Without providing details as to why they felt compelled to issue a written order, the State of Texas last night delivered orders to the family of America’s first imported Ebola case to remain home, and not accept unapproved visitors, while being monitored for possible symptoms until October 19th.
First the statement, then I’ll be back with a bit more on the issues of isolation vs. quarantine.
Texas Department of State Health Services
Oct. 2, 2014
Out of an abundance of caution, Texas and Dallas County health officials have ordered four close family members of the Dallas Ebola patient to stay home and not have any visitors to prevent the potential spread of disease.
“We have tried and true protocols to protect the public and stop the spread of this disease,” said Dr. David Lakey, Texas health commissioner. “This order gives us the ability to monitor the situation in the most meticulous way.”
The local health department had previously instructed the family to stay home, but a strict public health control order is needed to ensure compliance. Ebola is not contagious until symptoms appear. The family members do not have symptoms at this time.
The orders were hand delivered to the family members Wednesday evening by local health officials. The orders legally require the family to stay at home and not have any visitors without approval from the local or state health department until at least Oct. 19. The order is in place until the incubation period has passed and the family is no longer at risk of having the disease.
The order requires the family to be available to provide blood samples and agree to any testing required by public health officials and to immediately report any symptoms to Dallas County Health and Human Services. Symptoms include fever above 100.5 degrees, headache, nausea, diarrhea or abdominal pain.
Texas law allows the state health department and the local health authority to issue control measures to a person who is ill with, has been exposed to, or is the carrier of a communicable disease. (Health and Safety Code §81.083). Control measures by law can include isolation, quarantine and preventive therapy. If a person does not follow these orders, they can be enforced by the courts, and the person can face criminal charges.
Contrary to Hollywood’s draconian portrayal, quarantine usually consists of having an exposed person stay home, and report to a healthcare worker by phone each day, during a disease’s incubation period.
While usually voluntary, if there are reasons to suspect non-compliance and the threat to the public is considered great enough, then state and local health departments have legal recourse to enforce home (or other) confinement.
The CDC applies the term "quarantine" to more than just people. It also refers to any situation in which a building, conveyance, cargo, or animal might be thought to have been exposed to a dangerous contagious disease agent and is closed off or kept apart from others to prevent disease spread.
The Centers for Disease Control and Prevention (CDC) is the U.S. government agency responsible for identifying, tracking, and controlling the spread of disease. With the help of the CDC, state and local health departments have created emergency preparedness and response plans. In addition to early detection, rapid diagnosis, and treatment with antibiotics or antivirals, these plans use two main traditional strategies—quarantine and isolation—to contain the spread of illness. These are common health care practices to control the spread of a contagious disease by limiting people's exposure to it.
The difference between quarantine and isolation can be summed up like this:
- Isolation applies to persons who are known to be ill with a contagious disease.
- Quarantine applies to those who have been exposed to a contagious disease but who may or may not become ill.
Two months ago, in A Revision In the List Of Quarantinable Communicable Diseases, we looked at a recent executive order that expanded slightly the types of diseases that could be quarantined.
Ebola, and other hemorrhagic viruses, were already part of that short list.
Twenty months ago, in EID Journal: A Brief History Of Quarantine, we looked at the long and successful use of quarantine in the United States, and around the world, to contain highly infectious diseases. The ultimate containment of SARS in 2003 was due, in large part, to the use of home quarantines around the globe.
While never likely to be popular - particularly among those caught up in one – quarantines are an important public health tool, and can often spell the difference between containing a disease, and seeing it spread further.