During the COVID-19 pandemic of 2020, the terms quarantine and isolation have been used interchangeably. Isolation and Quarantine help protect the public by preventing exposure to people who may have a contagious disease.
Many healthcare providers offer this simple clarification: Quarantine is for people who are not sick but have been exposed to a virus, while isolation is for sick people with a disease.
Quarantine is used to keep someone who might have been exposed to COVID-19 away from others. People in quarantine should stay home, separate themselves from others, monitor their health, and follow directions from their state or local health department.
On December 2, 2020, the Centers for Disease Control and Prevention (CDC) announced it had revised quarantine guidelines for people who may have been exposed to the SARS-CoV-2 coronavirus for about 15 minutes and within 6-feet distance. If individuals do not develop symptoms, they should quarantine for 10 days. If they test negative, that period can be reduced to just 7-days.
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 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 related programs.
State-Based Isolation and Quarantine
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 US Centers for Disease Control and Prevention leaders announced expanding how it defines a “close contact” of someone with COVID-19. The CDC's leaders said on October 21, 2020, a close-contact is someone who spent a cumulative 15-minutes or more within 6-feet of someone infectious over 24 hours.
The CDC advises anyone who has been in close contact with a COVID-19 patient to quarantine for 2-weeks.
A key element in any most plans to reduce the coronavirus pandemic is ‘Contact Tracing,’ which can trace and monitor infected people's contacts. Using smartphones for digital contact tracing is being widely discussed by public health officials.
Social Distancing is an action taken to minimize contact with other individuals; social distancing measures comprise one category of non-pharmaceutical countermeasures (NPCs) to reduce disease transmission and reduce pressure on health services.
The tactic of 'social distancing' was previously deployed during the 1918 influenza outbreak in the USA.
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 for taking 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. If a person breaks a 'quarantine order,' it is a criminal misdemeanor in most states.
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.
A study published on November 8, 2020, based on 4,040 SARS CoV-2 RT-PCR tests, an exit test 96 hours after the start of quarantine for an offshore oil rig population was demonstrated to identify all known asymptomatic cases that previously tested negative at entry, and—moreover—successfully prevented an expected nine offshore transmission events, each a serious concern for initiating rapid spread and a disabling outbreak in the close quarters of an offshore rig. This successful outcome highlights the importance of context-specific guidelines for the duration of quarantine and timing of testing that can minimize economic impacts, disruptions to operational integrity, and COVID-related public health risks.
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.