Saturday, August 16, 2014

GateHouse:Quarantine and isolation in the shadow of Ebola

Matthew T. Mangino
GateHouse News Service
August 15, 2014
The World Health Organization has officially declared the Ebola virus an international health emergency.

Emphasizing that the outbreak’s quick rise is “serious and unusual,” the organization issued the following statement, “The Ebola outbreak in West Africa is an ‘extraordinary event’ and a public health risk to other surrounding States, as well as the spread to other countries through lack of screening and monitoring.”

Ebola is a severe, often fatal, disease in humans. It was first discovered in the Republic of Congo in 1976. Until recently, there were fewer than 1,500 recorded cases of the virus. The death toll inflicted in West Africa since February has exceeded 1,000.

“Ebola is so scary and so unfamiliar, it’s really important to outline what the facts are, and that we know how to control it. We control it by traditional public health measures,” said Centers for Disease Control and Prevention Director Tom Frieden.

What are traditional public health measures? Isolation and quarantine are the methods by which public health officials stop the spread of disease.

According to the Department of Health and Humans Services, the president by executive order provides for the use of federal isolation and quarantine for communicable diseases, including cholera, diphtheria, tuberculosis, smallpox, yellow fever and Ebola among other potential pandemic diseases.

Frieden told NBC News that there’s a very real possibility that someone infected with Ebola will enter the United States. But the chances of a U.S. outbreak are highly unlikely: “It’s a matter of isolating patients.”

Isolation is used to separate ill people who have a communicable disease from those who are healthy. Quarantine is used to separate and restrict the movement of people who are well but may have been exposed to a communicable disease.

Isolation and quarantine can have a significant impact on fundamental individual rights. The U.S. Constitution prohibits the federal government, as well as state governments, from depriving individuals of protected liberty rights.

Isolation and quarantine restrict the movement of people to help stop the spread of diseases. This means that an individual can be detained against his or her will for an extended period of time.

Quarantine and isolation are not new public health remedies. As far back as 1902 the U.S. Supreme Court recognized isolation and quarantine as legitimate public health techniques. Although, most patients normally have a right to refuse medical treatment, that right disappears when an infected or exposed person poses a significant risk to public health.

In addition to being medical functions, isolation and quarantine are also “police power” functions, derived from the right of the government to take action affecting individuals for the benefit of society. The authority for carrying out these functions has been delegated to the CDC.

Pursuant to federal regulations, the CDC is authorized to detain, medically examine, and release persons arriving into the United States and traveling between states who are suspected of carrying communicable diseases.

States also have police power functions to protect the health, safety, and welfare of persons within their borders. All 50 states have laws to enforce the use of isolation and quarantine.

For instance, in Pennsylvania, the Disease Prevention and Control Law provides that the state or local health departments may, without court intervention, order an individual quarantined or isolated if the individual poses a significant threat to the health of the public and there are no lesser restrictive means.

In Arizona, the governor, along with the state director of the Department of Health Services, have expansive authority in a state of emergency involving infectious disease. However, there must be an urgent threat to public health to establish a quarantine or isolation without an order of court.

In fact, in many states the governor has the authority to order a “cordon sanitaire” which is the quarantining of an entire town or city. Such authority has far-reaching implications for those not yet infected. They are being forcefully detained in an area were infected persons remain.

The government attempts to balance the good of the community with individual liberty. In times of international crisis, there is a heightened need to zealously protect those individual rights.

Matthew T. Mangino is of counsel with Luxenberg, Garbett, Kelly & George P.C. His book “The Executioner’s Toll, 2010” was recently released by McFarland Publishing. You can reach him at and follow him on Twitter at @MatthewTMangino.
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