Professor Wendy Mariner on Ebola: Government has Broad Quarantine Powers.
As worries about Ebola spread — with the death of Thomas Duncan, the first person diagnosed with the virus in the U.S., and the infection of two health care workers in Dallas—the word “quarantine” is working its way into water-cooler conversations.
Duncan’s family members, as well as others potentially exposed to the virus, are being kept in isolation for 21 days — the amount of time widely considered to be the maximum duration for Ebola incubation. Quarantine is a legal measure, as well as a public health tool.
SPH’s Wendy Mariner, professor of health law, bioethics and human rights, has been quoted extensively in the media about how quarantines and isolation work. Here are excerpts from an interview with her, featured on NPR’s “Shots” blog:
Q: How does isolation actually work?
A: Isolation can be voluntary or involuntary. When you have a really sick patient, like someone who has symptoms of Ebola, isolation is just good medical practice. They take care of a person in an isolation room in a hospital and use all kinds of infection control practices, and patients usually want that — they submit to that because they want to get better. That’s what happens in the vast, vast, vast majority of cases.
Only in a handful of cases do you have the possibility of involuntary isolation. From the law’s perspective, in order to require someone to be isolated, they would have to have a dangerous contagious disease that’s easily transmissible person-to-person and — and this is important — be unable or unwilling to isolate themselves. In other words, they would pose a danger to other people because they would come in contact with other people either voluntarily or because they couldn’t help themselves. For the most part, it just doesn’t happen very much in this country.
Q: What’s the process for putting someone under involuntary isolation?
A: When public health officials or a physician want to petition to have someone involuntarily isolated, then they would have to go to court and prove both those points: dangerous contagious disease and the probability that the person would spread it to others if not confined.View post
You’re clearly entitled to a hearing, and then you would have to be released once those conditions no longer apply — it can’t be forever.
Q: How is quarantine different from isolation?
A: Quarantine is most precisely used to mean confining people who may have been exposed to one of these dangerous contagious diseases. It’s not that they’re necessarily sick. But the goal is, if they’ve been exposed to a dangerous contagious disease, to keep them from exposing other people.
Q: What can you do while you’re in quarantine?
A: I think the public officials and physicians ought to provide you with information about how you should take care of yourself, and how to clean dishes, and how to make sure you don’t touch each other. You conduct your life as you would otherwise, but you’re probably bored to tears.
They’re monitoring to make sure that you don’t have any symptoms and presumably, if someone develops a symptom like fevers or headaches, they would probably whisk them into a hospital and ask them to stay in isolation.
Q: How do they decide how long to isolate or quarantine people?
A: All of this is highly fact-specific, according to the particular disease.
Q: When else has the U.S. used isolation and quarantine?
A: In the late 80s, early 90s, when a lot of treatment programs for tuberculosis lost funding and there was an influx of both HIV and TB — immigrants, homeless people, many who were mentally ill, or many who were on drugs and didn’t have any place to go, so they ended up being isolated in the hospital.
Early in the 1920s, there was sometimes isolation for somebody with sexually
transmitted infections before there were antibiotics to treat them. But again, it was targeted largely at poor sex workers and some immigrants.
Isolation is a useful tool in extreme circumstances, but it has an unhappy history of being applied rather selectively. But of course, as I said earlier, you really don’t need it for most people. Most people understand the need for staying away from other people if they’re infectious.
Q: What’s an example of quarantine’s unhappy history?
A: There have been circumstances, more than 100 years ago. There was a large quarantine order in San Francisco, which was struck down by the courts because it essentially quarantined the healthy with the sick, in plague, and was also highly discriminatory. It really only quarantined people of Chinese ancestry in Chinatown in San Francisco, kind of wound around the Caucasian places, so it was pretty obviously discriminatory.
Q: Where is the line between state and federal jurisdiction for isolation and quarantine?
A: States are sort of the first line — they have basic authority to impose involuntary
detention of a person within their territory. The federal government does have authority to quarantine, but it stems from the federal government’s power to regulate foreign and interstate commerce. So it really deals with people who are crossing the borders, not with local, non-commercial activities like going to the hospital. It is possible that, had anyone been aware of Duncan’s arrival from another country to the U.S., that the federal government could have taken some action and asked, but he was fine then. It’s mostly the states that do this — this is 99.9 percent state in practice.