Quarantine and Isolation, an (Almost) Timeless Tool in Combating Communicable Disease
Co-authored by CHHS Public Health Program Manager Trudy Henson, JD, and CHHS Research Assistant Andrew Geltman
Laws on quarantine and isolation are nothing new in the United States. However, at the time of the country’s founding, quarantine and isolation authority was viewed primarily as the responsibility of local and state governments. The ability of the states to impose quarantine and isolation was and is based on their broad “police powers” reserved in the Tenth Amendment.
However, states’ authority to impose quarantine and isolation does not mean that the federal government has no such authority. Very early on, the federal government recognized that it needed to have some ability to impose quarantine and isolation to protect public health. In 1799, President George Washington signed the first federal quarantine act into law. The law allowed for the seizure of ships and their passengers by federal authorities if they deemed the ship(s) to be in “insanitary conditions.” This law was subsequently repealed, thereby once again leaving the primary authority for quarantine and isolation to the states. But differing laws and sporadic enforcement by the states led the federal government to pass national legislation in 1878. This time, the federal law did not create unilateral federal authority to quarantine and isolate individuals. Instead, the law piggybacked on state laws by allowing federal officials to extend state-imposed quarantine and isolation periods. In 1884, President Chester Arthur issued a proclamation that authorized the quarantine and isolation of persons suspected of being infected with “pestilence” (tuberculosis) entering the U.S. through points of entry.
As the scientific understanding of disease expanded, the federal government expanded its quarantine authority. For example, states became less involved in the monitoring ports of entry. By 1921, all quarantine stations at U.S. ports had been turned over from the states/localities to the federal government. As a result, the quarantine and isolation system—at least for ports of entry—had become federalized.
The piece of legislation that firmly created federal quarantine and isolation authority was the Public Health Services Act of 1944. The act gave the Public Health Service (PHS) the responsibility to prevent the introduction and transmission of disease from foreign countries into the United States. After 1944, PHS’ authority expanded and shifted into different agencies until 1967, when quarantine authority was transferred to the Centers for Disease Control and Prevention (CDC).
The shifting of quarantine and isolation authority to the CDC signals the beginning of the current legal framework for federal quarantine and isolation authority. The modern legal framework is based in 42 U.S.C. § 264 (2002). This statute grants the federal government authority to isolate and/or quarantine persons with certain diseases, housed within an executive order issued by the President. Executive Order No. 13295 states that the federal government has the authority to quarantine individuals with Tuberculosis, Cholera, Diphtheria, infectious Plague, Smallpox, Yellow Fever, Severe Acute Respiratory Syndrome (SARS) and Viral Hemorrhagic Fevers (note that Ebola is a “Viral Hemorrhagic Fever”). The Executive Order 13295 has been expanded several times. Most recently, President Obama clarified the definition of SARS and also expanded it to include the Middle East Respiratory Syndrome (MERS).
The quarantine authority of states is divergent. However, after the 2001 anthrax attacks, many states updated their quarantine authorities. Some updated these authorities based on the Model State Emergency Health Powers Act, while other states have only adopted portions of the Act, arguing that it is too restrictive and severely infringes on Constitutionally-protected individual liberty and property interests..
Although the federal government has increased its presence and authority in the quarantine and isolation of individuals with communicable diseases, the exercise of such authority remains primarily a prerogative of state and local government. The last time that the federal government issued large-scale quarantine and isolation orders was during the outbreak of Spanish Flu between 1918-1919. Since then, federal-issued quarantine orders have been rare: the government issued one in 1963, when a passenger arriving in the U.S. was suspected of carrying smallpox and was placed under federal quarantine. In 2007, Andrew Speaker was placed under federal quarantine when he was suspected of being infected with extremely drug resistant tuberculosis (XDR-TB).
So far, the federal government has not issued isolation or quarantine orders for the Ebola outbreak—those orders have been pursuant to state quarantine authority. The Texas Department of State Health Services issued the isolation order for Thomas Eric Duncan and the quarantine order for his family. The New Jersey Department of Health issued a quarantine order to a NBC news crew suspected of being exposed to Ebola while in Liberia. However, the federal government has been significantly involved in handling the Ebola response. The CDC has issued guidance for hospitals on how to handle Ebola cases and has also issued new screening procedures for airports. The screening procedures call for the taking of temperatures of travelers from effected countries in Africa. If any travelers are displaying symptoms of Ebola the CDC will immediately isolate the individual. Additionally, measures from any entry points into the country—from border gates to airport gates—would be implemented largely from the federal level.
Despite increased precautions to prevent the introduction of Ebola from foreign countries, Americans overwhelming believe that a travel ban from affected countries is needed. Ninety-one percent of Americans also believe that more aggressive screening procedures at airports are needed. Many of these measures mirror measures that were proposed in a 2005 CDC quarantine ruleafter the avian flu outbreak. The rule would have required airlines to report ill passengers and collect and maintain the contact information of passengers to more easily facilitate contact tracing. The proposed rule also authorized the CDC to detain individuals for three days if they were suspected of being infected with various diseases, including Ebola. The Obama Administration withdrew the proposed rule before it was finalized.
However, new measures may be considered in the near future as the CDC “rethinks control measures,” and a House Subcommittee is preparing for a hearing on Thursday about the U.S. public health Ebola response.
 Although often spoken of in tandem, isolation and quarantine mean different things. Briefly, isolation separates those who are already sick from those who are not; quarantine separates and restricts the movement of those who have been potentially exposed but are not yet sick, to see if they become sick. For additional information, see the CDC’s Isolation and Quarantine webpage.