Quarantine: It’s one of the most delicate civil rights issues in history, because when does the common good trump individual freedoms? As fears about a possible pandemic spread thanks to air travel and the ready spread of viruses worldwide, the Obama Administration moved to widen quarantine powers via executive order, right in the middle of an Ebola outbreak in Africa. (The outbreak is not a pandemic, or an epidemic, for that matter, but more about that in a minute.) The timing certainly sent a clear message, but it may also have contributed to scaremongering about the risks of ebola.
The story starts in 2003, when President Bush signed Executive Order 13295: Revised List of Quarantinable Communicative Diseases. He was acting in response to Severe Acute Respiratory Syndrome (SARS) and wanted to create a framework for quarantining patients with the disease. He also named ebola among the subset of viral hemorrhagic fevers that merited quarantine. The Obama Administration has broadened the scope on SARS to include all “severe acute respiratory syndromes,” not just SARS.
The original text read:
(b) Severe Acute Respiratory Syndrome (SARS), which is a disease associated with fever and signs and symptoms of pneumonia or other respiratory illness, is transmitted from person to person predominantly by the aerosolized or droplet route, and, if spread in the population, would have severe public health consequences.
Now, it says that:
(b) Severe acute respiratory syndromes, which are diseases that are associated with fever and signs and symptoms of pneumonia or other respiratory illness, are capable of being transmitted from person to person, and that either are causing, or have the potential to cause, a pandemic, or, upon infection, are highly likely to cause mortality or serious morbidity if not properly controlled. This subsection does not apply to influenza.
This change in policy does not indicate that people will be forced into mandatory detention for being sick, or that they’ll be quarantined at random, as some scaremongers have claimed. In fact, their erroneous statements can lead people to conceal the signs of serious illness to avoid identification and quarantine, which poses a huge public health risk. In fact, federal law permits for quarantine when people are entering the country or crossing state boundaries, and otherwise leaves the matter up to the states. The update simply reflects the need for increased accuracy and a broader scope (covering conditions like Middle East Respiratory Syndrome, which wasn’t named in the original document) in the event of a truly dangerous disease.
And despite the timing, it has nothing to do with ebola, which is not passed via a respiratory route. The virus travels only through direct contact with infected body fluids. The administration’s unfortunate decision to make this change in the midst of an outbreak (the current situation is not widespread enough to be considered an epidemic, nor is it of the scope of a pandemic) was perhaps not the best PR move, but the change in language isn’t something people should be afraid of.
Before people are placed in quarantine, the situation is reviewed carefully by public health officials, administrators and medical personnel. The decision is not taken lightly, and everyone operates in awareness of the fact that isolating someone to prevent the spread of disease needs to be accompanied with sensitivity about depriving people of their liberties — and that people deserve the best possible care while in quarantine.
Photo credit: Anna Fox.