Every airline passenger who arrives in the United States from one of the three West African nations hardest hit by Ebola will be monitored by state and local health authorities for 21 days, the Centers for Disease Control and Prevention said Wednesday.

The travelers will be required to report their temperature daily and call a state hotline if they show any symptoms of the illness. The program will begin in six states — including Maryland and Virginia — on Monday and will expand to other states later, CDC Director Thomas Frieden said…

“What a logistical nightmare,” said John Connor, an associate professor of microbiology at Boston University and an investigator with the university’s National Emerging Infectious Diseases Laboratories. “It is an abundance of caution, and certainly, if carried out properly, it would do a good job of identifying anyone who is infected. This is going to be a very difficult task.”

Alarmed by the case of an Ebola-infected New York doctor, the governors of New Jersey and New York on Friday ordered a mandatory, 21-day quarantine of all medical workers and other arriving airline passengers who have had contact with victims of the deadly disease in West Africa…

New Jersey Gov. Chris Christie and New York Gov. Andrew Cuomo said the case led them to conclude that the two states need precautions more rigorous than those of the U.S. Centers for Disease Control and Prevention, which recommends monitoring of exposed people for 21 days but doesn’t require quarantine, in which they are kept away from others.

“It’s too serious a situation to leave it to the honor system of compliance,” Cuomo said.

Those who are forcibly quarantined will be confined either to their homes or, if they live in other states, to some other place, most likely a medical facility, the governors said.

New York and New Jersey also plan tougher screening measures at their airports than the federal government has imposed. These include an extensive interview with each incoming traveler from an Ebola-ridden country upon landing, conducted by state health officials, New York Gov. Andrew Cuomo said.

“It will be a full interview. It will not be just ‘check-the-box,’ which is basically what it is now,” he said, noting that officials will likely ask highly specific questions about where the individual traveled, their reason for travel and with whom they came in contact…

Lawmakers also asked defense officials Friday if protocols for returning U.S. troops are adequate. Under current military protocols, U.S. troops are monitored in the region, checked 12 hours before their departure, and in some cases, subject to a period of as long as 10 days in a controlled environment before being allowed to depart. A number of Democrats and Republicans indicated they would prefer a formal 21-day quarantine for troops and aid workers who had been in affected areas.

Cuomo and Christie said it no longer matters if someone is showing symptoms or not.

Indeed, in discussing the new plan, Cuomo and Christie said a policy of voluntary quarantine simply does not go far enough.

“Voluntary quarantine – you know it’s almost an oxymoron. This is a very serious situation,” Cuomo said. “Voluntary quarantine – raise your right hand and promise you’re going to stay home for 21 days. We’ve seen what happens.”

There are currently no legal restrictions on health workers’ movements when they return to the U.S. after caring for Ebola patients, though at least one U.S. aid organization voluntarily quarantines its workers upon their return. That doesn’t go far enough, said lawmakers at a hearing in Washington today, who questioned whether scientists know enough about how the virus is spread to be confident they can protect the American public.

Quarantining health workers “sets a strong perimeter of defense to protect public health here in the United States while allowing for infectious-disease experts to gain a better understanding of this virus,” Representative Tim Murphy, a Pennsylvania Republican, wrote in an editorial yesterday in the Pittsburgh Post-Gazette. “As we learn more, we can adjust these policies. But let’s start from the strongest line of defense and work our way down, not begin with the weakest line of public-health protections and scramble our way up.”…

“Any change would be based on politics,” because all the evidence indicates that people are not contagious before they have obvious symptoms of Ebola, said Robert Glatter, an emergency physician at Lenox Hill Hospital in New York.

The Obama administration is considering quarantining healthcare workers returning to the United States from the Ebola hot zone of West Africa, after a New York doctor who treated Ebola patients there tested positive for the virus.

Tom Skinner, a spokesman for the U.S. Centers for Disease Control and Prevention (CDC), told Reuters on Friday that quarantine is one option being discussed by officials from across the administration

“Whatever option we come up with just simply can’t hamper ability to respond to the situation in West Africa,” Skinner said. “Because as long as that’s going on over there, our risk will never be zero.”

Among medical professionals who have been fighting Ebola in West Africa, the restrictions only intensified the debate. While a few of those interviewed said an overabundance of caution was welcome, the vast majority said that restrictions like those adopted by New York and New Jersey could cripple volunteers’ efforts at the front lines of the epidemic

 The group Doctors Without Borders requires all health care workers returning from affected countries to follow a series of instructions, in hopes of identifying the illness as soon as it develops: Returning staff members must take their temperatures twice a day; be on the lookout for symptoms of Ebola; stay within four hours of a hospital with the ability to isolate patients with the disease; and finish their course of preventive malaria treatment, because symptoms of malaria can mimic Ebola’s.

But beyond that, returning workers are permitted to resume their normal activities, since a person without symptoms of the disease cannot transmit it. “Self-quarantine is neither warranted nor recommended when a person is not displaying Ebola-like symptoms,” the organization said in a statement on Thursday…

“I think we are just digging the grave deeper,” he said in a telephone interview from Freetown, the capital. “Come on, that’s exactly the move to push people away from going to Sierra Leone and other affected areas. It’s going to escalate the epidemic and not help solve the crisis.”

Rabih Torbay, senior vice president at International Medical Corps, testified that imposing quarantines would strongly discourage volunteer healthcare workers from assisting in the relief effort.

As an example, he said, the IMC requires a six-week minimum commitment to treat Ebola patients. Adding a 21-day quarantine would stretch doctors’ furloughs to nine weeks, a period of leave that few hospitals would allow.

“We cannot recruit staff from the U.S. or anywhere else in the world if there is not a chance they could come back to their families and their [jobs]” quickly, Torbay told lawmakers.

“Putting people in quarantine goes against our ability to recruit and retain [staff], and therefore, it will go against our ability to fight against the virus in West Africa.”

About a decade ago, at the height of the SARS scare, one researcher in Toronto thought the question was worth asking. Laura Hawryluck, an associate professor of critical care medicine at the University of Toronto, surveyed 129 people (mostly health workers) who had been quarantined, using psychometric tests designed to spot signs of depression and PTSD. Hawryluck found that about 29 percent of respondents exhibited signs of PTSD and 31 percent showed signs of depression after the period of isolation. She published her findings in Emerging Infectious Diseases in 2004. “One of the things we kept hearing repeatedly — people told us they felt like they were almost being seen as a pariah,” Hawryluck said. “And that psychological effect on people was very distressing.

“In terms of PTSD, it was a lot of anxiety, a lot of nightmares,” she said. “And in terms of depression, it was that feeling of being completely alone and isolated, with that concern of Would someone be there for me if I got sick?“…

What could be done better? For one, psychologists or social workers could be made available, said Harry Hull, an infectious disease epidemiologist who was once the epidemic intelligence officer for the Centers for Disease Control and Prevention. Or it could be as simple as making sure the health worker who checks in with the quarantined is always the same health worker, so some sort of relationship could potentially be established, Hull said. (Science of Us contacted the CDC to ask what measures, if any, they take to ensure the psychological health of those under quarantine; we’ll update the post if we hear back.) “We’re so focused on — and rightly so — infection control measures. That’s crucial,” Hawryluck said. But it’s also vital to keep the mental health of these people in mind, she said. “We need to look after each other and care for each other better, and not just push someone out of the herd or out of the group.”

Thousands of otherwise able-bodied New Yorkers are going to come down with the flu over the next few weeks. Tens of thousands are going to come down with colds. Hundreds of thousands are probably going to feel sick at some point, even if they’re not. If some non-trivial fraction of these people starts showing up in emergency rooms because they worry they have Ebola when they don’t, then it’s going to overwhelm the city’s public health infrastructure and make it tough to care for people who actually do have serious health problems.1

In this context, publicly calling out Dr. Spencer for his failure to self-quarantine could have turned into its own minor disaster. Cuomo, de Blasio, and Bassett were generally pretty effective: They correctly assured people that it’s very difficult to contract Ebola, that all the relevant protocols were followed once Dr. Spencer came forward with his symptoms, that the city had thoroughly war-gamed this scenario. Had they taken the additional step of criticizing Spencer for not isolating himself beforehand, you can imagine that dominating the headlines, drowning out most of what they said, and generally contributing to the very panic they were trying to defuse. Everyone who’d ridden a subway or used Uber to get around New York on Wednesday would be asking themselves, Well, if he should have been quarantined but wasn’t, how much danger was I exposed to? (The answer, again, is almost certainly none.) Far better to play it cool while, behind the scenes, making sure any health worker who’s recently returned from the affected African countries has a month’s supply of Stouffer’s in his freezer and a complimentary Netflix subscription.

Which is to say, if Spencer, out of an abundance of caution, stayed home from work in order not to infect his patients and colleagues, why in god’s good name was he going bowling across the East River? What was in that bowling alley that was so pressing that he needed to get on a crowded, poorly ventilated subway car a full day after the onset of symptoms?…

From where I sit, it often looks like the other side of American individualism, which becomes selfishness when you lay it on thick. It’s the belief that you and your needs are acutely exceptional and important, and take precedence over those of the people around you. It’s the unspoken belief that your day radiating sickness at the office is worth a couple of your colleagues being bedridden with your flu for a week. You may not be actively thinking that, but that’s the math your actions—and those of the 40 percent polled in that survey—imply. It’s selfishness and solipsism, pure and simple

We’ll likely ride out this Ebola thing without it spreading too much further, but flu season is around the corner. So please, if you’re feeling sluggish and febrile, be a mensch and don’t go bowling.

“We have to be guided by the facts, not fear.”