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).
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.
Interim Guidance for Coronavirus Disease 2019 in the USA
On March 15, 2020, the CDC, in accordance with its guidance for large events and mass gatherings, recommends that for the next 8 weeks, organizers cancel or postpone in-person events that consist of 50 people or more throughout the United States. This recommendation does not apply to the day to day operation of organizations such as schools, institutes of higher learning, or businesses.
This recommendation is made in an attempt to reduce the introduction of the SARS-CoV-2 coronavirus into new communities and to slow the spread of infection in communities already affected by the virus. This CDC recommendation is not intended to supersede the advice of local public health officials.
State-Based Emergency, 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 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).
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.
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."
Discontinuing Home Isolation
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:
- Time-since-illness-onset and time-since-recovery strategy (non-test-based strategy). Persons with COVID-19 who have symptoms and were directed to care for themselves at home may discontinue home isolation under the following conditions. At least 3 days (72 hours) have passed since recovery defined as resolution of fever without the use of fever-reducing medications and improvement in respiratory symptoms (e.g., cough, shortness of breath); and, At least 7 days have passed since symptoms first appeared.
- Test-based strategy (simplified from initial protocol) Previous recommendations for a test-based strategy remain applicable; however, a test-based strategy is contingent on the availability of ample testing supplies and laboratory capacity as well as convenient access to testing. For jurisdictions that choose to use a test-based strategy, the recommended protocol has been simplified so that only one swab is needed at every sampling.
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.
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.
They are staffed with medical and public health officers from the CDC and managed by CDC’s Division of Global Migration and Quarantine. These health officers decide whether ill persons can enter the United States and what measures should be taken to prevent the spread of contagious diseases.
Interim Guidance for Public Health Professionals Managing People With COVID-19 in Home Care and Isolation Who Have Pets or Other Animals
- This interim guidance is for public health professionals managing the home care and isolation of people with COVID-19 who have pets or other animals (including service or working animals) in the same home. The intent of this guidance is to facilitate preparedness and establish practices that can help people and animals stay safe and healthy.
- At this time, there is no evidence that companion animals, including pets, can spread COVID-19 disease.
- 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.
- Decisions on when and how to implement social distancing measures should always be informed by evidence, but they will very rarely be purely evidence-based. Social and political considerations will also need to be taken into account.
- The tactic of 'social distancing' was previously deployed during the 1918 influenza outbreak in the USA. Schools, theaters, churches and dance halls in cities across the country were closed. Kansas City banned weddings and funerals if more than 20 people were to be in attendance. New York mandated staggered shifts at factories to reduce commuter traffic. Seattle’s mayor ordered his constituents to wear face masks.
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 March 29, 2020.