What it Means to be Under Federal Quarantine

As Wuhan‘s coronavirus continues to spread beyond China, federal public health officials in the United States took an unusual step: issuing a mandatory quarantine, the first in more than 50 years.

“The goal here is to delay the entry of this virus into the United States,” says Dr. Nancy Messonnier, director of the National Center for Immunization and Respiratory Diseases at the CDC.

This is a federal quarantine.

What the federal quarantine implies may depend exactly on the circumstances, said James Hodge, director of the Center for Public Health Law and Policy at Arizona State University.

Generally, people facing a mandatory quarantine are under the direct order of the federal authorities to remain in the same place for a short period, while medical professionals assess whether they have been infected with a particular disease.

In the latter case, people are ordered to remain in facilities designated by the federal government, although in other potential situations, they could be confined to a hospital or their own homes, Hodge told CNN.

Americans who have been in the Chinese province of Hubei in the last 14 days or have traveled to other parts of mainland China and show symptoms associated with the virus will be examined at one of the 11 designated US airports and will be subject to a mandatory quarantine at a nearby facility, the US Department of Homeland Security announced.

The Centers for Disease Control and Prevention is also quarantining Americans who have been evacuated by the Wuhan State Department, the agency said.

“This strategy is not intended to trap all travelers returning from China with a new coronavirus. Given the nature of this virus and how it is spreading, that would be impossible. But working together we can catch most of them,” Messonnier said in a call to journalists on Monday.

The CDC said “it is working with state and local partners to identify locations where eligible travelers enter through the 11 designated US airports. They could be in quarantine. They could include military bases, hotels or other sites,” Messonnier said.

Other evacuees from Wuhan by the State Department stay in military homes, the CDC said.

Two charter flights carrying US citizens from Wuhan landed Wednesday at the Travis Air Force Base in California. One will remain there, while the other is expected to continue at the Miramar Marine Corps Air Station in San Diego, a US official with knowledge of the matter told CNN.

At the end of this week, two more flights must land in the United States, the CDC said. One will arrive at Lackland Air Force Base in San Antonio, Texas, and the other must arrive at Eppley Airfield in Omaha, Nebraska.

In addition to those places, the Pentagon has announced that the 168th Regiment of the Colorado Regional Training Institute could also be used to quarantine people.

Last week, another flight organized by the United States government arrived from Wuhan at the March Air Reserve Base in Riverside County, California, where 195 Americans remain in quarantine.

But Hodge said he is worried that the federal government will quickly run out of capacity to house quarantined people.

“They only have room for 1,000 people,” he said. “It’s four flights.”

The CDC said it expects the number of travelers arriving in the US to decrease. from Wuhan and Hubei Province and the number of people who meet the federal quarantine criteria.

While a federal quarantine does not look exactly like a four-star hotel, people have the right to food, water, lodging and medical treatment, and are free to communicate with family and friends, Hodge said. But they cannot leave their specific location until federal authorities indicate it.

A group of 195 Americans, many of them diplomats and their families, arrived by plane last week at the March Air Reserve Base in Riverside County, California.

They have undergone a mandatory quarantine of 14 days from the moment they left Wuhan.

According to Jarred Evans, one of the Americans under quarantine at the base, everyone is in a good mood.

The CDC medical staff monitors people at the base twice a day, takes their temperature and asks about their symptoms, he said. As far as he knows, no one has developed symptoms so far.

To pass the time, the evacuees have access to Zumba and kickboxing classes, and the children have toys and organized activities, he said. And as for food, the meals have included eggs, potatoes, muffins, sandwiches and french fries.

“Everyone respects each other,” Evans told CNN. “However, there are no group hugs or trembling hands.”

Yes, although some epidemiologists, lawyers and health organizations have expressed concern that the broad authority of the CDC may pose a threat to civil liberties.

The Department of Health and Human Services, under which the CDC is located, has the authority to isolate or quarantine people to prevent communicable diseases from spreading or spreading from a foreign country to the United States or from one state to another .

The government can only isolate or quarantine people who the CDC “reasonably believe” may be infected or exposed to a quarantine disease, including smallpox, viral hemorrhagic fevers, and severe acute respiratory syndromes.

Before issuing a quarantine or isolation order, the CDC conducts a public health risk assessment that considers a person’s symptoms and whether they could have been exposed to the disease.

The CDC has three days from the moment they put a person in custody to deliver a quarantine, isolation or parole order.

The CDC ensures that they strive to use “less restrictive and time-consuming measures” to protect public health. But keeping someone in a military base in California is considerably more restrictive than domestic quarantine, says Hodge.

“The CDC is clearly concerned, as we are doing worldwide, about any spread of this condition anywhere in the United States, and it is certainly a legitimate concern,” said Hodge.

“But, is it different from what we have seen in situations of previous infectious diseases, such as Ebola and other fronts where we allow quarantine at home in those circumstances? Most likely not.”

But it is possible that the CDC has information about quarantined people who have not made public, which could justify the agency’s case for this type of quarantine, he added.

CNN has contacted the CDC about these questions but has not yet received an answer.

The government may quarantine someone “only the time necessary to protect the public,” in accordance with regulations issued by DHS in 2017.

At that time, the government would provide the public with health care options to protect against the disease, such as voluntary immunization or drug treatment, and ensure that quarantined persons who have been exposed to the disease do not infect others.

At this time, there is no vaccine to prevent infection with the new coronavirus. Experts indicate that the best way to prevent infection is to avoid exposure to the virus.

While the new coronavirus has killed more than 400 people in mainland China, US officials say the overall risk to the American public is low.

There are currently 11 confirmed cases of the new coronavirus in the United States: nine of those people had recently traveled to Wuhan. The other two remaining cases had maintained close contact with people who traveled to Wuhan.

People who are in quarantine are entitled to a written order from the CDC within 72 hours of being detained explaining why the agency believes that quarantine is necessary.

If a quarantined person believes that the CDC has made a mistake, they may request that the agency reevaluate their order in writing within 72 hours.

If the CDC maintains that quarantine is necessary, the person may request an independent medical review to determine if the CDC’s recommendation is appropriate.

They can also hire representation to be present at the medical review they are in charge of.

Those who cannot afford to hire their own representation may have a designated representative at the expense of the government.

Quarantined persons also have the right to take their concerns to court.

If a person has health insurance, the CDC will bill their insurance provider for the costs of care provided during quarantine, according to Hodge. Then, depending on your insurance coverage, a person could be responsible for some or all of those costs.

During the public comment period on the last HHS rule on quarantine regulations, which entered into force in 2017, a union of flight attendants argued that the federal government should pay the medical costs incurred by quarantine flight attendants. But HHS rejected the suggestion.

“… Although the HHS/CDC does not intend to unduly charge people with the costs of their own isolation or quarantine, the payment of expenses shall be made in accordance with the constitutional and ethical obligations to meet basic needs, for for example, food, medical treatment, for those subject to such public health orders,” explains the department in its final rule.

For those who consider themselves unable to pay health insurance, the government will pay the bill but Hodge said it could take some of those costs to programs such as Medicaid when possible.

Evans told CNN that evacuees at the March Air Reserve Base will be billed for their evacuation flight. He does not know what other evacuees are being charged, but said his own bill is $ 1,100. And once the quarantine is over, he said everyone will have to pay their own trip to their final destination.

If someone decides to leave and violate quarantine evasion orders, there will be consequences.

Federal law states that a person who violates quarantine orders is subject to a fine of up to US $ 100,000, one year in prison or both, if the violation does not result in a death.

If it results in a death, the person would be subject to a fine of up to US $250,000, one year in jail or both.

Prior to concerns about the new coronavirus, the last time US officials issued a federal quarantine order was in the 1960s for smallpox evaluation, said Dr. Martin Cetron, director of the Division of Migration and Quarantine CDC global to journalists on Friday.

The CDC defines quarantine as the separation and restriction of movement of people who have been exposed to a contagious disease to see if they get sick.

It is more common for the agency to issue federal isolation orders, which separate people who have been infected with a contagious disease from those who have not been infected.

The CDC said it issues about one or two orders of quarantine, isolation or conditional release a year.

In general, confining people who have or might be suspected of having a disease such as coronavirus in one place is effective in preventing it from being transmitted to others, Hodge said.

But how quarantine orders are executed makes a big difference, he said. Forcing people to stay in a facility away from home for a period of up to two weeks could have unwanted consequences.

Potentially, people could lie or misrepresent their degree of exposure to a disease to avoid that kind of situation, Hodge said.

“The potential implementation of the federal hard-hand quarantine can be problematic and can be counterproductive,” he said.

Allowing people to be contained within their own homes would be a better solution, Hodge said, and would make people more willing to comply.

But CDC officials said Friday that once people receive information about why the federal government believes that quarantine is necessary, they mostly cooperate.

“We understand that this is a difficult situation for them. They have gone through a test,” said Messonnier.

“And we ask them to take some time with us to make sure they are protecting their families and their communities, and we really admire their flexibility and resilience.”




Source: CNN