The Ebola Outbreak & The U.S. Response to Infectious Disease

September 5, 2014

Ebola virus containment quarantineWest Africa is currently experiencing the largest Ebola outbreak ever recorded, creating fear and panic even here in the U.S., despite assurances that there is little risk to the general population in the United States. According to the World Health Organization (WHO), the Ebola virus is a severe, often fatal illness with a fatality rate of up to 90%. Incidents and outbreaks of Ebola typically appear in remote Central and West Africa. The current outbreak is occurring primarily in Guinea, Liberia, and Sierra Leone, though Nigeria has begun to see some cases. The WHO estimates there have been 3,069 cases as of August 26, 2014 in the current outbreak.

In early August, two American missionaries working in Liberia were afflicted with the Ebola virus.  They were transported to Emory University Hospital from West Africa for treatment and were later discharged. Emory University Hospital is located in Atlanta near the Centers for Disease Control headquarters and is one of only four facilities in the U.S. equipped to handle highly contagious diseases like Ebola. Their isolation unit (“Serious Communicable Disease Unit”) was developed and built in conjunction with the CDC to care for CDC scientists and others exposed to infectious diseases.

Despite efforts, West Africa has struggled to contain the outbreak and the WHO has declared the outbreak a Public Health Emergency of International Concern. The WHO has requested affected countries to declare emergencies and put screening programs in place at airports, seaports and land crossings to prevent infected individuals from traveling.  While these procedures are being implemented across the Atlantic Ocean, the question is raised: What kind of emergency procedures and protocols does the United States or the states individually have designed to address a public health emergency such as this? I ran the following WestSearch in all state and federal materials on WestlawNext:

QUARANTINE INFECTIOUS DISEASE HUMAN PERSON

 I clicked into the Statutes first. Here are some examples of statutes that came up in our initial results:

IA ST § 139A.2 Definitions

  • This is a definitions section under the Public Health title, and chapter for Communicable and Infectious Diseases and Poisonings in Iowa Code. It contains definitions for “Quarantine.” “Communicable Disease.” “Contagious or infectious disease,” “exposure,” and “Isolation,” among many others.

20 ILCS 2305/2 Powers

  • Illinois statute providing for the powers of the State Department of Public Health to declare and enforce quarantine and isolation, and order observation and monitoring of persons, in an effort to “prevent the spread of dangerously contagious or infectious disease among humans.”

20 Del.C. § 3142

  • Delaware statute delegating to the state Public Health Emergency Planning Commission, the responsibility of creating a plan to respond to public health emergencies, including guidelines and plans for effective communication, stockpiling, evacuation, treatment, human remains and waste disposal, and isolation, quarantine and vaccination, among others.

Some notable Secondary Source results included the following:

Robert W. Parnacott, Anthrax, Smallpox, and Flu, Oh My! The Law of Infectious Disease Control in Kansas, J. Kan. B. Ass’n, October 2009, at 24

Alfred J. Sciarrino, The Grapes of Wrath & the Speckled Monster (Epidemics, Biological Terrorism and the Early Legal History of Two Major Defenses – Quarantine and Vaccination), 7 Mich. St. U. J. Med. & L. 117 (2003)

Felice Batlan, Law in the Time of Cholera: Disease, State Power, and Quarantines Past and Future, 80 Temp. L. Rev. 53 (2007)

  • This article provides a brief but comprehensive history of quarantine law in the United States, both federal and state powers.

Much of what we’re seeing focuses on the state quarantine power, which makes sense considering the 10th Amendment’s reservation of powers to the states, including, as historically interpreted, police powers to protect the health and safety of citizens. But I wanted to see regulations regarding quarantine and the role of the CDC. I ran the following query in WestlawNext across all content again:

CENTERS FOR DISEASE CONTROL QUARANTINE

The first result in Regulations was 42 C.F.R. § 70.2 – Measures in the event of inadequate local control.

  • This appears to be a regulation that allows the CDC to act to prevent the spread of communicable diseases between states upon a determination that methods taken by any state are insufficient to do so.

To provide myself a little more context for this regulation, I clicked on the Table of Contents link from 42 C.F.R. § 70.2 and noticed that Part 71 of Title 42 (Public Health) in the CFR covers Foreign Quarantine. 42 C.F.R. § 71.1 establishes that Part 71 contains regulations to prevent the introduction, transmission, and spread of communicable disease from foreign countries into the states or territories of the U.S. This section also links to an Executive Order from April of 2003 that contains a list of quarantinable communicable diseases. Exec. Order No. 13295 Revised List of Quarantinable Communicable Diseases, 68 FR 17255. This list includes Ebola, among other Viral Hemorrhagic Fevers.