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To contain the spread of a contagious illness, public health authorities rely on many strategies. Two of these strategies are isolation and quarantine. Both are common practices in public health and both aim to control exposure to infected or potentially infected individuals. Both may be undertaken voluntarily or compelled by public health authorities. The two strategies differ in that isolation applies to people who are known to have an illness and quarantine applies to those who have been exposed to an illness but who may or may not become infected.

Isolation: For People Who Are Ill

Isolation of people who have a specific illness separates them from healthy people and restricts their movement to stop the spread of that illness. Isolation allows for the focused delivery of specialized health care to people who are ill, and it protects healthy people from getting sick. People in isolation may be cared for in their homes, in hospitals, or at designated health care facilities. Isolation is a standard procedure used in hospitals today for patients with tuberculosis (TB) and certain other infectious diseases. In most cases, isolation is voluntary; however, many levels of government (federal, state, and local) have basic authority to compel isolation of sick people to protect the public.

Quarantine: For People Who Have Been Exposed But Are Not Ill

Quarantine, in contrast, applies to people who have been exposed and may be infected but are not yet ill. Separating exposed people and restricting their movements is intended to stop the spread of that illness. Quarantine is medically very effective in protecting the public from disease.

States generally have authority to declare and enforce quarantine within their borders. This authority varies widely from state to state, depending on the laws of each state. The Centers for Disease Control and Prevention (CDC), through its Division of Global Migration and Quarantine, also is empowered to detain, medically examine, or conditionally release individuals suspected of carrying certain communicable diseases. This authority derives from section 361 of the Public Health Service Act (42 U.S.C. 264), as amended.

SARS and Isolation

SARS patients in the United States are being isolated until they are no longer infectious. This practice allows patients to receive appropriate care, and it contains the potential spread of the illness. Those who are more severely ill are being cared for in hospitals. Those whose illness is mild are being cared for at home. Individuals being cared for at home have been asked to avoid contact with other people and to remain at home until 10 days after the resolution of fever, provided respiratory symptoms are absent or improving. (For more information on SARS infection control precautions, visit CDC's SARS Web site.)

SARS and Quarantine

To date, CDC has recommended isolation of individuals with SARS, but has not compelled quarantine or isolation of these individuals.

Q.1. What is CDC’s quarantine authority?

A.1. Title 42 United States Code Section 264 (Section 361 of the Public Health Service Act) gives the Secretary of Health and Human Services (HHS) responsibility for preventing the introduction, transmission, and spread of communicable diseases from foreign countries into the United States and within the United States and its territories/possessions. This statute is implemented through regulations found at 42 CFR Parts 70 and 71. Under its delegated authority, the CDC is empowered to detain, medically examine, or conditionally release individuals suspected of carrying a communicable disease.

Q.2. Why was an Executive Order necessary?

A.2. Under the procedures required under the PHS Act, the list of diseases for which quarantine is authorized must first be specified in an Executive Order of the President, on recommendation of the HHS Secretary. By amending the list to include SARS, HHS is simply taking the pragmatic step of readying all options as we continue to tackle this disease.

Q.3. What does the Executive Order accomplish?

A.3. In the event a passenger infected with SARS were to arrive in the United States on board an international flight, the Executive Order provides HHS with clear legal authority to detain or isolate the non-compliant passenger and prevent the passenger from infecting others. This authority would only be used if someone posed a threat to public health and refused to cooperate with a voluntary request.

Q.4. Were any other diseases added to the list?

A.4. No, the Executive Order only added SARS to the list of communicable diseases for which isolation and/or quarantine is authorized. The other diseases: Cholera; Diphtheria; infectious Tuberculosis; Plague; Smallpox; Yellow fever; and Viral Hemorrhagic Fevers, have appeared on the list since 1983.

Q.5. Why did CDC issue a new rule?

A.5. Amending the quarantine regulations to incorporate the Executive Order by reference eliminates the unnecessary administrative delay in the future of publishing another regulation if the list needs to be changed again. These revisions also serve the dual capacity of giving HHS the flexibility to better protect the public against the increased threat of a new microbe deliberately used in a bioterrorism event.

Q.6. Why was this new rule issued without notice and comment?

A.6. This rule was issued on an interim final basis with no prior notice and comment and no delay in effective date. As of April 12, 2003, the WHO has reported 2960 cases and 119 deaths of severe pneumonia-like illness of unknown origin in a growing number of countries. Several countries, including Canada, Hong Kong SAR, and Singapore have instituted maximum health measures, including quarantine, to prevent the further spread of the disease. The CDC is currently investigating 188 suspected cases of the disease in the United States. Accordingly, appropriate public health control measures including quarantine need to be available immediately to protect against this threat.

Q.7. Have other countries taken similar steps?

A.7. Several countries, including Canada, Hong Kong SAR, and Singapore have instituted maximum health measures, including quarantine, to prevent the further spread of the disease. Ontario, Canada has taken the additional step of making SARS a reportable, virulent, communicable disease under Ontario’s Health Protection and Promotion Act. This allows Canadian public health officers to issue orders to stop infected people from engaging in activities that transmit SARS.

Q.8. Have these new quarantine powers been used yet?

A.8. CDC has not compelled the isolation or quarantine of anyone for SARS. CDC routinely uses the authority of the PHS Act to monitor passengers arriving into the United States for communicable diseases.

Q.9. When was this quarantine power last used?

A.9. The last litigated case involving the involuntary quarantine of a passenger arriving into the United States occurred in 1963 and involved a suspect case of smallpox. On the other hand, CDC routinely temporarily detains incoming planes and interviews passengers for health reasons. For example, CDC temporarily detained an incoming plane and interviewed passengers in Seattle in December 2001 to verify that a report of smallpox aboard the flight was in fact a hoax.

Q.10. When does CDC intend to use these quarantine powers?

A.10. In general, HHS defers to the state and local health authorities in their primary use of their own separate quarantine powers. Based upon long experience and collaborative working relationships with our state and local partners, CDC would continue to anticipate the need to use this federal authority to actually quarantine a person only in rare situations, like events at ports of entry or in similar time-sensitive settings.
 

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