force a state health agency to quarantine someone?

The CDC does not have enforcement over state agencies, but Drexel’s Field says federal authority in those instances is rarely used. “It would be an unusual situation in which the federal government wanted to quarantine someone and a state did not,” he says.

Can you be kicked off a plane for being suspected of having Ebola?

Planes kick people off for all sorts of reasons, including joking about Ebola. So it doesn’t seem terribly far off that airlines could also kick someone off for having Ebola, considering they’re a private business and it wouldn’t be considered a discriminatory practice.

“The Americans With Disabilities Act says you can’t discriminate because of a disability,” says Drexel University’s Field. “But there are exceptions for someone who presents direct threats involving something like an infectious disease. An airline could use that exception to deny someone access to a plane.”

But it’s more likely that the CDC would get involved. Indiana University’s Fidler says that airlines are required to notify the CDC if there’s a sick passenger aboard who may have a contagious disease.

How about a cruise ship?

Cruise ships also appear to be able to temporarily quarantine or isolate a sick passenger or even remove them from a ship, but they would be required to immediately notify the CDC of such an event. Indiana University’s Fidler says it’s likely that a cruise ship would call the CDC for guidance on what to do.

But Peter Jacobson, a University of Michigan professor of health law and policy, says it’s likely that cruise ship passengers sign a contract that gives the captain wide discretion to take action to avoid harm to others on board.

TIME ebola

Obama on Ebola: ‘We Can’t Give in to Hysteria’

"This is a serious disease, but we can't give in to hysteria or fear," Obama said

President Barack Obama on Saturday urged Americans to remain calm about the Ebola virus that has thus far been diagnosed in three people in the United States and killed one, emphasizing that cautious practices on the part of health authorities as well as aid for the West African countries hardest hit by the disease are the best approaches to preventing it from spreading.

“What we’re seeing now is not an ‘outbreak’ or an ‘epidemic’ of Ebola in America,” Obama said in his weekly video address. “This is a serious disease, but we can’t give in to hysteria or fear.”

“We have to keep this in perspective,” Obama continued. “Every year, thousands of Americans die from the flu.” The President also pointed out that five people who contracted Ebola in West Africa had been brought back to the U.S. and treated successfully without infecting others.

The Ebola outbreak has so far killed 4,500 people in Liberia, Sierra Leone and Guinea. Liberian national Thomas Eric Duncan, who was diagnosed with the disease in Dallas after traveling from his home country to the U.S., died of the illness Oct. 8. A pair of American health workers have been diagnosed after coming in contact with Duncan and are being treated for the illness. More than 100 people who have been in contact with Duncan and the two sick nurses are being monitored for symptoms. Ebola has an incubation period of up to 21 days and is only transmitted by direct contact with the bodily fluids of a person who is already showing symptoms of the disease.

The Centers for Disease Control and Prevention, under fire for not adequately instructing medical staff in how to deal with Ebola patients, took steps this week to address those criticisms. Several lawmakers have also criticized Obama’s handling of the crisis directly, with the President announcing Friday the appointment of a so-called “Ebola czar” to manage the country’s response to the virus.

Obama, however, warned against calls by some politicians to halt travel between the U.S. and West Africa. CDC officials and other experts have said cutting off the border would be ineffective because sick passengers can still take connecting flights through third countries, and it would make it harder to know who was entering the country and perform contact tracing if travelers later showed symptoms of the virus.

Obama also argued that stopping travel would halt the flow of health workers to West Africa, where they could help contain the disease. “We can’t just cut ourselves off from West Africa,” Obama said. “Trying to seal off an entire region of the world — if that were even possible — could actually make the situation worse.”

TIME ebola

Memorial Service Held for First U.S. Ebola Victim

Thomas Eric Duncan
Thomas Eric Duncan, the first Ebola patient diagnosed in the U.S., at a wedding in Ghana in 2011. Wilmot Chayee—AP

Family and friends of Thomas Eric Duncan, the first and so far only person to die of Ebola in the U.S., gathered Saturday for an emotional memorial service in North Carolina. Mourners celebrated the 42-year-old’s life at Rowan International Church in Salisbury, where his sister, mother and nephew worship, according to NBC affiliate WCNC.

Duncan died in Dallas on Oct. 8, and had started showing symptoms of the virus on Sept. 24 after travelling to Texas from Liberia. He wasn’t admitted to a Dallas hospital until Sept. 28 — two days after he first visited the hospital…

Read the rest of the story on NBC News.

TIME ebola

Canada Shipping Experimental Ebola Vaccine to Curb Outbreak

Liberia Races To Expand Ebola Treatment Facilities, As U.S. Troops Arrive
U.S. Navy microbiologist Lt. Jimmy Regeimbal handles a vaccine box with blood samples while testing for Ebola at the U.S. Navy mobile laboratory on October 5, 2014 near Gbarnga, Liberia. John Moore—Getty Images

The vaccine is being tested on humans, Canadian authorities say

Canada will begin shipping an experimental Ebola vaccine to the World Health Organization in Geneva on Monday, the government announced Saturday, with the hope of addressing the current outbreak of the deadly virus.

The effects of the vaccine in animals have been “promising,” Canadian authorities said. The vaccine is just beginning to be tested on human subjects in order to determine the safety of the vaccine and the dosage required to stimulate a person’s immune system into producing the proper antibodies.

Canada is sending 800 vials of experimental Ebola vaccine contained at -80 degrees celsius in three separate shipments via aircraft to the WHO in Geneva. Canada’s Public Health Agency is supplying it to the WHO so it can be used as an “international resource.”

“This vaccine, the product of many years of scientific research and innovation, could be an important tool in curbing the outbreak,” said Dr. Gregory Taylor, Chief Public Health Officer of Canada.

TIME Diet/Nutrition

6 Strange But True Health Tips

Plate, kinfe and fork made up of food
Getty Images

Grabbing a 100-calorie snack pack of cookies or pretzels may seem virtuous, but it's more likely to make you hungrier than if you ate something more substantial

Many methods to improve your health are pretty straightforward: to lose weight, eat less and exercise more; to boost your energy, get more sleep; to prevent dehydration, drink more water. Others, however, are totally counterintuitive. The following tips really do work—but they may leave you scratching your head.

Drink coffee to have a better nap

In a Japanese study that examined how to make the most of a nap, people who took a “coffee nap”—consuming about 200 milligrams of caffeine (the amount in one to two cups of coffee) and then immediately taking a 20-minute rest—felt more alert and performed better on computer tests than those who only took a nap.

HEALTH.COM: 12 Surprising Sources of Caffeine

Why does this work? A 20-minute nap ends just as the caffeine kicks in and clears the brain of a molecule called adenosine, maximizing alertness. “Adenosine is a byproduct of wakefulness and activity,” says Allen Towfigh, MD, medical director of New York Neurology & Sleep Medicine. “As adenosine levels increase, we become more fatigued. Napping clears out the adenosine and, when combined with caffeine, an adenosine-blocker, further reduces its effects and amplifies the effects of the nap.”

For healthy teeth, don’t brush after eating

Don’t brush your teeth immediately after meals and drinks, especially if they were acidic. Acidic foods—citrus fruits, sports drinks, tomatoes, soda (both diet and regular)—can soften tooth enamel “like wet sandstone,” says Howard R. Gamble, immediate past president of the Academy of General Dentistry. Brushing your teeth at this stage can speed up acid’s effect on your enamel and erode the layer underneath. Gamble suggests waiting 30 to 60 minutes before brushing.

HEALTH.COM: 20 Things That Can Ruin Your Smile

To wear a smaller size, gain weight

Muscle weight, that is. If two women both weigh 150 pounds and only one lifts weights, the lifter will more likely fit into a smaller pant size than her sedentary counterpart. Likewise, a 150-pound woman who lifts weights could very well wear the same size as a 140-pound woman who doesn’t exercise. The reason: Although a pound of fat weighs the same as a pound of muscle, muscle takes up less space, says Mark Nutting, fitness director of SACO Sport & Fitness in Saco, Maine. “You can get bigger muscles and get smaller overall if you lose the fat,” he says. “The bulk so many women fear only occurs if you don’t lose fat and develop muscle on top of it.” Cut back on calories and add weight to your workout to lose inches.

To eat less, eat more

Grabbing a 100-calorie snack pack of cookies or pretzels may seem virtuous, but it’s more likely to make you hungrier than if you ate something more substantial, says Amy Goodson, RD, dietitian for Texas Health Ben Hogan Sports Medicine. “Eating small amounts of carbohydrates does nothing but spike your blood sugar and leave you wanting more carbs.” Goodson recommends choosing a protein such as peanut butter or string cheese with an apple. “They are higher in calories per serving, but the protein and fat helps you get full faster and stay full longer—and you end up eating fewer calories overall,” she says.

HEALTH.COM: 17 High-Protein Snacks That Speed Up Weight Loss

Skip energy drinks when you’re tired

Energy drinks contain up to five times more caffeine than coffee, but the boost they provide is fleeting and comes with unpleasant side effects like nervousness, irritability, and rapid heartbeat, says Goodson. Plus, energy drinks often contain high levels of taurine, a central nervous system stimulant, and upwards of 50 grams of sugar per can (that’s 13 teaspoons worth!). The sweet stuff spikes blood sugar temporarily, only to crash soon after, leaving you sluggish and foggyheaded—and reaching for another energy drink.

HEALTH.COM: 14 Reasons You’re Tired All the Time

Drink a hot beverage to cool off

Which will cool you off faster on a steamy summer morning: iced coffee or hot? Two recent studies say the latter—and so do others where drinking hot tea in hot weather is the norm, like in India. When you sip a hot beverage, your body senses the change in temperature and increases your sweat production. Then, as the sweat evaporates from your skin, you cool off naturally.

This article originally appeared on Health.com

TIME ebola

Texas Tells Ebola Health Care Workers Not to Travel

Dr. Daniel Varga, Chief Clinical Officer, Senior Executive Vice President, Dallas Mayor Mike Rawlings, Dallas County Judge Clay Jenkins and Dallas County Human and Health Service Director Zach Thompson held a news conference about the new Ebola case on Oct. 15, 2014 at Dallas County Commissioners Court in Dallas.
Dr. Daniel Varga, Chief Clinical Officer, Senior Executive Vice President, Dallas Mayor Mike Rawlings, Dallas County Judge Clay Jenkins and Dallas County Human and Health Service Director Zach Thompson held a news conference about the new Ebola case on Oct. 15, 2014 at Dallas County Commissioners Court in Dallas. David Woo—Dallas Morning News/Corbis

The news comes as one nurse self-quarantines on a cruise

Health care workers who came in close proximity to the first Ebola patient diagnosed in the U.S. are being told they need to avoid public places or they may be involuntarily quarantined.

Under the new rules, which were issued late Thursday by the Texas Department of Health and affect almost 100 people, nurses who entered the hospital room of the first patient must stay away from restaurants and theaters, and forgo travel on airplanes or trains. The new directives from the state, which has seen each of the first three Ebola diagnoses on U.S. soil, lay out explicit guidelines for monitoring health care workers. They come as the federal government is under increasing pressure to do more to contain the virus. After officials were grilled by lawmakers Thursday, President Barack Obama on Friday tapped a longtime Washington aide to be an Ebola “czar” and coordinate the federal response. And the Centers for Disease Control and Prevention (CDC), which has been under particularly harsh scrutiny for its handling of the crisis, is expected to issue new guidelines for health care workers treating Ebola patients soon, Bloomberg reports.

Under the new Texas directives, hospital employees directly involved in caring for Thomas Eric Duncan, the Ebola patient who died Oct. 8, will be monitored with twice-daily check-ins for the 21-day duration of the disease’s incubation period. One of the daily check-ins must be conducted in person.

The state has threatened to subject anyone who ignores the guidelines to a “communicable disease control order”—or in other words, to quarantine them—but officials said they expect compliance.

“These are hometown health care heroes,” Clay Jenkins, a Dallas judge who has been closely involved in managing the containment effort, told the New York Times. “They want to do this. They’re going to follow these agreements.”

The announcement comes amid news that two health care workers who had treated Duncan later traveled out of state—Amber Joy Vinson by plane and another on a cruise ship. Vinson was diagnosed with Ebola following her flight and is being treated at Emory University Hospital in Atlanta. The other, who has not been unidentified, is self-monitoring in isolation aboard the cruise ship.

The new restrictions prevent both flights and cruises, along with any other “commercial transportation” or travel to “any location where members of the public congregate.”

The Ebola outbreak has killed more than 4,500 people in West Africa.

TIME Diet/Nutrition

Soda May Age You as Much as Smoking, Study Says

The link between soda and telomere length

Nobody would mistake sugary soda for a health food, but a new study published in the American Journal of Public Health just found that a daily soda habit can age your immune cells almost two years.

Senior study author Elissa Epel, PhD, professor of psychiatry at University of California San Francisco, wanted to look at the mechanisms behind soda’s storied link to conditions like diabetes, heart attack, obesity, and even higher rates of death. She studied telomeres, the caps at the end of chromosomes in every cell in our body, from white blood cells. Shorter telomeres have been linked to health detriments like shorter lifespans and more stress, cardiovascular disease, diabetes and cancer, the study notes.

Epel and her team analyzed data from 5,309 adults in the National Health and Nutrition Examination Survey (NHANES) from about 14 years ago. They found that people who drank more sugary soda tended to have shorter telomeres. Drinking an 8-ounce daily serving of soda corresponded to 1.9 years of additional aging, and drinking a daily 20-ounce serving was linked to 4.6 more years of aging. The latter, the authors point out, is exactly the same association found between telomere length and smoking.

Only the sugary, bubbly stuff showed this effect. Epel didn’t see any association between telomere length and diet soda intake. “The extremely high dose of sugar that we can put into our body within seconds by drinking sugared beverages is uniquely toxic to metabolism,” she says.

She also didn’t see a significant link between non-carbonated sugary beverages, like fruit juice, which Epel says surprised her. But she thinks the results might be different if the data were more modern. “We think that the jury’s still out on sugared beverages—theoretically they’re just as bad,” she says. “But 14 years ago people were drinking a lot less sugared beverages…they were mostly drinking soda.” At the time of the study, 21% of adults in the study reported consuming 20 ounces or more of sugar-sweetened soda each day, but soda consumption has been on the decline for years.

Telomere length dwindles naturally as we age, but it may not be an irreversible process. Previous research shows that it’s possible to increase telomere length by as much as 10% over 5 years by stressing less and eating a healthy diet—no soda included.

Read next: Here’s How to Stop Teens From Drinking Soda

TIME ebola

Rick Perry Wants to Ban Air Travel From West Africa Amid Ebola Outbreak

Rick Perry
Republican Gov. Rick Perry of Texas, delivers the keynote address at a Heritage Foundation event titled "The Border Crisis and New Politics of Immigration," August 21, 2014. Tom Williams—CQ-Roll Call,Inc.

He joins a growing list of politicians calling for such a ban

Texas Gov. Rick Perry on Friday called on the federal government to impose a ban on air travel from the West African countries hardest hit by Ebola, joining a growing list of politicians supporting such a travel restriction.

Perry reasoned a ban is the right move given that the first patient diagnosed with Ebola in the United States, Thomas Eric Duncan, traveled from Ebola-ridden Liberia to eventually reach Texas, the Associated Press reports. The governor’s call for travel restrictions is a reversal of his stance from just 10 days ago when he said an enhanced medical screening process would be more effective at keeping Ebola out of the country.

“The impact from banning flights from these areas is not going to be an efficient way to deal with this,” Perry said last week, according to The Hill. Referring to a travel ban, Perry added, “There are some that would make the argument that it would [hamper the fight against Ebola].”

Several prominent Republican politicians in particular, including Mitt Romney, have called for flight restrictions, but many health officials say that such a ban would only hurt efforts to contain the disease.

[AP]

TIME Laws

The CDC Has Less Power Than You Think, and Likes it That Way

Ebola isn’t likely to lead to a widespread quarantine but it certainly raises interesting constitutional questions

Director of the Centers for Disease Control and Prevention Tom Frieden has come under fire in recent days for what some charge is the agency’s stumbling response to the appearance of Ebola in America. This week, reporters and lawmakers alike grilled Frieden over how two nurses in Texas contracted the virus and how one of them was able to board an airplane even after she reported a raised temperature.

Breakdowns in good practice notwithstanding, it’s important to remember that Ebola in the U.S. is largely contained and very unlikely to lead to any kind of significant outbreak. Still, the charges leveled against Frieden raise a question that leads to a surprisingly complicated answer: just what, exactly, can—and should—the CDC do?

Since time immemorial, public health officials’ main weapon against the outbreak of a disease as been to restrict the ability of people to interact with one another, also known as a quarantine. The term comes from the Latin “quadraginta,” meaning 40, and is derived from the 40-day period ships traveling from plague-stricken regions were kept at bay before being allowed to dock in medieval European ports.

Imposing a quarantine—effectively stripping innocent people of the most basic right to move freely in the world—is one of the most serious actions a government can take against its own citizenry. Partly for this reason, in the American federal system (designed from the outset to check the power of the national government) the power to quarantine resides largely with state and local authorities. Should Texas, or any other state, someday face the threat of a true epidemic, the states have broad authority to restrict the movement of people within their own borders. Public health codes granting the state power to impose quarantine orders vary from state to state, of course. Violating a quarantine order in Louisiana is punishable by a fine of up to $100 and up to a year in prison; in Mississippi the same infraction could cost a violator up to $5000 and up to five years in prison.

The federal government does have its own powers. The CDC, as the U.S.’s primary agency for taking action to stop the spread of disease, has broad authority under the Commerce Clause of the Constitution to restrict travel into the country and between states of an infected person or a person who has come in contact with an infected person, according to Laura Donohue, director of the Center on National Security and the Law at Georgetown Law School. Federal quarantine can be imposed, too, on federal property, like a military base or National Forest land. And as the preeminent employer of experts on public health crises, the CDC is always likely to get involved within any affected state in the event of a looming pandemic.

But its power to act is extremely restricted. The agency traditionally acts in an advisory role and can only take control from local authorities under two circumstances: if local authorities invite them to do so or under the authority outlined in the Insurrection Act in the event of a total breakdown of law and order.

And here the picture becomes murkier yet because authority does not always beget power.

“It’s not a massive regulatory agency,” said Wendy Parmet, a professor in public health law at Northeastern University in Boston. “They don’t have ground troops. They don’t have tons of regulators. They’re scientists. Even if the states asked them to do it it’s not clear how they would do it.

Even in the highly unlikely event that the CDC were called to respond to a—let’s reiterate: extremely-unlikely-to-occur—pandemic, quarantine and isolation would be imposed not by bespeckled CDC scientists but by local or federal law enforcement or troops. Most importantly, the CDC is extremely reluctant to be seen as a coercive government agency because it depends as much as any agency on the good will and acquiescence of citizens in order to respond effectively to a public health emergency. When the bright lights of the Ebola crisis are not on it, the CDC will still need people to get vaccinated, to go to the doctor when they get sick, and to call the authorities if they see trouble.

“Our public health system is built on voluntary compliance,” Donohue tells TIME. “If the CDC starts to become the enemy holding a gun to [someone’s] head and keeping them in their house, they lose insight.”

TIME ebola

Nurse Infected With Ebola in Dallas Now Being Treated in Maryland

Texas Nurse Infected With Ebola Transferred To Maryland
The airplane carrying Texas Health Presybterian Hospital nurse and Ebola patient Nina Pham takes off from Love Field airport October 16, 2014 in Dallas, Texas. Chip Somodevilla—Getty Images

Nina Pham now has a staff of 50-60 trained health care workers taking care of her at the National Institutes of Health

Nina Pham, the first person to be infected with Ebola in the U.S., arrived at the National Institutes of Health Special Clinical Studies Unit in Maryland just before midnight Thursday evening, the NIH said Friday.

Dr. Anthony Fauci, director of the NIH’s National Institute of Allergy and Infectious Diseases (NIAID), and Dr. Rick Davey, deputy director of NIAID’s division of clinical research, said Pham was in fair condition and resting comfortably. Davey will be the physician overseeing Pham’s care.

Fauci said that from the time when Liberian Ebola patient Thomas Eric Duncan became the first person diagnosed with the disease in the U.S., “we made very clear that we could make the highly specialized facility available if called upon. We were called upon to accept Nina and we did.”

The seven-bed NIAID unit in Rockville, Maryland was created in 2011 as part of the U.S.’s bio-terror preparedness efforts. It’s designed and equipped to care for patients with the most dangerous infectious diseases. The unit has a dedicated staff of 50 to 60 personnel who are specially trained in infection control for biohazards, and, said Fauci, retained continuously to keep their education up to date. The unit’s isolation unit has a separate ventilation system that directs air into specialized filters, and the unit has a dedicated system for removing patient waste and other biohazardous materials.

The center is not just a hospital, but also a research facility. Every patient treated there is also a research subject, and Pham will be no exception. Dr. H. Clifford Lane, clinical director of NIAID, said that Pham’s virus and her immune system’s response to it will be studied extensively. The researchers at the unit are also part of vaccine studies and are working on ways to intervene earlier in the disease’s course with better treatments. Such treatments may help not just Pham, but also the thousands in West Africa currently battling Ebola.

As far as what therapies Pham will receive, Fauci would only reveal that Pham has so far received, while in Dallas, plasma donated from Dr. Kent Brantly, the first American patient successfully treated for Ebola — Brantly was diagnosed while in Liberia before being flown to the U.S. for treatment. Pham is at all times being cared for by four to five nurses working 12 hour shifts; two of these nurses are allowed into her room at one time, with the remaining nurses serving support duties. One full-time infectious disease doctor and one critical care intensive care physician is also assigned to her care in rotating shifts.

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