A nurse released from isolation at a New Jersey hospital after treating Ebola patients in West Africa headed home to Maine on Monday, with state health officials seeking to quarantine the woman at her residence in Fort Kent and monitor her for signs of illness.

Nurse Kaci Hickox has not been diagnosed with Ebola and “has thankfully been symptom-free for the last 24 hours,” the New Jersey Department of Health said in a news release.

Hickox was en route to Maine from New Jersey by private car Monday afternoon, according to her attorney, Steven Hyman of the New York law firm McLaughlin & Stern.

Hickox, who treated Ebola patients in Sierra Leone, was placed in isolation against her will in a tent outside University Hospital in Newark before her discharge Monday. She had planned to challenge her quarantine in a lawsuit, saying it violated her constitutional rights.

While she no longer plans to sue, her case underscored the dilemma federal and state officials face in trying to prevent the spread of Ebola. While New Jersey’s protocols exceeded precautions adopted by the federal government, Maine released updated protocols that call for Hickox to be quarantined at home.

Her boyfriend, Ted Wilbur, told the Bangor Daily News on Sunday that Hickox planned to stay at his home in Fort Kent for a 21-day, self-imposed quarantine. He said he had no further comment about her plans when contacted Monday.

“Under this policy, Maine will make every possible effort to implement an agreed-upon in-home quarantine,” Maine CDC said in a statement accompanying the updated protocols. “We fully expect individuals to voluntarily comply with an in-home quarantine.”

The Maine CDC later clarified that while it couldn’t “release specific details about any one individual … all known travelers returning from West Africa to Maine are cooperating with State health officials at this time.”

It remained unclear how the state would respond if Hickox, or other travelers exposed to Ebola in West Africa, refused an in-home quarantine.

Maine’s approach appeared to push the boundaries of revamped guidelines released Monday by federal health officials. U.S. CDC Director Tom Frieden called for isolation of people at the highest risk for Ebola infection but said most medical workers returning from the three countries at the center of the epidemic would require daily monitoring without isolation.

Hyman said he hadn’t yet discussed Maine’s protocols with Hickox.

“She didn’t enter into this in order to become a combatant,” he said. “She did it to be a nurse. Let’s see how it’s handled and what decisions will be made as we go forward.”

Dr. Dora Anne Mills, who formerly headed the Maine CDC under Gov. John Baldacci and now serves as vice president for clinical affairs at the University of New England, said Maine statute drafted during her tenure protects patients’ rights while safeguarding the public from infectious disease. In most cases, the mandatory quarantine New Jersey ordered for Hickox couldn’t happen in Maine without public health officials first obtaining a court order, she said.

The state could impose an immediate quarantine if the governor declared a public health emergency, but would have to seek judicial approval within 48 hours, she said.

“I think what we came up with was a nice set of tools that first and foremost ensure public health but also assure civil liberties are protected as much as possible,” Mills said.

Maine’s protocols largely follow recommendations issued by the federal CDC.

Maine will require “active monitoring” of all travelers with a history of direct contact with Ebola patients who exhibit no symptoms of the disease, according to the protocols.

“We will work collaboratively with the affected individual to establish quarantine of the individual in his or her home for 21 days after the last possible exposure to Ebola,” the Maine CDC protocols state.

Twenty-one days is the maximum incubation period for Ebola, or the longest period it can take from the time a person is infected until developing symptoms. The virus is spread only through direct contact with the bodily fluids of an infected individual who shows symptoms of illness. Infectious disease experts say Ebola isn’t spread through the air or by infected people who show no symptoms.

“We certainly understand [health care] workers’ desire to get home after doing good work in West Africa,” Gov. Paul LePage said in a statement. “But we must be vigilant in our duty to protect the health and safety of all Mainers, as well as anyone who may come in contact with someone who has been exposed to Ebola.”

Hyman said he hoped Hickox would be permitted to visit with her family and friends, and believed she would reside with Wilbur, her partner.

“We’re right now focusing on getting her out of New Jersey, which was not terribly hospitable, and getting her back to Maine, where she can regroup, rethink and recharge,” he said.

On Monday, those living near the couple’s Fort Kent residence said they understand Hickox’s desire to return home but hope she will abide by the 21-day quarantine.

“My view is, as long as they both stay in that house, that’s fine,” Jake Robichaud said on Monday. “Yes, I am concerned, they have a 21-day quarantine for a reason.”

Robichaud, who lives about a mile down the road from Hickox’s and Wilbur’s house and owns a commercial/residential cleaning business, said he does have some health concerns.

“This time of year I have cracked and open sores on my hands,” he said. “So all I need is someone sneezing next to me and I could potentially get infected.”

According to the U.S. CDC, Ebola doesn’t spread through the air like respiratory illnesses such as measles or chickenpox. An individual infected with Ebola must be showing symptoms to spread the virus.

If a symptomatic person coughed or sneezed on someone, the virus could be transmitted provided their saliva or mucus came into contact with the other individual’s eyes, nose, mouth or an open wound, according to the CDC. Coughing and sneezing are not common symptoms of Ebola.

Robichaud, who said he is working to educate himself with reliable information, added he is looking forward to welcoming Hickox back to the neighborhood.

“We want to welcome her with open hearts,” he said. “We are grateful for the service she did.”

Reggie and Tammy Roy, who live about a quarter mile from Hickox and Wilbur, said Monday said they are a bit nervous.

“I would have liked to see her do the 21 days,” Reggie Roy said. “We are certainly now paying more attention to [Ebola] now that this has been in the news.”

Their neighbor Martha Couture said Monday she had no real concerns.

“As long as they took care of everything in New Jersey, I’m not really all that nervous,” she said. “I think people tend to overreact sometimes.”

At the Fort Kent town office on Monday, staff fielded calls all day from concerned residents and members of the national media.

“The phones have not stopped ringing all day,” one town office worker said. “We had a news crew camped out on the front lawn this afternoon.”

Town Manager Don Guimond said people are calling concerned about the town’s health protocols and wondering what, if any plans, are in place.

“The long and the short of it is Ebola has been a problem in places around the world,” Guimond said. “Now there is that connection to Fort Kent.”

There is a great deal of fear and misinformation surrounding the disease, he said, and there is every indication that Hickox spending her 21-day quarantine in her home is not going to place anyone in danger.

“People just need to calm down and respect the situation she is in,” Guimond said. “She just wants to come home, and she has every right to come home.”

Guimond said he met the couple last August just after they had moved to Fort Kent.

“They came into the town office to ask all the questions new residents often ask,” he said. “At the time [Hickox] indicated she was going to be working in Sierra Leone and I believe she needs to be commended for stepping up to the plate and offering her services to those who so desperately need them.”

The mandatory quarantine policies put in place on Friday by the governors of New York and New Jersey have come under criticism that they may discourage health care workers from traveling to West Africa to help in the fight against Ebola.

The virus has killed nearly 5,000 people in West Africa.

Maine will work with health care workers to ensure no direct contact with others during in-home quarantine and “help make sure the [health care] worker has everything to make this time as comfortable as possible,” LePage said.

Maine CDC will coordinate food and medicine if needed, according to its statement.

The Maine CDC statement said Maine “will take further measures, out of an abundance of caution, to ensure public safety,” but it did not stipulate what those measures are.

If any traveler develops symptoms, “protocols will be initiated to transport the individual to the proper health facility for immediate treatment.”

Maine’s protocols apply to those whose travel originated in Liberia, Sierra Leone or Guinea — the countries hardest hit by Ebola — in accordance with federal CDC guidelines.

Maine health officials also are monitoring another traveler to the state who did not come into contact with Ebola patients, according to the statement. Under the updated protocols, that individual must contact Maine CDC daily to report his or her temperature and must notify health officials immediately of any symptoms of Ebola, including headache, joint and muscle aches, weakness, diarrhea, vomiting, stomach pain, lack of appetite or abnormal bleeding. The individual also must report any additional travel plans.

Maine CDC has released no other details about that traveler, including where the individual is being monitored.

News of Hickox’s return to Maine prompted a statement Monday afternoon from the University of Maine at Fort Kent, where Wilbur is a nursing student. School officials are coordinating with state and local public health officials, emergency personnel and Northern Maine Medical Center in Fort Kent to ensure the campus is prepared to support students or community members potentially affected by the Ebola outbreak, the statement said.

Dan Demeritt, a spokesman for the University of Maine System, said the university in Fort Kent is still working out the details of its response, and couldn’t comment on whether Wilbur would be permitted to attend classes if he’s living with Hickox.

The university system has communicated since late August with officials across the system to share information from the CDC about the Ebola virus, according to the statement.

“The University of Maine at Fort Kent is proud of our nursing program and our students’ commitment to public health and safety,” said UMFK President Wilson Hess. “We will take every appropriate step within established CDC protocols to protect our campus while offering our support and compassion to those affected by travel to parts of the world where outbreaks have occurred.”

Northern Maine Medical Center officials have said the hospital is equipped to provide a temporary quarantine setting until any potential Ebola patients could safely be taken to a CDC-designated location for treatment.

Reuters contributed to this report.

Jackie Farwell

I'm the health editor for the Bangor Daily News, a Bangor native, a UMaine grad, and a weekend crossword warrior. I never get sick of writing about Maine people, geeking out over health care data, and...