States Take Preemptive Measures to Guard Against Ebola

QuarantineAs concerns mount regarding the Ebola outbreak in the United States, state governments are taking matters into their own hands to proactively protect their citizens from the deadly disease. On October 7, although no cases of Ebola had been identified in the state at the time, Connecticut Governor Dannel Malloy signed an order declaring a public health emergency (PHE) in relation to Ebola. By signing the order, Malloy authorized Commissioner of Public Health Jewel Mullen to order the isolation or quarantine of any individuals or groups whom the commissioner “reasonably believes to have been exposed to, infected with, or otherwise at risk of passing the Ebola virus.”

In much of the media coverage on Ebola, there is often a lack of clarity about the terms isolation and quarantine. Isolation refers to separating a person who is contagious with Ebola from others who are not sick to prevent them from spreading the disease. Quarantine refers to restricting the movement of people who could become infected with Ebola because they have history of close contact with a person infected with Ebola. Isolation and quarantine minimize contact with others and can help break the chain of transmission.

According to the governor’s office, without the PHE order there is no statewide authority to isolate or quarantine suspected cases of Ebola under Connecticut law. Rather, local health directors are responsible for ordering the isolation or quarantine of individuals infected with (or suspected of being infected with) a communicable disease. However, with the governor’s PHE order, the authority to isolate or quarantine is removed from local control and transferred to the state. Mullen stated that “[w]hile local health officials are certainly on the front lines of this effort, at the ready to address any situation, having this order in place will allow us to have a more coordinated response” in the event of a suspected or actual case of Ebola.

Due to the high mortality rate of Ebola and the goal of containing the spread of the outbreak as quickly as possible, Connecticut became the first state to take control away from local officials in an effort to ensure a coordinated response. And though decision-making authority is now at the state level, local health departments will still be involved in response conversations and efforts.

The continued involvement and relevance of local health departments was recently demonstrated in Connecticut when a Yale doctoral student was admitted to Yale-New Haven Hospital on October 16 with Ebola-like symptoms, though tests have since come back negative. The student, along with a classmate, recently returned from Liberia after working on a computer system to model the spread of Ebola to assist Liberia’s efforts to combat the disease. Yale University initially asked the two students to self-quarantine for 21 days (Ebola’s incubation period); however, Yale reversed that decision upon the students’ return citing lack of direct contact with infected individuals. Paul D. Cleary, dean of Yale University’s School of Public Health, said in an October 13 letter that “after carefully considering the matter, a University-wide team of physicians, epidemiologists, and senior administrators concluded that a 21-day sequestration was unnecessary.” Cleary indicated that the decision was made in consultation with the Centers for Disease Control and Prevention (CDC). Mullen did not use her PHE powers to order the quarantine of the two student researchers upon their return. Moreover, during the infection scare, Yale-New Haven Hospital stated that it was working with city, state, and federal health officials to address the possible situation. Thus, all levels of government, including LHDs, are active participants in efforts to contain the deadly disease.

In response to Connecticut’s PHE declaration, the governors of several other states, including Massachusetts and New Hampshire, have indicated that no similar declaration is needed in their states to provide state health officials with isolation or quarantine authority. In Oklahoma, State Representative Mike Ritze is calling on Governor Mary Fallin to issue a declaration of catastrophic emergency to ensure that state health officials have the authority to quarantine individuals suspected of carrying Ebola. Alex Weintz, spokesman for Fallin’s office, indicated that the state health commissioner already had that authority and that declaring a state of emergency before an Oklahoman became infected with Ebola would be “premature.” Weintz further stated that “Governor Fallin is coordinating with health officials and hospitals to ensure that the state is prepared to treat and contain any incidents of Ebola in Oklahoma.” As in Connecticut, local health departments remain active participants in Ebola response efforts in Oklahoma.

In Louisiana, state Attorney General Buddy Caldwell successfully petitioned for a temporary restraining order blocking transportation of Thomas Eric Duncan’s incineration belongings to a Louisiana landfill, stating that “there are too many unknowns at this point” for the ashes to cross state lines. The order from Louisiana 19th District Court Judge Bob Downing prohibits the Texas company that destroyed Duncan’s belongings from transporting the ashes into Louisiana and prohibits the Louisiana facility that originally accepted Duncan’s incinerated belongings from doing so. The order requires the two companies to provide detailed information regarding the handling of the waste and remains in place until an October 22 preliminary injunction hearing.

These actions demonstrate that state governments are actively monitoring the Ebola situation and are willing to take immediate (and preemptive) action to protect their citizens. While certain actions take decision-making out of the hands of local health departments, local health departments remain necessary components to response efforts and continue to work side-by-side on the frontlines with state health departments and hospitals in the fight to defeat Ebola.

Tina Batra Hershey, JD, MPH,  is an Assistant Professor in the Health Policy & Management Department at the University of Pittsburgh’s Graduate School of Public Health.  Her work includes directing a training program to educate state and tribal court judges across the United States regarding the science and law issues that are associated with infectious disease emergencies.  To date, judges have been educated in 14 states and over 20 tribes.

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