NEW YORK, N.Y. - For three weeks, Dr. John Fankhauser and his family lived in two RVs in a meadow in North Carolina, watching movies, playing cards and huddling around a fire pit — with no other campers around.
But their isolation was interrupted each morning by a visit from a public health nurse, who came to ask Fankhauser how he was feeling and to watch him take his temperature.
The doctor is one of the more than 2,600 people who have undergone the 21-day ritual ordered by the federal government to guard against cases of Ebola from entering the country from West Africa. Now, anyone who has travelled from four West African nations is monitored for three weeks for fever and other signs of the disease.
The program reaches the one-month mark on Thursday, and so far, it hasn't found any cases of Ebola.
It's up to local officials to decide how to keep track of the travellers who end up in their states, and determine what — if any — restrictions to impose. Most checking is done through daily phone calls, often with the person calling in to report their temperature and any symptoms.
And by all accounts, most travellers have been co-operative. Last week during a Congressional hearing, Centers for Disease Control and Prevention Director Tom Frieden said health officials lost track of only a tiny proportion of travellers — "less than 1 per cent."
Success varies from place to place, but overall more than 95 per cent of travellers from the countries are promptly contacted and monitored daily, according to CDC officials.
"State and local health departments have really stepped up to the challenge," said Randolph Daley, a CDC epidemiologist helping to co-ordinate the effort.
But there have been headaches. In the beginning, local health officials frequently complained they were getting bad contact information, or that travellers were getting or using the wrong phone numbers to dial in. Officials had to send their disease detectives out to track down the travellers.
"The first week was really bad. I went out to eight homes because no one was calling," said Jeanette Oliveras, a nurse for Trenton, New Jersey's health department.
She and health officials say the quality of the contact information has improved, but the extra work has been a burden. On an average day, 90 to 100 passengers arrive in the U.S. from the West African countries struggling with the worst Ebola epidemic in world history — Guinea, Liberia, Sierra Leone and — more recently — Mali.
Those passengers are added to the lists, as others drop off.
"As it continues, it has become a strain," said Dr. Marcus Plescia, head of the Mecklenburg County Health Department, who was sending a nurse out to see Fankhauser, a 25-minute drive outside of Charlotte, North Carolina, until this week.
The U.S. didn't start checking passengers from West Africa until a Liberian man visiting Dallas came down with Ebola in September. At first, travellers were only checked upon arrival for a fever. But as Ebola anxiety spread across America and some in Congress pushed for a travel ban, the Obama administration began to ratchet up its measures.
Today, anyone who is travelling to the U.S. from West African countries with Ebola is funneled through one of five major airports. They are given thermometers and told to check their temperature twice daily. They are also required to provide contact information for themselves as well as a friend or relative, which is relayed to state health officials.
The program also tracks workers at U.S. hospitals where Ebola patients were treated.
It was created more for political than medical reasons, said Stephen Morse, a Columbia University infectious disease expert.
"Everyone in office wants to be seen as doing something," he said.
Monitoring is not the best way to control Ebola in this country, said Dr. Jay Varma, deputy commissioner for disease control at New York City's health department. Better approaches would be sending medical help to West Africa to stop the epidemic and preparing U.S. hospitals to handle Ebola cases here, he said.
In Trenton, Oliveras said many travellers have gone beyond what health officials ask of them. None has been required to stay in quarantine, but roughly half have isolated themselves in homes or hotels. Most are Liberians aware of Americans anxiety about Ebola, and they did it to prevent people in the community "from getting upset," she said.
Fankhauser was a different story. He had worked at an Ebola hospital in Liberia, and local officials restricted where he could go and required in-person symptom checks.
When he returned from Liberia earlier this month, he agreed to stay at a campground on the campus of SIM, a North Carolina-based medical aid organization. His recent work for the group in Liberia was administrative, and he said he was in full personal protective equipment during his one encounter with an Ebola patient.
Still, he had to ask permission to visit a friend's home or visit a coffee shop. The county denied his request to go to dinner with family and friends at a restaurant.
Local media had reported on Fankhauser, and the idea of him being seen at a crowded restaurant seemed problematic, the health department's Plescia said.
Fankhauser said he had no problem being monitored, but some restrictions were about "appeasing people's irrational fears."