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Advocates Urge Governor Cuomo to Withdraw Mandatory Quarantine Order

Download a PDF of this letter here.

October 26, 2014

The Honorable Andrew Cuomo
Governor of New York
Albany, New York

Dear Governor Cuomo:

We write as professionals, activists, and public health researchers who have worked to combat AIDS and other infectious diseases in New York and around the world for over three decades.  We have not forgotten how HIV/AIDS was at first largely ignored while it appeared to affect only marginalized communities or the stigma generated once fear of the virus took hold in the larger population.  We have watched with growing concern as Ebola virus disease (EVD) was ignored far too long while confined to some of the poorest countries in the world, and how it has now led to hysteria here in the United States, based on only a very small number of cases. As you know, stigma remains our biggest enemy in fighting AIDS and could quickly become the biggest barrier in combatting EVD.  Therefore, we implore you to withdraw the mandatory quarantine requirement for all people entering the United States through Newark Liberty International Airport and John F. Kennedy International Airport who have had direct contact with individuals with EVD in Guinea, Liberia, and Sierra Leone.

This aspect of the procedural plan being put into place to minimize the risk of outbreaks of EVD in the New York metropolitan area is not supported by scientific evidence and will potentially have a profound effect on efforts to recruit U.S.-based health care professionals who are desperately needed to help combat the burgeoning EVD epidemic in West Africa while increasing stigma toward persons who come from those countries. There is no evidence that indicates quarantines are superior to active monitoring for symptoms with respect to preventing transmission of EVD. We urge New Jersey and New York to instead require that all health care workers and others with potential exposure to EVD returning to the U.S. through Port Authority international airports engage in CDC-recommended active monitoring for signs and symptoms of EVD and that they remain in close proximity to a hospital with isolation facilities.

Port Authority-mandated quarantines for all arriving passengers who have had direct contact with individuals with EVD may have consequences that are the antithesis of effective public health policy. Should the New York metropolitan area be the destination of individuals who have contact with people with EVD in West Africa, but they instead travel through multiple hubs (thereby significantly extending their transit time) or deny potential exposure to circumvent these mandatory entry requirements, we will have undermined the most important evidence-based components of breaking EVD transmission chains: prompt diagnosis, isolation of those with bona fide symptoms and clear instructions for those with possible exposure to Ebola. Unnecessary quarantines will also lead to stigma and discrimination directed toward people of West African origin, regardless of their exposure to Ebola.

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

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

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

Respectfully submitted,

ACT UP/NY

Adaora Adimora, MD, MPH, Chair, HIV Medicine Association

AIDS Treatment Activists Coalition

American Run to End AIDS, New York

Jeton Ademaj, ACT UP NY

Frederick L. Altice, MD, MA, Professor of Medicine, Epidemiology, and Public Health; Director of Clinical and Community Research, Yale University School of Medicine
and School of Public Health

Wendy Armstrong, Vice Chair, HIV Medicine Association

Ramin Asgary, MD, MPH, Assistant Professor, Department of Population Health, New York University School of Medicine

Benjamin Bashein, Executive Director, ACRIA

Chris Beyrer, MD, MPH, President, The International AIDS Society; Professor, Johns Hopkins Bloomberg School of Public Health

Bernadette Boden-Albala, MPH, DrPH, Associate Dean of Program Development; Director, Division of Social Epidemiology; Professor of Public Health, Neurology and Dentistry, Global Institute of Public Health, New York University

Elizabeth H. Bradley, Professor of Public Health and Director of Yale Global Health Initiative

Karen F. Brudney, MD, Assistant Professor of Medicine, Columbia University College of Physicians and Surgeons

Anthony P. Cannella, MD, MSc, Assistant Professor of Medicine, Division of Infectious Diseases and Global Medicine, Department of Medicine, University of Florida College of Medicine

Arthur L. Caplan, PhD, Drs. William F. and Virginia Connolly Mitty Professor of Bioethics; Director Division of Medical Ethics, Department of Population Health (Med Ethics), New York University School of Medicine

Rea Carey, Executive Director, National LGBTQ Task Force

Guillermo Chacon, President, Latino Commission on AIDS 

Eric Cioe, MD Columbia University International Emergency Medicine Fellow; Instructor of Medicine & Attending Physician, New York-Presbyterian Hospital 

Paul D. Cleary, PhD, Anna M. R. Lauder Professor of Public Health (Health Policy); Dean, Yale School of Public Health; Director, Center for Interdisciplinary Research on AIDS (CIRA)

Rachel M. Cohen, AIDS & Global Health Activist

Ted Cohen, MD, MPH, DPH, Associate Professor of Epidemiology (Microbial Diseases), Yale School of Public Health

Jim Curran, MD, MPH, Director and PI of Emory Center for AIDS Research

Julie Davids, AIDS Activist

Dr. Sheila Davis, Chief Nursing Officer, Chief Ebola Response, Partners In Health

Patrick Dawson, MPH, Columbia University Department of Epidemiology

Haile T. Debas, MD, Director of the University of California Global Health Institute; Distinguished Professor of Surgery, Emeritus

Carlos del Rio, MD, Chair-Elect, HIV Medicine Association

Hans N. Desnoyers, Director of Operations, Diaspora Community Services

Erin Drinkwater, Executive Director, Brooklyn Community Pride Center

Wafaa El-Sadr, MD, MPH, Director, International Center for AIDS Programs (ICAP)

End AIDS Now, New York

Joel D. Ernst, MD, Professor of Medicine, Pathology, and Microbiology; Acting Director, Division of Infectious Diseases and Immunology, New York University School of Medicine

Paul Farmer, MD, Kolokotrones University Professor, Harvard University; Co-Founder, Partners in Health

Sally Findley, Professor of Population and Family Health, Mailman School of Public Health, Columbia University

Jennifer Flynn,  Executive Director, VOCAL-NY

Gerald Friedland, MD, Yale School of Medicine

Eric A. Friedman, JD, O’Neill Institute for National and Global Heath Law, Georgetown University Law Center

Gregg J. Fromell, MD, Vice President, Science Operations, NYU Langone Medical Center

Kevin Frost, CEO, amfAR

Robert E. Fullilove, EdD, Cities Research Group, Columbia University

Jennifer Furin, MD, PhD, Assistant Professor of Medicine, Case Western Reserve University

Joel Gallant, MD, MPH, Immediate Past Chair, HIV Medicine Association

Tracie M. Gardner, Co-Director of Policy, Legal Action Center

Laurie Garrett, Senior Fellow for Global Health, Council on Foreign Relations

Annette Gaudino, ACT UP NY & ACT UP NY Women's Caucus

Shelley Geballe, JD, MPH, Lecturer, Yale School of Public Health, Visiting Clinical Lecturer, Yale Law School

Toorjo Ghose, Associate Professor, School of Social Policy & Practice, University of Pennsylvania

GNP+ NA (The Global Network of People Living with HIV, North America)

Lewis Goldfrank, Chairman of Emergency Medicine, New York University and Bellevue Hospital Center

Gregg Gonsalves, Global Health Justice Partnership, Yale Law School-Yale School of Public Health

Lawrence O. Gostin, University Professor, Founding O'Neill Chair in Global Health Law, Georgetown Law; Faculty Director, O'Neill Institute for National and Global Health Law; Director, World Health Organization Collaborating Center on Public Health Law & Human Rights

Karen Grepin, Assistant Professor of Global Health Policy, New York University

Sally Guttmacher, PhD, Professor of Public Health, New York University

Mark Harrington, Executive Director, Treatment Action Group 

Tim Horn, HIV Project Director, Treatment Action Group 

Sanjat Kanjilal, MD, Infectious Disease Fellow, Massachusetts General Hospital

William B. Karesh, DVM, Exec. Vice President, EcoHealth Alliance

Salmaan Keshavjee, MD, PhD, ScM, Director, Program In Infectious Disease and Social Change, Department of Global Health and Social Medicine, Harvard Medical School

Gerald T. Keusch, MD, Professor of Medicine and International Health, Associate Director, National Emerging Infectious Diseases Laboratory, Boston University

Kaveh Khoshnood, PhD, Associate Professor, Yale School of Public Health

Jacqui Kilmer, COO, Harlem United

Charles King, Chief Executive Officer, Housing Works, Inc. 

Michael Kinzer, MD, MPH

Albert Icksang Ko, MD, Professor of Epidemiology (Microbial Diseases) and of Medicine (Infectious Diseases); Department Chair—Epidemiology of Microbial Diseases, Yale School of Public Health

Thomas Krever, Chief Executive Officer, Hetrick-Martin Institute 

Ann Kurth, PhD, CNM, MPH, Associate Dean for Research, NYU Global Institute of Public Health

Tim Lahey, MD MMSc, Associate Professor, Infectious Diseases & International Health, Geisel School of Medicine at Dartmouth, Dartmouth-Hitchcock Medical Center

Jay Laudato, Executive Director, Callen-Lorde Community Health Center

Philip Lederer, MD, Infectious Disease Fellow, Massachusetts General Hospital

Jeffrey Levi, PhD, Executive Director, Trust for America's Health

Kelsey Louie, CEO, GMHC

Amanda Lugg, Director of Advocacy, African Services Committee

Hon. Keith Martin, MD, PC, Executive Director, Consortium of Universities for Global Health

Robert McNamara, Managing Director, Friends In Deed

Peter Meacher, MD, Chief Medical Officer, Callen-Lorde Community Health Center

Suerie Moon, MPA, PhD, Research Director and Co-Chair, Forum on Global Governance for Health, Harvard Global Health Institute, and Lecturer, Department of Global Health and Population, Harvard School of Public Health

David Mushatt, MD, Chief, Infectious Diseases Section, Tulane University

Nancy Neveloff Dubler, LL.B, Adjunct Professor, NYU Langone Medical Center

Gbenga Ogedegbe, MD, MPH, Vice Dean & Chief Medical Officer, Global Institute of Public Health, New York University

Cynthia O’Neal, President, Friends In Deed

David Paltiel, PhD, Professor, Yale School of Public Health Yale School of Management

Melinda Mary Pettigrew, PhD, Associate Professor of Epidemiology (Microbial Diseases); Associate Dean for Academic Affairs, Yale School of Public Health

Jonathan Platt, MPH, Columbia University Mailman School of Public Health

J. L. Pottenger, Jr., Nathan Baker Clinical Professor of Law, Yale Law School

Gina Quattrochi, Esq., CEO, Bailey House

Miriam Rabkin, MD, MPH, Associate Professor Medicine and Epidemiology, Columbia University Mailman School of Public Health

Asghar Rastegar, MD, Professor of Medicine; Director, Office of Global Health, Yale University School of Medicine

Robert H. Remien, PhD, Clinical Psychologist (New York, NY)

Elena Rios, MD, MSPH, President & CEO, National Hispanic Medical Association

Joyce Rivera, Founder & Executive Director, St. Ann's Corner of Harm Reduction

Maria Said, Physician, Board Certified Internal Medicine and Infectious Diseases

Nathan Schaefer, Executive Director, Empire State Pride Agenda

Carl Siciliano, Executive Director, Ali Forney Center

Virginia Shubert, J.D., Shubert Botein Policy Associates

Michael Silverman, Executive Director, Transgender Legal Defense & Education Fund

Prabhjot Singh, MD, PhD, Director of Systems Design, Earth Institute; Assistant Professor of International & Pubic Affairs, Columbia University

Barbara Smith, PhD, RN, FACSM, FAAN, Associate Dean for Research, Michigan State University

Kimberleigh Smith, VP, Policy & Advocacy, Harlem United

Samara Soghoian, MD, MA, Assistant Professor of Emergency Medicine, New York University School of Medicine

Andrew Spieldenner, PhD, Assistant Professor, Hofstra University 

Peter Staley, AIDS Activist 

Sharon Stapel, Executive Director, New York City Anti-Violence Project

Rev. Moonhawk River Stone, MS, LMHC, RiverStone Consulting

Sean Strub, Executive Director, Sero Project

Dan Suarez, RN, MA, President, National Association of Hispanic Nurses (NAHN)

Glennda Testone, Executive Director, The NYC Lesbian, Gay, Bisexual and Transgender Community Center

Melanie Thompson, MD, AIDS Research Consortium of Atlanta, HIVMA Board of Directors

David Tiersten, MD, FCAP, Past President, New York State Society of Pathologists

Francesca Torriani, MD, FIDSA, Professor of Medicine and Director of UCSD Infection Prevention and Clinical Epidemiology and TB Units, Division of Infectious Diseases, Department of Medicine, UC San Diego

United States People Living With HIV Caucus

Tom Viola, Executive Director, BROADWAY CARES/EQUITY FIGHTS AIDS

Terri Wilder, AIDS Activist

Suzanne Willard, PHD, APN, FAAN

Brian Yablon, MD, Internal Medicine/Pediatric Physician, Anchorage, AK

 

cc:

Tom Frieden, CDC Director

Ron Klain, Ebola Response Coordinator, Executive Office of the President

Sylvia Burwell, United States Secretary of Health and Human Services

Douglas Brooks, Director of the Office of National AIDS Policy

Cecilia Munoz, Assistant to the President for Domestic Policy

Lisa Monaco, Assistant to the President for Homeland Security and Counterterrorism