Although quarantines are considered a measure of last resort, “police powers” give states, counties and even cities broad authority to make residents stay home.
States and local governments across the United States have issued some variant of
stay-at-home orders covering more than half of all Americans. They range in severity from pleas to avoid gatherings and to stay indoors combined with business closings to mandatory orders with severe consequences, as in Hawaii, where violators face a $5,000 fine or up to a year in jail.
Rare in modern history, quarantines were fairly common in ancient times, before medicine stemmed the ferocious spread of contagious diseases. The very word quarantine is rooted in the Italian words quarantenara and quaranta giorni, or 40 days, the period of time that the city of Venice forced ship passengers and cargo to wait before landing in the 14th and 15th centuries to try to stave off the plague. Quarantines have often generated tensions between protecting public health versus respecting individual rights.
Here are answers to some common questions about how quarantines are imposed and enforced in the United States in the wake of the coronavirus.
Can the government force anybody into quarantine or to ‘shelter in place’?
The legal authority to impose quarantines or shelter-in-place orders on individuals is rooted in the “police powers” granted broadly to states, counties and cities to protect public health. That means for most Americans, a state or local stay-at-home order imposed to prevent the spread of the coronavirus will be far more important than any federal order.
When it comes to the federal government, it can impose quarantines under the Public Health Service Act for two main reasons: to prevent the spread of communicable disease into the United States or between states.
Although President Trump has said he would like to reopen the country by Easter, it is not clear that he has the power and authority to do this. The police powers held by states to protect public health came before the Constitution and it did not change them, said Lawrence O. Gostin, a professor at Georgetown University Law School who specializes in public health law. Mr. Trump, for example, could not go into a state and order a business to start operating, experts said.
What is the difference between a quarantine and a stay-at-home order?
A quarantine is designed to isolate someone sick or at least known to have been exposed to a contagious disease, whereas a stay-at-home order is meant to promote social distancing and thus lower the number of infections.
Quarantines are considered a measure of last resort when no preferable means is available to halt the spread of a deadly communicable disease. “We do not want to restrict people’s liberty unless it is necessary, unless we cannot achieve the public health end with less draconian measures,” said Wendy E. Parmet, the director of the Center for Health Policy and Law at Northeastern University.
So there is no blanket law?
No, the laws vary by state and even locality. Some 40 states updated their quarantine laws after fears spread over a possible broad anthrax attack in the months after the Sept. 11 attacks, according to Professor Gostin., He is the author of a legal template called the State Emergency Health Powers Act, which many states adopted in whole or in part. Some states retain antiquated regulations on their books.
Are quarantines, including self-isolating at home, voluntary or mandatory?
It is a bit of a gray area. It often seems voluntary until the person involved tries to leave, at which point health officials are likely to make it compulsory, experts said. The rules are notoriously hard to confirm because county governments often do not publish their regulations online.
The bottom line, however, is that if a quarantine is not enforced and other people catch the fatal disease as a result, the local government could be held liable, Mr. Gostin said. “Thinking about this as purely voluntary is wishful thinking.”
Is it a crime to evade a quarantine?
Again, laws vary by state, but those who ignore the rule could face fines or jail time. Logic dictates that draconian enforcement would be difficult and often counterproductive. No local law enforcement agency would likely compound its problems by throwing a quarantine scofflaw with a deadly communicable disease in among its jail population.
Local authorities often have some form of enforcement power, but usually try gentle persuasion to convince people that it is for their good and the good of the community. An infected person blatantly ignoring an order might be forced to go into medical isolation — that is, some form of locked hospital ward.
Experts worry that many Americans might think they have the right to go someplace local like the supermarket without considering the consequences for others. “We have lost this tradition of the common good and social responsibility to each other and that could be a big problem in America,” Mr. Gostin said.
Is there a right to appeal?
States should have some manner of appeal process, and some require a court order from the outset. If there is no medical tribunal or other means for a second opinion, ultimately anyone could challenge a quarantine order in court through a writ of habeas corpus.
Quarantine laws
tend to be controversial because they are akin to jail time, using the coercive power of the state to tell people that they have to stay confined, even if in their own homes.
The C.D.C. rewrote its quarantine guidelines in 2017 and they have never been tested in court. The Supreme Court has also never dealt with an infectious disease quarantine case, Mr. Gostin said.
Under C.D.C. rules, the federal government must test those confined within 72 hours and define the length of stay from the outset — two weeks for the coronavirus because that is the incubation period for the disease.
The most famous recent test case was Kaci Hickox, a nurse who was initially quarantined involuntarily at Newark Liberty International Airport in 2014 upon returning from West Africa, where she had worked with Ebola patients.
After a few days, she was allowed to return to her home state of Maine but ordered to remain in isolation. Having tested negative for the virus, Ms. Hickox sued and the judge rejected the quarantine order.
With the help of the A.C.L.U., Ms. Hickox also sued New Jersey, which resulted in a settlement that gave arriving passengers more rights, including the right to appeal the decision and to seek legal advice.
What does the government provide during a quarantine?
The most glaring hole in American quarantine laws, experts said, is that there is no guaranteed salary. An employer could even fire a quarantined employee. President Trump has said that his administration would address financial relief for people quarantined.
If you are separated from the community for the public good, the government should provide medical service, essential medications, food and other social support if you need it, Mr. Gostin said.
Are quarantines effective?
They generally help slow the spread of the disease but sometimes do not depending on the disease and the conditions of the quarantine, experts said. In China, that seemed to decelerate the exponential spread of the virus, they said, whereas holding passengers on the Diamond Princess cruise ship in Japan appeared to create a kind of petri dish with more people infected.
Could there be broad quarantines in the United States like those imposed by China or Italy?
The United States government lacks the broad authority to impose the sweeping quarantine seen in China, where some 70 million people were confined in the largest such effort in history. Italy, which has a more centralized government, attempted to lock down the entire country. But in the United States neither federal nor state law contains the powers for such expansive measures, Mr. Gostin said.
In addition, the United States does not really have the logistical systems in place to guarantee the distribution of medical services, food and other necessities to people under quarantine.
New York State decided to deploy the National Guard in New Rochelle, a New York City suburb and the center of a significant outbreak, to help provide those kinds of services and to help scrub public spaces clean. The center of the city is considered a “containment zone,” but it is not under quarantine.
Is there any history of quarantines in the United States?
The measures being implemented now around the globe are the most sweeping since the 1918 influenza pandemic.
In the United States, quarantines have been extremely rare. The last federal quarantine was in the early 1960s against a suspected smallpox outbreak. Instead the C.D.C. tends to issue health warnings, like advising pregnant women to avoid Southern Florida in 2016 during an outbreak of the Zika virus.
In earlier times, there were frequent legal quarantines, dating back to at least the early 18th century. The fact that they often targeted minority immigrant communities is a key reason that civil libertarians are leery about giving the government wide powers today.
Two of the most notorious cases occurred during the late 19th and early 20th centuries.
In 1900, the city of San Francisco tried to impose a quarantine on Chinatown, arguing that a diet of rice made people more susceptible to bubonic plague than the more American diet of meat, and demanded that its residents submit to an unproven vaccine, according to Howard Markel, the director of the Center for the History of Medicine at the University of Michigan. Residents sued under the 14th Amendment, which guarantees due process and equal treatment under the law, and won.
In New York City, which once deployed health police armed with billy clubs and powers of arrest, an outbreak of typhus among Russian Jewish and Italian immigrants on the Lower East Side prompted the authorities to confine some 1,200 people on North Brother Island off the Bronx for several months in 1892.
Perhaps the island’s most infamous resident ever was Mary Mallon, known as “Typhoid Mary,” an Irish-born cook who infected dozens of people in New York, killing some of them, by changing jobs frequently and refusing to stop working as a cook.
Mr. Markel cited in his book “Quarantine” an example of the sense of sweeping power held by the authorities at that time, when they thought it was in the public interest to impose a quarantine.
Asked to testify in Congress about quarantining hundreds of immigrants on the island in 1892, Cyrus Edson, the New York City’s sanitary supervisor, responded, “We may take possession of the City Hall forcibly and turn it into a contagious disease hospital if in our opinion it is necessary to do so.”
