Thomas Duncan, the first person diagnosed with the Ebola virus in the United States, is in isolation in a Dallas hospital, and the family he stayed with is now in quarantine in an apartment complex north of downtown Dallas.
That means the family has been ordered not to leave their home and is banned from hosting any visitors until the 21-day incubation period for Ebola has passed. While they are in quarantine, police are surveying the building and necessities are being delivered to the family.
Quarantine is a legal move as much as it is a public health tool. Under the Texas Health and Safety Code, police can charge the family with a third-degree felony should they leave the apartment.
This has Shots wondering, how do isolation and quarantine actually work? We talked to Wendy Mariner, a professor of health law at the Boston University School of Public Health. Here are highlights of the conversation, edited for clarity and brevity.
How does isolation actually work?
Isolation can be voluntary or involuntary. When you have a really sick patient, like someone who has symptoms of Ebola, isolation is just good medical practice. They take care of a person in an isolation room in a hospital and use all kinds of infection control practices and patients usually want that; they submit to that because they want to get better. That's what happens in the vast, vast, vast majority of cases.
Only in a handful of cases do you have the possibility of involuntary isolation. From the law's perspective, in order to require someone to be isolated, they would have to have a dangerous contagious disease that's easily transmissible person-to-person and, and this is important, be unable or unwilling to isolate themselves. In other words, they would pose a danger to other people because they would come in contact with other people either voluntarily or because they couldn't help themselves. For the most part, it just doesn't happen very much in this country.
What's the process for putting someone under involuntary isolation?
When public health officials or a physician want to petition to have someone involuntarily isolated, then they would have to go to court and prove both those points: dangerous contagious disease and the probability that the person would spread it to others if not confined.
You're clearly entitled to a hearing, and then you would have to be released once those conditions no longer apply — it can't be forever.
How is quarantine different from isolation?
Quarantine is most precisely used to mean confining people who may have been exposed to one of these dangerous contagious diseases. It's not that they're necessarily sick. But the goal is, if they've been exposed to a dangerous contagious disease, to keep them from exposing other people.
What can you do while you're in quarantine?
I think the public officials and physicians ought to provide you with information about how you should take care of yourself, and how to clean dishes, and how to make sure you don't touch each other. You conduct your life as you would otherwise, but you're probably bored to tears.
They're monitoring to make sure that you don't have any symptoms and presumably, if someone develops a symptom like fevers or headaches, they would probably whisk them into a hospital and ask them to stay in isolation.
How do they decide how long to isolate or quarantine people?
All of this is highly fact-specific according to the particular disease.
When else has the U.S. used isolation and quarantine?
In the late 80s, early 90s, when a lot of treatment programs for tuberculosis lost funding and there was an influx of both HIV and TB; immigrants, homeless people, many who were mentally ill, or many who were on drugs and didn't have any place to go, so they ended up being isolated in the hospital.
Early in the 1920s there was sometimes isolation for somebody with sexually transmitted infections before there were antibiotics to treat them. But again it was targeted largely at poor sex workers and some immigrants.
Isolation is a useful tool in extreme circumstances, but it has an unhappy history of being applied rather selectively. But of course, as I said earlier, you really don't need it for most people. Most people understand the need for staying away from other people if they're infectious.
What's an example of quarantine's unhappy history?
There have been circumstances, more than 100 years ago. There was a large quarantine order in San Francisco which was struck down by the courts because it essentially quarantined the healthy with the sick, in plague, and was also highly discriminatory. It really only quarantined people of Chinese ancestry in Chinatown in San Francisco, kind of wound around the Caucasian places, so it was pretty obviously discriminatory.
Where is the line between state and federal jurisdiction for isolation and quarantine?
States are sort of the first line; they have basic authority to impose involuntary detention of a person within their territory. The federal government does have authority to quarantine, but it stems from the federal government's power to regulate foreign and interstate commerce. So it really deals with people who are crossing the borders, not with local non-commercial activities like going to the hospital. It is possible that had anyone been aware of Duncan's arrival from another country to the U.S., that the federal government could have taken some action and asked, but he was fine then. It's mostly the states that do this — this is 99.9 percent state in practice.