Coronavirus Isolation & Quarantine

Coronavirus Isolation & Quarantine

The US 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 United States and between US states.

Federal isolation and quarantine programs are authorized by an Executive Order (EO) of the President. The President can revise these programs by 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).

COVID-19 Quarantine News

  • February 21, 2020 - BMJ published 'Rules on isolation rooms for suspected COVID-19 cases in the UK.
  • February 18, 2020 - Nebraska Medicine/UNMC and the CDC, Nebraska National Guard, Governor Pete Ricketts, Office of the Assistant Secretary for Preparedness and Response (ASPR), and many other local and state agencies joined together for a press conference to explain more about the arrival of evacuated Americans from Japan.
  • February 17, 2020: The WHO has developed guidance documents for managing public health events at Points of Entry. This document aims to provide advice on the detection and management of ill travelers suspected of COVID-19 infection, at international airports, ports and ground crossings. 
  • February 16, 2020:  A new study in China used a fluorescence-based quantitative PCR kit to detect 8,274 close contacts in the Wuhan region against two loci on the 2019-nCoV genome. This study found among the 8,274 subjects, 2,745 (33.2%) had the COVID-19 infection.
  • CDC update on February 15, 2020:  Americans returned by flights chartered by the State Department will be subject to a 14-day, federal quarantine and be housed at two existing federal quarantine sites for repatriated travelers. Those passengers returning from Japan will be housed separately from individuals already in quarantine from previous Wuhan repatriation flights. All travelers from Japan will be screened before boarding the State Department-chartered aircraft to prevent symptomatic travelers from departing Japan.
  • CDC statement on February 12, 2020:  According to the CDC's Dr. Chris Braden, “At this time there is no indication of the person-to-person spread of this virus at the quarantine facility, but CDC will carry out a thorough contact investigation as part of its current response strategy to detect and contain any cases of infection with this virus.”
  • CDC update on February 5, 2020:  There are 4 more planes carrying passengers from Wuhan, China back to the United States.  The plan is for the planes to arrive at the following locations in three states, Travis Air Force Base in Sacramento, California, marine corps air station Miramar in San Diego, California, Lackland Air Force Base in San Antonio, Texas and Eppley Airfield in Omaha, Nebraska.  CDC staff are there meeting the planes and assessing the health of each passenger.  The passengers will be screened, monitored and evaluated by medical and public health personnel including before takeoff and during the flight.  Medical care will be readily available at the first onset of symptoms if needed.  Like the plane that arrived in March Air Reserve base last week, these passengers will be issued quarantine orders upon arrival at their designated locations. This legal order is intended to protect the travelers, their families, and their communities.  The quarantine period will begin the day the flight leaves Wuhan and will continue for 14 days.  We do not believe these people pose a threat to the communities where they are being housed. Joint Base San Antonio (JBSA) Lackland announced it will provide housing for American citizens quarantined due to the ongoing coronavirus outbreak.
  • February 4, 2020 - Japan's Prime Minister Shinzo Abe says people on a cruise ship moored off Yokohama will be asked to remain on board for an extended period, as 10 of them have tested positive for the new coronavirus. Abe said officials will ask the 10 infected people to disembark and go to hospitals. Infectious disease control law permits authorities to require hospitalizations. Abe said officials will ask the other people to stay aboard the vessel for a while, as the virus has an incubation period of up to 14 days.
  • February 3, 2020 – To protect the American people from exposure to the novel coronavirus known as 2019-NCoV, the Acting Homeland Secretary Chad F. Wolf issued new instructions clarifying where airplanes from China are authorized to land in the USA.
  • February 1, 2020 – The Secretary of Health and Human Services (HHS) who is the Chairman of the President’s task force on the novel coronavirus, announced significant travel-related changes that take effect at 5 p.m. ET on Sunday, February 2, 2020.

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). 

Recently, the CDC announced 'all people who have been in Hubei Province in China during the past 14 days are considered at high risk of having been exposed to the COVID-19 disease and are subject to a temporary 14-day quarantine.

Quarantine Duration

While the World Health Organization (WHO) estimates the incubation period of COVID-19 could be up to 14 days, this upper limit was actually observed for a small proportion of cases of SARS.

The CDC also says, at this time, that symptoms of COVID-19 may appear in as few as 2 days or as long as 14 days after exposure. This is based on what has been seen previously as the incubation period of MERS-CoV viruses.

In the context of an accelerating COVID-19 disease outbreak, a higher upper limit (possibly 21 days) for the incubation period is being debated to adequately protecting the public. A recent study from China reported an upper limit of 24 days for the COVID-19 incubation period.

However, the WHO commented that this "can reflect a double exposure" or "outliers," and that the "outlying observation" of 24 days "needs to be taken seriously" but in the "context of all of the other studies."

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.

Isolation and Quarantine programs

Isolation and Quarantine help protect the public by preventing exposure to people who have or may have a contagious disease.

  • Isolation separates sick people with a contagious disease from people who are not sick.
  • Quarantine separates and restricts the movement of people who were exposed to a contagious disease to see if they become sick.

Quarantine Stations

U.S. Quarantine Stations are part of a comprehensive Quarantine System that serves to limit the introduction of infectious diseases into the United States and to prevent their spread. U.S. Quarantine Stations, located at ports of entry and land border crossings, are located where most international travelers arrive at 20 US ports of entry, and they cover all 300-plus US ports of entry.

The University of Nebraska Medical Center

Since Nebraska Medicine and the University of Nebraska Medical Center (UNMC) handled the treatment of Ebola-infected patients in 2014, they have led the treatment, training and quarantine methods for highly infectious diseases in the USA.

  • Commissioned in 2005 by the United States Centers for Disease Control, the Nebraska Biocontainment Unit (NBU) provides the first line of treatment for people affected by bio-terrorism or highly hazardous communicable diseases. The NBU is one of only a few biocontainment units in the United States and is the largest, with up to a 10-bed capacity depending upon the specific infection.
  • Some of the unit's unique features include high-efficiency particulate air (HEPA) filtration system to ensure that micro-organisms do not spread beyond the patient rooms. There is a secured access main entrance featuring double doors that are pressure controlled. The staff has a separate, secured access entrance and exit.
  • Nebraska Medicine Health Centers, Immediate Care Clinics, emergency rooms, and the UNL and UNO campus health clinics are screening patients to promptly identify and evaluate any suspected cases. Travelers to certain parts of the world, particularly China, may have a higher risk.

Hand Sanitizers

While in quarantine or isolation, the CDC suggests washing hands with soap and water whenever possible because handwashing reduces the amounts of all types of germs and chemicals on hands. But if soap and water are not available, using a hand sanitizer with at least 60% alcohol can help you avoid getting sick and spreading germs to others.

Many studies show that hand sanitizers work well in clinical settings like hospitals, where hands come into contact with germs but generally are not heavily soiled or greasy. Some data also show that hand sanitizers may work well against certain types of germs on slightly soiled hands.

According to the World Health Organization, "an alcohol-containing preparation (liquid, gel or foam) designed for application to the hands to inactivate microorganisms and/or temporarily suppress their growth. Most alcohol-based hand antiseptics contain isopropanol, ethanol, n-propanol, or a combination of 2 of these products. The antimicrobial activity of alcohols can be attributed to their ability to denature and coagulate proteins. The microorganism’s cells are then lysed, and their cellular metabolism is disrupted.

Alcohol solutions containing 60% to 95% of alcohol are most effective.

Notably, higher concentrations are less potent because proteins are not denatured easily in the absence of water. Alcohol concentrations in antiseptic hand rubs are often expressed as percent by volume, but sometimes as percent by weight.

Note: This content was sourced from the CDC and has been review by health care professionals, such as Dr. Robert Carlson. Last reviewed on February 22, 2020.