Cuomo and Christie Order Strict Ebola Quarantines

The governors of New York and New Jersey on Friday ordered quarantines for all people entering the country through two area airports if they had direct contact with Ebola patients in Guinea, Liberia and Sierra Leone.

The announcement signaled an immediate shift in mood, since public officials had gone to great lengths to ease public anxiety after a New York City doctor received a diagnosis of Ebola on Thursday.

A few hours later, New Jersey health officials said a nurse who had recently worked with Ebola patients in Africa and landed in Newark on Friday had developed a fever and was being placed in isolation at a hospital. The nurse, who was not identified, had been quarantined earlier in the day under the new policy, even before she had symptoms. Officials did not know Friday night whether or not she had the virus.The new measures go beyond what federal guidelines require and what infectious disease experts recommend. They were also taken without consulting the city’s health department, according to a senior city official.

But both governors, Andrew M. Cuomo of New York and Chris Christie of New Jersey, portrayed them as a necessary step. “A voluntary Ebola quarantine is not enough,” Mr. Cuomo said. “This is too serious a public health situation.”

In New York City, disease investigators continued their search for anyone who had come into contact with the city’s first Ebola patient, Dr. Craig Spencer, since Tuesday morning. Three people who had contact with Dr. Spencer, 33, have been quarantined, and investigators have compiled a detailed accounting of his movements in the days before he was placed in isolation at Bellevue Hospital Center on Thursday.

He remained in stable condition on Friday, and doctors were discussing the use of various experimental treatments. He was able to talk on his cellphone and was even well enough to do yoga in his room, according to friends.

The new protocols at the airports, outlined by the governors in an afternoon news conference, raised a host of questions, including how the screening process would work and whom it would target. The two airports in question are Kennedy International and Newark.

Officials from New York and New Jersey said they were still working out many details, including where people would be quarantined, how the quarantine would be enforced and how they would handle travelers who do not live in either of those states.

The mandatory quarantine for nonsymptomatic travelers will last 21 days, the longest documented period it has taken for an infected person to show symptoms of the disease.

On Friday, the White House sidestepped questions about whether a nationwide quarantine of returning health care workers was being considered. Instead, officials defended the procedures the administration has put in place, including enhanced airport screenings and the monitoring of people arriving from Ebola-afflicted countries.There was immediate concern that the move by New York and New Jersey might have an adverse effect on getting workers to West Africa, where more than 4,500 people have died of the virus and medical workers are in short supply.

The United Nations emergency Ebola mission says that 19,000 doctors, nurses and paramedics are needed by Dec. 1 and that it is nowhere near that number.

“We will not hesitate to take any action that we feel has the potential to fortify us against additional imported Ebola cases,” a senior Obama administration official said. “At the same time, we must do so in a manner that is coordinated and that minimizes any unintended consequences, including those that would hinder our ability to eliminate this threat at its source in West Africa.”

Mr. Christie, a Republican, said he and Mr. Cuomo, a Democrat, had decided to take action because the federal guidelines were not strict enough. “We are no longer relying on C.D.C. standards,” he said, referring to the federal Centers for Disease Control and Prevention.

The C.D.C., in a terse statement, said that it would make its decisions based on the best available science but that the states were within their legal rights to institute the measures.

In New York City, health officials said that initial reports were incorrect when they indicated that Dr. Spencer had a 103-degree fever when he notified the authorities of his ill health. He actually had only a 100.3 fever. Officials attributed the mistake to a transcription error and said the lower temperature made it highly unlikely that he could have spread the disease before going to the hospital. Still, out of caution, they were tracing his contacts back to Tuesday, the day he began feeling fatigued. Dr. Spencer had been working with Doctors Without Borders in Guinea, treating Ebola patients, before leaving Africa on Oct. 14 and returning to New York on Oct. 17.

Since March, three international staff members and 21 locally employed staff members of Doctors Without Borders have fallen ill while battling the Ebola outbreak in Guinea, Liberia or Sierra Leone, according to the group. Thirteen have died.

As a hazardous material team arrived at Dr. Spencer’s apartment in Harlem to sanitize the residence, public officials took to the airwaves seeking to reassure wary residents that the risk to the general public was exceedingly small.

“New Yorkers who have not been exposed to an infected person’s bodily fluids are simply not at risk,” Mayor Bill de Blasio said at a news conference.

“We have the finest public health system, not only anywhere in the country but anywhere in the world,” he added.

Much of the public’s concern focused on the movements of Dr. Spencer the night before he reported feeling ill.

On Friday, officials added some new details about those movements. He traveled on the A and L subway lines to Brooklyn, where he went bowling in Williamsburg and took a taxi back to Manhattan on Wednesday evening. He assured officials that he did not have symptoms at the time.

Earlier in the day, he went for a three-mile jog along Riverside Drive. On Tuesday, the day Dr. Spencer first began to feel sluggish, he visited the High Line and ate at the Meatball Shop in the West Village.

Health workers are in the process of visiting every location Dr. Spencer visited, said Dr. Mary Travis Bassett, the city health commissioner.

Dr. Bassett praised the work Dr. Spencer was doing in Africa to combat the disease. She also sought to insulate him from criticism about his activities before falling ill, saying he followed all the proper protocols.

“There’s this young guy who went over there, really doing the right thing, the courageous thing, and he handled himself really well,” she said. “I don’t want anyone portraying him as reckless.”

She spoke before the governors’ news conference, in which Mr. Cuomo incorrectly said Dr. Spencer had violated a quarantine; he had not been under quarantine.

Though Doctors Without Borders and the health department said Dr. Spencer followed protocols, Dr. William Schaffner, an infectious disease specialist at Vanderbilt University, said Dr. Spencer probably should have stayed home beginning on Tuesday.

“At that point I would have locked myself in, and I would have started checking my temperature hourly,” he said.

Dr. Schaffner also said he saw no need for an automatic 21-day quarantine or isolation period for people arriving from West Africa, not even health workers. There is no medical reason for it, he said, because people are not contagious until they develop symptoms.

Dr. Bassett, in a Twitter post, suggested that the new quarantine policy might discourage American doctors and nurses from helping to contain the disease in Africa. “People who go and volunteer, we have to look at how the new quarantine policy would impact them,” she said.