The U.S. federal government derives its authority for isolation and quarantine programs from the Commerce Clause of the U.S. Constitution, section 361 of the Public Health Service Act (42 U.S. Code § 264). The U.S. Secretary of Health and Human Services is authorized to take measures to prevent the entry and spread of communicable diseases into the USA and between states.
Federal isolation and quarantine programs are authorized by an Executive Order (EO) of the President and can be revised by another EO.
On January 31, 2020, the President issued the 'Proclamation on Suspension of Entry as Immigrants and Nonimmigrants of Persons who Pose a Risk of Transmitting 2019 Novel Coronavirus.' The authority for carrying out quarantine related functions in the USA is delegated to the Centers for Disease Control and Prevention (CDC).
National Emergency in the USA: The Robert T. Stafford Disaster Relief and Emergency Assistance Act (Public Law 100-707), signed into law on November 23, 1988; amended the Disaster Relief Act of 1974 (Public Law 93-288). The Stafford Act constitutes the statutory authority for most Federal disaster response activities especially as they pertain to the Federal Emergency Management Agency (FEMA) and FEMA programs.
State-Based Isolation and Quarantine
Isolation and Quarantine help protect the public by preventing exposure to people who have or may have a contagious disease. A US state of emergency declaration affords greater powers to the governor to implement a comprehensive emergency management plan and introduce emergency sanitary regulations, among other measures.
A US state’s governor may activate the National Guard under Title 32 State Active Duty authority “in response to natural or man-made disasters or Homeland Defense missions.” Guardsmen remain under “command and control” of the Governor," according to the National Guard Bureau, as of 2006.
The use of quarantine or isolation powers may create sensitive issues related to civil liberties. Individuals have rights to due process of law, and generally, isolation or quarantine must be carried out in the least restrictive setting necessary to maintain public health.
The decision to discontinue home isolation should be made in the context of local circumstances says the CDC. Options now include both 1) a time-since-illness-onset and time-since-recovery (non-test-based) strategy, and 2) a test-based strategy.
On July 22, 2020, the U.S. CDC said 'Accumulating evidence supports ending isolation and precautions for persons with COVID-19 using a symptom-based strategy.'
'This CDC update incorporates recent evidence to inform the duration of isolation and precautions recommended to prevent transmission of SARS-CoV-2 to others while limiting unnecessarily prolonged isolation and unnecessary use of laboratory testing resources.'
The table at this link summarizes state law authority for quarantine and isolation within state borders, including the authority to initiate quarantine and isolation, limitations on state quarantine powers, and penalties for violations. Please note this may not be a comprehensive list.
Who Are Close-Contacts?
The CDC defines Close-Contact as persons within approximately 6 feet (2 meters) or within the room or care area of a confirmed or probable patient for a prolonged period of time, or with direct contact with infectious secretions while the case patient was likely to be infectious (beginning 1 day prior to illness onset and continuing until resolution of illness).
Social Distancing is an action taken to minimize contact with other individuals; social distancing measures comprise one category of non-pharmaceutical countermeasures (NPCs) aimed at reducing disease transmission and thereby also reducing pressure on health services.
The tactic of 'social distancing' was previously deployed during the 1918 influenza outbreak in the USA.
A key element in any most plans to reduce the coronavirus pandemic is ‘Contact Tracing’, which is the ability to trace and monitor the contacts of infected people.
Using smartphones for contact tracing is being widely discussed by public health officials and experts The latest Kaiser Health Tracking Poll finds the US public is divided on whether they would be willing to download an app for these purposes.
Pandemic Vs Outbreak
The term 'outbreak' is often defined as a sudden rise in the number of cases of a disease. An outbreak may occur in a community or geographical area or may affect several countries. It may last for a few days or weeks, or even for several years. Some outbreaks are expected each year, such as influenza.
Infectious disease outbreaks currently being reported on by CDC can be found at this link.
Pandemics are very rare, generally announced by the WHO. They are global disease outbreaks that differ from an outbreak because it affects a wider geographical area, often worldwide, infects a greater number of people than an epidemic, and is often caused by a new virus or a strain of the virus that has not circulated among people for a long time. Humans usually have little to no immunity against it, which means a virus spreads quickly from person-to-person worldwide.
Who Is In Charge?
The federal government is responsible to take action to prevent the entry of communicable diseases into the USA. And the US States have police power functions to protect the health, safety, and welfare of persons within their borders.
To control the spread of disease within their borders, states have laws to enforce the use of isolation and quarantine. These laws can vary from state to state. In some states, local health authorities implement state law. In most states, if a person breaks a 'quarantine order', it is a criminal misdemeanor.
Tribes also have police power authority to take actions that promote the health, safety, and welfare of their own tribal members. Tribal health authorities may enforce their own isolation and quarantine laws within tribal lands if such laws exist.
Note: This content was sourced from the CDC, WHO, the U.S. government, and media sources and has been review by healthcare professionals, such as Dr. Robert Carlson.