TIME society

‘Operation’ Inventor, 77, Can’t Afford Real Life Operation

John Spinello sold the game for only $500

In an ironic twist of fate, the inventor of the famous board game Operation is in need of money to pay for an operation.

In 1964, John Spinello invented the classic children’s game, in which players attempt to perform “surgery” without tripping a buzzer, and sold it to a toy invention firm for just $500. In spite of its great success, that’s the only money he ever received for the game. Now 77, Spinello can’t afford to pay $25,000 for an oral surgery.

“John has had a good life, but has admitted to us that he is struggling to pay his bills and is in need of a medical procedure without sufficient insurance coverage,” his friends Tim Walsh and Peggy Brown wrote in a crowd funding campaign.

Walsh told The Huffington Post that Spinello isn’t bitter about never receiving royalties for a game that has inspired everything from shower curtains to boxers to Simpsons editions of the game, and has generated what he estimates to be $40 million.

“John celebrates the game wherever he can, though his kids do give him a hard time in a good-natured way,” Walsh said.

On top of the crowd-funding campaign, Spinello plans to auction off the original prototype in December to pay the bills.

TIME ebola

Dallas Nurse Who Had Ebola Will Be Released From Hospital

Texas Health Presbyterian Hospital Dallas staff line the drive that exits the emergency room as they wait for an ambulance carrying Nina Pham on Oct. 16, 2014, in Dallas. Amber Vinson, another nurse diagnosed, was taken to a similar location in Atlanta the day prior.
Texas Health Presbyterian Hospital Dallas staff line the drive that exits the emergency room as they wait for an ambulance carrying Nina Pham on Oct. 16, 2014, in Dallas. Amber Vinson, another nurse diagnosed, was taken to a similar location in Atlanta the day prior. Tony Gutierrez—AP

(ATLANTA) — A Dallas nurse who was being treated for Ebola will be released from an Atlanta hospital Tuesday after tests showed she’s virus-free, a hospital spokeswoman said.

Amber Vinson, 29, would be leaving Emory University Hospital following a 1 p.m. news conference to make a statement after tests showed she’s virus-free, Emory spokeswoman Holly Korschun told The Associated Press.

Vinson worked as a nurse at Texas Health Presbyterian Hospital Dallas and cared for Thomas Eric Duncan, a Liberian man who died of Ebola at the hospital on Oct. 8.

Vinson’s family announced Oct. 22 that doctors could no longer detect the deadly virus in her body, a step toward recovery her mother described as an answered prayer.

Vinson was one of two nurses who became infected while caring for Duncan. The other infected nurse, Nina Pham, was released Oct. 24 from a hospital attached to the National Institutes of Health near Washington.

It remains unclear exactly how the nurses became infected.

Vinson attended to Duncan on Sept. 30, the day he tested positive for Ebola, according to medical records that Duncan’s family released to The Associated Press. Like Pham, the reports note that Vinson wore protective gear and a face shield, hazardous materials suit, and protective footwear. At the time, Duncan’s body fluids were highly infectious if someone made contact with them. At one point, Vinson inserted a catheter into Duncan.

TIME ebola

Chris Christie Defends Controversial Ebola Quarantine

"They don't want to admit that we were right and they were wrong"

New Jersey Gov. Chris Christie defended his heavily criticized decision to forcibly quarantine a nurse returning from West Africa for Ebola on Tuesday morning, saying the state’s policy of mandatory quarantining of returning health workers will remain in place.

“I don’t think it’s draconian,” Christie, appearing on the Today show, said of New Jersey’s mandatory 21-day quarantine on health care workers returning from Liberia, Sierra Leone, or Guinea. “The members of the American public believe it is common sense, and we are not moving an inch. Our policy hasn’t changed and our policy will not change.”

Nurse Kaci Hickox was discharged and allowed to go home to Maine Monday after being held in isolation for three days at University Hospital in Newark over protests from the Centers for Disease Control and Prevention (CDC), members of the Obama administration, and her lawyer. “Governors ultimately have the responsibility to protect the public health and public safety,” Christie said, noting that when Hickox tested negative she was sent home.

Christie denied he had acted out of political expediency, arguing that mandatory quarantines are a nonpartisan issue, having been adopted by at least six red and blue states. “I will not submit to any political pressure in doing anything less than I believe is necessary,” he said.

The governor also said the CDC has been too slow to change its policies, and is now “incrementally taking steps to the policy we put in effect in New Jersey.” The CDC announced on Monday new guidelines for people traveling from West Africa, but still recommends voluntary at-home isolation rather than state-mandated quarantines.

“What’s the difference of telling someone who has been a health care worker at high risk that they can’t go in public places, public transportation and we want them to work from home, what’s the difference between that and a quarantine?” he said. “They don’t want to admit that we’re right and they were wrong.”

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

TIME ebola

CDC Issues New Guidelines for Returning Health Workers

Tom Frieden
Dr. Tom Frieden, head of the Centers for Disease Control and Prevention, speaks at a news conference in Atlanta on Oct. 12, 2014 John Amis—AP

Travelers coming to the U.S. from Ebola-affected countries who do not require mandatory quarantines upon arrival will undergo voluntary at-home isolation and could be placed on “do not board” lists, according to new guidelines released by the Centers for Disease Control and Prevention (CDC) on Monday.

The CDC’s new guidelines break down travelers’ risk level into categories: high risk, some risk, low risk and no risk.

People who fall into the high-risk category are those who had direct contact with Ebola patients in West Africa, and who may be at a high risk for infection. For instance, they handled bodily fluids without protection. Those individuals will be asked to isolate themselves in their homes for 21 days. They would be allowed to leave and go out on a jog, for example, but they would not be allowed to take public transportation or go to places with high volumes of people or “congregate gatherings.” They will undergo active monitoring.

People who fall under the “some risk” category would have their temperatures checked twice a day, and their travel and public activities will be assessed on a case-by-case basis. This distinction might apply to a health care worker who did not have direct contact with patients, or who had direct contact but used personal protective equipment fastidiously.

These guidelines are a marked departure from the sweeping quarantine mandate that Florida, Illinois, New Jersey and New York implemented over the last week, stirring up controversy after a recently returned nurse who tested negative for the virus protested her forcible detainment in New Jersey.

When asked why CDC recommendations differ from some states, CDC director Dr. Tom Frieden said, “We find that state health departments generally do follow CDC guidelines.” He added that if states wish to be more stringent, they’re within their rights to do so.

Frieden said fewer than 100 people a day are coming into the U.S. from the Ebola-affected countries. So far there have been 807 people, and of those, 46 are health care workers. The CDC has already instituted daily monitoring for travelers coming in from the Ebola-affected countries. Every traveler is given a kit to take their temperatures and must provide local health care officials with contact information to get in touch with them.

“We base our decisions on science and experience,” said Frieden. “As the science and experience changes, we adapt.” Frieden also acknowledged the active monitoring approach that Doctors Without Borders has urged its physicians to follow. Dr. Craig Spencer is the first Doctors Without Borders worker to be diagnosed with the disease in the U.S., but was immediately quarantined after he reported the first sign of an infection (a lower-grade fever). “This is the kind of approach that they will be effective,” said Frieden.

During the press conference, Frieden cited a 1995 study conducted in what is now the Democratic Republic of the Congo that looked at the Ebola infection risk of 173 people living within a household of someone with Ebola. The study showed that only 28 (16%) of the 173 contacts of 27 primary Ebola cases developed Ebola, and those who did develop Ebola had direct contact with a known patient. None of the 78 family members who did not have direct contact later became infected, stressing that Ebola needs very direct contact to spread.

“We will only get to zero risk by stopping it at the source,” said Frieden.

On Monday, New Jersey Governor Chris Christie said health care worker Kaci Hickox was released after being put in a mandatory quarantine despite not having any symptoms for the disease.

TIME ebola

5-Year-Old Tests Negative for Ebola in NYC

The child is being held at the same hospital as Doctors Without Borders physician Dr. Craig Spencer

A five-year-old boy put in isolation at Bellevue Hospital in New York City Monday has tested negative for Ebola.

The child was taken to the hospital by specialists in personal protective equipment on Sunday evening to undergo monitoring for Ebola, and did not have a fever at that time. On Monday morning, the child developed a fever and the city decided to conduct a test for Ebola. The children had been in one of the three Ebola-affected countries within the last 21 days.

“Out of an abundance of caution, further negative Ebola tests are required on subsequent days to ensure that the patient is cleared,” the New York City health department said in a statement. “The patient will also be tested for common respiratory viruses. The patient will remain in isolation until all test results have returned.”

The child is being held at the same hospital as Doctors Without Borders physician Dr. Craig Spencer.

TIME ebola

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

Doctors Without Borders (Medecins Sans Frontieres) and other major medical groups voice opposition to mandatory quarantines imposed by New York and New Jersey on health workers returning from the Ebola epidemic

Doctors Without Borders, also known as MSF for Medecins Sans Frontieres, joined a growing number of professional medical groups that are critical of the mandatory quarantines both New York and New Jersey put into place on Oct. 24. Those orders required any returning health care workers who have had contact with Ebola-infected patients in west Africa into a mandatory quarantine for 21 days. The first nurse held under the new rule, Kaci Hickox, was brought to an isolation tent at Newark University Hospital, and held there for two and a half days despite having no symptoms of the disease.

In MSF’s first statement about the quarantine rules, the group says the forced quarantine, regardless of whether the health workers are have symptoms, “is not grounded on scientific evidence and could undermine efforts to curb the epidemic at its source.”

The group already has strict policies for its returning staff, which includes self-monitoring for 21 days for fever, one of the earliest signs of infection with Ebola. “We need to be guided by science and not political agendas,” said Dr. Joanne Liu, international president of MSF. “The best way to reduce the risk of Ebola spreading outside West Africa is to fight it there. Policies that undermine this course of action, or deter skilled personnel from offering their help, are short sighted. We need to look beyond our own borders to stem this epidemic.”

Liu says that the quarantine policy has already caused some volunteers to reduce their tours in the hardest hit countries of Guinea, Liberia and Sierra Leone. And because the humanitarian aid organization relies on health professionals to volunteer their time to curbing the epidemic, such disincentives could lead to fewer people willing to take the time and effort that are critically needed to curb the outbreak. Currently, MSF has 270 international staff members in the three Ebola-stricken countries, and oversees an additional 3000 local staff members.

The group’s criticism of the stricter quarantine rules are echoed by others in the medical community and even the White House; an official told the Wall Street Journal “We have let the governors of New York, New Jersey and other states know that we have concerns with the unintended consequences… [that quarantine] policies not grounded in science may have on efforts to combat Ebola at its source.”

Here’s what other health groups are saying about the quarantines:

Dr. Robert Wah, president of the American Medical Association (AMA):

“It is critical that we respect and support U.S. health professionals who are volunteering to help bring this epidemic under control in West Africa. The AMA’s Code of Medical Ethics emphasizes that decisions related to quarantine or isolation be based on scientifically sound information. In the case of Ebola infection, relevant scientific evidence indicates that the virus is spread only through contact with the body fluids of symptomatic individuals.”

The Infectious Diseases Society of America:

“IDSA does not support mandatory involuntary quarantine of asymptomatic healthcare workers returning from Ebola-affected areas. This approach carries unintended negative consequences without significant additional benefits.”

Association for Professionals in Infection Control and Epidemiology:

“While we understand public concerns, APIC does not support mandatory quarantine of healthcare providers with no symptoms of Ebola who have treated patients with EVD.

APIC believes that quarantining healthcare professionals returning from caring for Ebola patients in West Africa will deter potential healthcare volunteers and lead to increased difficulty in assembling care teams in West Africa and the U.S. Forced quarantines of healthcare workers with no symptoms of Ebola who have risked their lives to protect others, are unnecessarily harsh and are not aligned with scientific evidence. Quarantines may affect the healthcare worker’s ability to make a living and may also have negative emotional and social consequences as a result of being stigmatized for their service.”

AIDS activists, doctors and researchers in a letter to Governor Andrew Cuomo:

“[The quarantines are] not supported by scientific evidence” and “may have consequences that are the antithesis of effective public health policy.”

On Monday, New Jersey Governor Chris Christie released Hickox from quarantine.

TIME Cancer

Hospitals Furious at Cancer-Drug Price Hikes

Some of the nation’s hospitals are seriously ticked off at Genentech, the San Francisco biotech firm, for implementing a stealth price hike for three critical cancer drugs. On September 16, Genentech told hospitals and oncology clinics that as of October 1, they can only buy Avastin, Herceptin and Rituxan—three of the biggest weapons in the cancer arsenal—through specialty distributors instead of general line wholesalers they’ve been using for years.

The shift means hospitals will lose out on standard industry discounts—which Genentech and its distributors will then pocket. “Our blunt estimate: It will cost $300 million more in the U.S. overnight in what folks are paying for these lifesaving drugs,” says Pete Allen, group senior vice president, sourcing operations, for Novation, a health care services company that negotiates drug contracts. Novation estimates the hospitals it represents will take a $50 million hit—and that’s before the costs of additional inventory, handling and paperwork the hospitals might also incur.

Sales of Avastin, used to treat colorectal, ovarian and other cancers, hit $6.6 billion last year. Sales in what the company calls its HER2 breast cancer franchise—Herceptin, Perjeta and Kadcyla— rose 14% to nearly $7 billion.

“As a result of the decision to change its distribution system, Genentech’s use of specialty distributors is resulting in unprecedented price hikes, the results of which will harm the patients we serve,” said Dr. Roy Guharoy, chief pharmacy officer at Ascension Healthcare, a Catholic, nonprofit health system with some 1,500 locations, in a statement.

Genentech—owned by Roche, which had $50 billion in sales last year—says the switch to specialty wholesalers will improve the efficiency and security of the supply chain. The company says its newer cancer drugs, such as Perjeta, Kadcyla and Gazyva, are already supplied this way, which allowed it to reduce the number of distribution centers from 80 to five. “We do believe this is the best distribution model for these medicines,” said Charlotte Arnold, the company’s associate director of corporate relations. “We understand that there maybe a business impact on hospitals.” The company wouldn’t explain the specifics of why the specialty model is better.

Hospitals aren’t buying the company’s rationale. “I haven’t talked to anyone who thought this was a safer way to distribute these drugs,” says Bill Woodward, senior director of contracting at Novation. “There is nothing about these drugs that would make them safer to be in the specialty channel.” Most of the major wholesalers, in fact, already have specialty distribution arms although one general firm, Morris & Dickson, had to create a specialty arm to remain a Genentech distributor. It’s a difference without a distinction, say the hospitals, except that Genentech earns more money.

The financial cost to the hospitals comes first through the loss of rebates from the big wholesalers. But more importantly, hospitals also lose to ability to negotiate what are called cost-minus discounts with their wholesalers that, depending on the cost of a drug, amounts to a 2%-to–5% price reduction. The cost of this “back-end” funding had been borne by Genentech; now the hospitals will have eat it.

Ascension says it is already seeing significant net price hikes. A 400 mg dose of Avastin jumped from $2,382.28 on October 12 to $2,511.36 on October 14, a nearly 8% increase. Similarly, a 500mg dose of Herceptin rose to $3,878.89 from $3,586.52. Even worse for the hospitals, they can’t pass this increase on to insurance companies—since the list price remained the same, as far as insurers are concerned there’s been no increase.

Ascension has flatly alleged that Genentech is reclassifying Avastin, Herceptin and Rituxan as “specialty” drugs to enhance profits moreso than improve the supply chain. Specialty drugs usually fall under the FDA’s Risk Evaluation and Mitigation Strategy (REMS) program, established for compounds like the testosterone drug AndroGel that may have unusual side effects; or for drugs that are unusually expensive. According to Ascension, in 1990 only 10 specialty drugs existed. By 2012 that number jumped to nearly 300 compounds. “The end result is large price hikes unaccounted for in our 2015 budgets, and it will mean that already scarce resources will need to be stretched,” says Guharoy.

The hospitals are already being forced to deal with rising prices for all kinds of drugs. According to Ascension, its drug costs have risen $36 million in the past year. With 2015 pharmacy budgets already set, Genentech’s new distribution model threatens to bust hospital budgets before the year has even started.

Genentech tried a similar switch in 2006, but outraged customers forced the company to rescind the program. This time Genentech seems like it’s digging in. “We understand there may be some adjustments,” said Arnold of Genentech’s testy customers, noting that the company was “working to educate them” about the benefits of the new system.

Judging from the bile level, that could take awhile.

TIME ebola

Why Christie’s Ebola Quarantine Gambit Backfired

His attempt to force a nurse to stay under a 21-day quarantine didn't work out as expected

It’s never a wise move to pick a fight without knowing your opponent. When Chris Christie ordered a mandatory quarantine for health-care workers returning from West Africa, he might have thought his foil was a lethal virus or an unpopular president or some feckless federal bureaucrats who failed to keep Ebola from arriving in the U.S. Instead the New Jersey Republican found himself battling a brave nurse, who captivated the country as she skewered the policy from behind the plastic screen of an isolation tent in a Newark hospital.

Kaci Hickox won the fight. By Monday morning, she was on her way to a cozier confinement at home in Maine. And Christie was scrambling to explain why he had penned her up against the advice of medical experts, who said she posed no threat, and the wishes of Obama administration officials, who argue a forced 21-day quarantine could deter the nurses and doctors who are desperately needed to stamp out the outbreak in West Africa.

Christie’s decision capped a head-snapping weekend of walk backs from the New Jersey governor and New York Democrat Andrew Cuomo, his counterpart from across the Hudson River. On Friday night, the bipartisan pair held a hastily planned press conference to decry federal safety guidelines as insufficient and order high-risk travelers to submit to mandatory quarantine.

Now both governors have flipped, or at least softened a stance whose goal in the first place was to project toughness. Christie’s move to send Hickox home on Monday came mere hours after Cuomo’s own change of heart, announced at a strange Sunday night news conference in which the governor and New York City Mayor Bill De Blasio referred to each other as “doctor” with barely veiled passive-aggression.

Left to scrambling to explain the decision, Christie denied it was a reversal at all. He said Hickox was kept in the sad tent with the portable toilet and no shower simply because she had no residence in the state. “Our preference always is to have people quarantined in their homes,” he explained Monday morning, “but you can’t take chances on this stuff and allow people who may, in fact, be contagious to be able to travel.”

The shift may have been more tonal than substantive. But it seemed like Christie and Cuomo had let politics trump policy, only to find the politics of the quarantine weren’t great after all. What’s more, the shift followed pressure from the Obama Administration, which warned the governors over the weekend of its “concern with the unintended consequences of policies not grounded in science,” according to a senior administration official. Hours earlier, Christie had slammed the Centers for Disease Control and Prevention (CDC), calling its safety protocols for Ebola “a moving target.” Now he is letting doctors and federal officials determine that Hickox, who threatened to sue over the forced confinement, can be sent home.

The episode illustrated the unpredictable risks of playing politics with a lethal virus. In a campaign season that has been more fear than hope, Ebola becme the boss villain in the parade of horribles—from the rise of the Islamic State to the rocky economy to the “war on women.” Politicians from both parties have pandered to the anxieties of the electorate, jockeying to position themselves as tough leaders capable of keeping voters safe in the absence of presidential leadership.

The impulse must be particularly tempting when you face a referendum on leadership yourself. Cuomo, who is thought to harbor national ambitions, first faces a re-election test on Nov. 4. So does Illinois Gov. Pat Quinn, another Democrat fighting for re-election who followed suit by imposing his own quarantine policy.

For Christie, the panic wrought by the lethal virus may have seemed a prime opportunity to run his favorite play: the one where the tough leader takes a common-sense stand in the face of federal dithering. This is the move that drew bipartisan plaudits after Hurricane Sandy ravaged the Jersey shore in 2012, and one Christie may hope will propel a possible presidential candidacy in 2016. The play has worked swimmingly when run against teachers’ unions, or bungling bureaucrats, or “idiots” loitering on a stretch of beach in the face of an oncoming storm.

It doesn’t wear as well when the target is a nurse who risked her life to fight a deadly disease.

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

TIME Diet/Nutrition

The Rise of Celiac Disease Still Stumps Scientists

What You Need to Know About Gluten
Soren Hald—Getty Images

This is your gut on gluten

Two new studies in the New England Journal of Medicine rocked the world of celiac research, both proving that scientists have a ways to go in their understanding of celiac disease, which affects about 1% of the population, whether they know it or not.

One Italian study wondered if the age at which gluten is introduced into the diet could affect a person’s likelihood of developing the autoimmune disease—so they kept gluten away from newborns for a year. To the shock of the researchers, delaying exposure to gluten didn’t make a difference in the long run. In some cases it delayed the onset of the disease, but it didn’t stop people from developing the disease, for which there is no cure.

The second study, of almost 1,000 children, introduced small amounts of gluten into the diets of breastfeeding infants to see if that fostered a gluten tolerance later on in those who were genetically predisposed to celiac disease. No such luck for them, either. Though both studies were excellently designed and executed, says Joseph A. Murray, MD, professor of medicine and gastroenterologist at the Mayo Clinic in Rochester, each was “a spectacular failure.”

What is it about gluten that causes so many people to double over in pain? How could the innocent, ancient act of breaking bread be so problematic for some?

It’s a question researchers are actively trying to answer. “I think of celiac disease now as a public health issue,” Murray says. He’s been researching the bread protein for more than 20 years and has seen the incidence of celiac disease rise dramatically; celiac is more than four times as common as it was 50 years ago, according to his research, which was published in the journal Gastroenterology. Even though awareness and testing methods have dramatically improved, they can’t alone account for all of that increase, he says.

About 1% of Americans have celiac disease, and it’s especially common among Caucasians. There’s a strong genetic component, but it’s still unclear why some people get it and other people don’t. It seems to affect people of all ages, even if they’ve eaten wheat for decades. And you can’t blame an increased consumption of the stuff; USDA data shows we’re not eating more of it.

Something else in the environment must be culpable, and theories abound about possible factors, from Cesarean sections to the overuse of antibiotics and the hygiene hypothesis, which suggests that as our environment has become cleaner, our immune system has less to do and so turns on itself—and maybe particular foods like gluten—as a distraction.

Or maybe there’s something different about gluten itself. The wheat seed hasn’t changed all that much, but the way we process and prepare gluten products has, Murray says. “There have been some small studies looking at old forms of bread-making…that have suggested it’s not as immunogenic, it doesn’t drive the immune response as strongly as more modern grain or bread preparations,” Murray says.

A small 2007 study found that sourdough bread, when fermented with bacteria, nearly eliminates gluten—but we need much more research before the truly allergic should be reaching for a slice of the stuff.

Dr. Alessio Fasano, MD, director of the Center for Celiac Research and chief of the division of pediatric gastroenterology and nutrition at Mass General Hospital for Children, was a co-author of that recent study about breast-feeding and timing of gluten introduction. He says he found the “major, unpredictable results shocking. The lesson learned from these studies is that there is something other than gluten in the environment that can eventually tilt these people from tolerant to the immune response in gluten to developing celiac disease,” he says.

He suspects it may come down to how the modern, hyper-processed diet has influenced the makeup of our gut bacteria. “These bacteria eat whatever we eat,” Fasano says. “We’ve been radically changing our lifestyle, particularly the way that we eat, too fast for our genes to adapt.” Fasano hopes to explore the microbiome in his next study, in which he says he’ll follow kids from birth and search for a signature in their microbiome that predicts the activation of their gluten-averse genes, which leads to a child developing celiac disease. The hope, then, is that a probiotic or prebiotic intervention will bring the troubled guts back from “belligerent to friendly.”

“That would be the holy grail of preventive medicine,” he says.

Read next: ‘Gluten Free’ Label Now Actually Means Gluten Free

TIME ebola

U.S. Soldiers Returning From Liberia Isolated for Ebola Observation

A health worker takes the temperature of U.S. Marines arriving to take part in Operation United Assistance on Oct. 9, 2014 near Monrovia, Liberia.
A health worker takes the temperature of U.S. Marines arriving to take part in Operation United Assistance on Oct. 9, 2014 near Monrovia, Liberia. John Moore—Getty Images

A small group is isolated and being monitored in Vicenza, Italy

American soldiers who returned from Liberia are being isolated in Italy over worries about spreading the Ebola virus, it emerged Monday.

A small group of U.S. soldiers are currently isolated and being monitored in Vicenza, Italy, the Pentagon confirmed. The group reportedly includes Maj. Gen. Darryl Williams, who was commanding the Army in Africa but recently turned over his duties to the 101st Airborne Division. Officials said the troops would be subject to “controlled monitoring” for 21 days, but that it was not a “quarantine.”

The soldiers were apparently met by Italian national police officers in hazmat suits, according to CBS News, which first reported the measures. A 25-bed hospital being built by the U.S. in the capital, Monrovia, is expected to be fully operational in early November.

“The Department of Defense (DoD) continues to address the precise nature of the monitoring that will take place for DoD personnel returning from operation United Assistance,” the Pentagon said in a statement. “Out of an abundance of caution, the Army directed a small number of military personnel (about a dozen) that recently returned to Italy to be monitored in a separate location, at their home station (Vincenza). There has been no decision to implement this force wide and any such decision would be made by the Secretary of Defense.”

The Pentagon says none of the individuals have shown any symptoms of exposure.

The cautionary measures, which could yet extend to the hundreds more troops who are aiding the fight against the virus, come as a number of countries sort out the best practices for monitoring health care workers returning from Guinea, Sierra Leone or Liberia. The three hardest-hit countries of the Ebola outbreak have seen about 10,100 people sickened, including more than 4,900 deaths, according to the World Health Organization.

In recent days, New York and New Jersey have implemented some form of a mandatory 21-day quarantine for returning medical professionals, going back and forth on the severity, following New York City’s first case of Ebola in a health worker who returned from Guinea.

New Jersey Gov. Chris Christie announced Monday that nurse Kaci Hickox, who was confined to a tent at a New Jersey hospital despite not having symptoms and a negative test for the virus, would be allowed to finish out her isolation at home in Maine. Christie has been heavily criticized for the nurse’s treatment.

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