CDC Seeks Quarantine Powers

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February 14, 2017 | 34,767 views

Story at-a-glance

  • On January 19, 2017, the last day of the Obama administration, the U.S. Centers for Disease Control and Prevention (CDC) published a new final rule on the Control of Communicable Diseases that is scheduled to take effect in March
  • The new rule gives the CDC expanded authority to apprehend, isolate and quarantine for at least 72 hours a person entering the U.S. or traveling between states, who is suspected of being infected or at risk of being infected with one of nine diseases on the U.S. quarantine list
  • The rule allows the CDC to detain a person exhibiting certain infection symptoms such as fever, headache, acute gastroenteritis (abdominal cramps, loose stools or vomiting), and also strengthens federal surveillance of travelers for non-quarantinable diseases like measles, pertussis and meningococcal disease

By Dr. Mercola

The federal government's legal authority to detain and quarantine persons infected with certain highly communicable and deadly infectious diseases historically primarily has involved detaining people entering the U.S. by boats and airplanes or traveling across state lines.

Federal government officials have long had the authority to apprehend, isolate and quarantine people for a limited number of infectious diseases on the U.S. quarantine list.  

However, the legal authority for surveillance, detention and quarantining of citizens residing in the U.S. suspected of being infected with certain non-quarantinable communicable diseases historically has resided with state government health officials.1

On January 17, 2017, the last day of the Obama administration, a new final rule on the Control of Communicable Diseases was issued by the U.S. Centers for Disease Control and Prevention (CDC) that is schedule to take effect in March.

The new rule gives the CDC expanded authority to apprehend, isolate and quarantine for at least 72 hours a person entering the U.S. or traveling between states, who is suspected of being infected, or at risk of being infected, with one of the nine diseases on the U.S. quarantine list (cholera, plague, diphtheria, smallpox, yellow fever, infectious tuberculosis, viral hemorrhagic fevers [like Ebola], severe acute respiratory syndrome [SARS] and influenza) that can cause a pandemic.2

The rule also strengthens federal surveillance of travelers for symptoms of non-quarantinable diseases like measles, pertussis and meningococcal disease.3

While proponents are touting the changes as necessary to protect the public health, critics have been arguing since the CDC first published the Notice of Proposed Rule Making (NPRM) in August 2016, that it is an example of government overreach, which poses a risk to  health and civil liberties.4  

Because the National Vaccine Information Center (NVIC) and other organizations advocating for protection of civil liberties urged Americans to contact the CDC and oppose the NPRM last summer, the CDC received more than 15,000 comments from the public, many of them expressing concern that the rule violated the U.S. Constitution, and human and civil rights.

Although the CDC rejected this characterization, the agency did make changes to the final rule, including eliminating a provision that would have allowed the CDC to require individuals to agree to submit to public health measures such as hospitalization, vaccination and medical treatment.

In addition, the final rule states that medical examinations can only be conducted with prior informed consent.5

Who Could Be Quarantined Under the New Rule?

The new rule gives the CDC the power to detain for further health assessment a person who is crossing the U.S. or state borders if he or she is exhibiting certain infection symptoms associated with quarantinable diseases, such as fever, headache and acute gastroenteritis (abdominal cramps, loose stools or vomiting).

The new rule also makes it clear that rash and cough symptoms of non-quarantinable infectious diseases, such as measles and pertussis, among travelers are going to be more closely monitored by federal government officials as well.

For non-quarantinable diseases, CDC will be working with state health departments, who have the legal authority to detain and quarantine citizens suspected of being infected with, or at risk for, being infected with a communicable disease.

James Hodge Jr., a professor of public health law and ethics at the Sandra Day O'Connor College of Law at Arizona State University, told NPR, "Because of the breadth and scope of the definition of ill persons, CDC can target a much wider swath of persons to assess and screen."6

Airline Pilots and Ship Operators to Become Surveillance Crews?

The new rule also includes new reporting requirements for airplanes and ships. If the rules take effect, airline pilots and ship operators would be required to report not only deaths on board but also "certain overt and common signs and symptoms of sick travelers" to the CDC prior to arriving into the U.S. Barbara Loe Fisher, NVIC co-founder and president noted:7

"It is not a good idea to make the public's airport experience even more difficult by enlisting flight crews to report passengers with symptoms that could be nothing more than eczema, acne, norovirus or the common cold.

…. What started out as a vacation could be turned into a nightmare spent in an airport quarantine center."

The required signs and symptoms include the following, and must be reported not only during international travel, but also on airline flights flying domestically, between states:8

Airlines:

(1) Fever (defined as measured temperature of 100.4 degrees F [38 degrees C] or greater, feels warm to the touch or gives a history of feeling feverish)

AND one of the following:

  • Skin rash
  • Difficulty breathing
  • Persistent cough
  • Decreased consciousness or recent onset of confusion
  • New unexplained bleeding or bruising
  • Persistent diarrhea
  • Persistent vomiting (other than airsickness)
  • Headache with stiff neck
  • Appearing obviously unwell; OR

(2) Fever that has persisted for more than 48 hours; OR

(3) Other signs or symptoms of communicable disease CDC is concerned about and has announced in the Federal Register.

Ships:

(1) Fever (defined as measured temperature of 100.4 degrees F [38 degrees C] or greater, feels warm to the touch or gives a history of feeling feverish)

AND one of the following:

  • Skin rash
  • Difficulty breathing or suspected or confirmed pneumonia
  • Persistent cough or cough with bloody sputum
  • Decreased consciousness or recent onset of confusion
  • New unexplained bruising or bleeding
  • Persistent vomiting (other than seasickness)
  • Headache with stiff neck
  • Appearing obviously unwell; OR

(2) Fever that has persisted for more than 48 hours; OR

(3) Acute gastroenteritis (inflammation of stomach or intestines or both), defined as:

  • Diarrhea, defined as within a 24-hour period, three or more episodes of loose stools or an occurrence of loose stools that is above normal for the person, or
  • Vomiting and one or more of the following additional symptoms: one or more episodes of loose stools in a 24-hour period, abdominal cramps, headache, muscle aches or fever (temperature of 100.4 degrees F [38 degrees C] or greater); OR

(4) Other signs or symptoms of communicable disease CDC is concerned about and has announced in the Federal Register.

Is This Part of Global Efforts to Eradicate Measles?  

In August 2016, NPRM, the CDC pointed to "the ongoing persistence of measles in the United States" as an example of why the updated rules are necessary. They even said, "Every case of measles in the United States is considered a public health emergency because of its extremely high transmissibility."9

The World Health Organization (WHO) and U.S. health officials have targeted mass MMR vaccination campaigns as the solution to eradicating measles, even though serious questions remain about the vaccine's efficacy and safety.

In the final rule, measles outbreaks in the U.S. were again highlighted. It illustrates why travelers with a rash or cough could become the subject of scrutiny and reporting to the CDC by airline and other public transportation personnel as the federal government more closely monitors almost all signs of illness in all travelers.

Will the New Rules Backfire?

Once it becomes widespread knowledge that an airline pilot or ship's captain must report symptoms of common illness directly to the federal government, and that information could be used to immediately detain or quarantine you, there's a good chance people may try to evade the system. Jennifer Nuzzo, a research epidemiologist at the Johns Hopkins Center for Health Security, told NPR:10

"The worst-case scenario is that people may try to evade these procedures by, say, taking medicines to reduce their fever, or be afraid to report it if they are feeling ill on a plane … We don't want to drive cases underground by putting measures in place that seem as though they carry some penalties associated with them."

Emergency Health Measures Should Be Grounded in Science, Not Fear

While one concern is that increased surveillance of travelers by health officials could drive diseases underground, another is that overreaching power could allow people to be wrongly detained. An op-ed piece in The New York Times described the case of Kaci Hickox, who had volunteered as a nurse treating Ebola patients in Sierra Leone, West Africa.

She had no known exposure to the disease, as she had worn heavy protective gear, but upon her return to the U.S., New Jersey Gov. Chris Christie ordered her quarantined to an area hospital. This was against the current CDC guidelines, which stated she should monitor herself for symptoms at home.

"It's imperative that whenever the next outbreak hits, emergency health measures are grounded in scientific evidence and guided by clear, fair rules to protect people from wrongful deprivation of their liberties," the Times piece states, continuing:11

"That incident wasn't an anomaly. During a bubonic plague outbreak in 1900, for example, government officials quarantined the entire Chinatown neighborhood of San Francisco.

The quarantine applied only to Chinese residents, and lacked any scientific basis. It was fueled by little more than naked fear and racism. Given this history, we want to ensure that federal officials applying the new regulations will act on the basis of science and evidence and not on politics and public fear."

What Diseases Are Covered in the Quarantine Rules?

According to the new rules, "CDC may apprehend, detain, examine or conditionally release an individual if it reasonably believes that he/she may be infected with or exposed to a quarantinable communicable disease."12 Those diseases currently include the following:

Cholera

Diphtheria

Infectious tuberculosis

Plague

Smallpox

Yellow fever

Viral hemorrhagic fevers (Lassa, Marburg, Ebola, Crimean-Congo, South American and others not yet isolated or named)

Severe acute respiratory syndromes (e.g., SARS, MERS)

Influenza caused by novel or reemergent influenza viruses that are causing, or have the potential to cause, a pandemic

However, as mentioned, the new rule also allows the CDC to step up federal surveillance of travelers displaying a number of common illness symptoms associated with non-quarantinable diseases like measles and pertussis.

Although travelers found to be infected with or at risk for being infected with a non-quarantinable disease like measles cannot be quarantined by federal health officials, state health officials do have the legal authority to detain and quarantine residents infected with certain communicable diseases, depending upon the state's public health laws.

The final rule was originally scheduled to go into effect February 21, 2017. However, with the change in administration, the new regulations are being reviewed and will not take effect until the end of March 2017, at the earliest.13

[+]Sources and References [-]Sources and References

  • 1 Cole JP, Swendiman JS. Mandatory Vaccinations: Precedent and Current Laws. Congressional Research Service May 21, 2014.
  • 2 CDC. Legal Authorities for Isolation and Quarantine
  • 3, 8, 12 U.S. CDC, Final Rule for Control of Communicable Diseases: Interstate and Foreign
  • 4 CDC to Amend Public Health Service Act
  • 5 Jurist: Federal Communicable Disease Regulation: Balancing Civil Liberties and Public Health
  • 6, 10, 13 NPR February 2, 2017
  • 7, 9 Enhanced Online News September 13, 2016
  • 11 The New York Times January 23, 2017