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With Coronavirus cases rapidly increasing in the US, an emergency quarantine declaration has brought up questions about the police powers held by health authorities in the US. And it reminds some people of the case of Hongkham Souvannarath.
She spent 11 months in a county jail, but was not a prisoner—she had multidrug-resistant tuberculosis. Months into TB treatment Souvannarath, a mother of six children in her early 50s, stopped taking her medicine, making her potentially contagious. She would later state that she was having side effects from her treatment, but could not explain this using her limited English.
After failing to submit to a mandated health checkup (ordered with instructions in English), authorities took her to the Fresno County Jail at gun point in July 1998. They told her she was being taken to a hospital, according to a judge's decision.
Once in jail, Souvannarath’s life was hardly different from any of the other jail inmates. She could meet twice a week with family through a glass barrier for half an hour. When she was taken to the hospital for treatment she was shackled at the wrists, ankles, and waist, and chained to her hospital bed.
Since her release in May 1999, Souvannarth’s detention led to a million-dollar settlement and became a case study for health care workers who must weigh the delicate balance between civil rights and public health. And such decisions may soon become more common since the COVID-19 outbreak triggered the first U.S. federal quarantine in almost 60 years.
'Aggressive Containment,' Community Spread
On Tuesday, CDC officials described the current quarantine as unprecedented in scale. "The U.S. has been implementing an aggressive containment strategy that requires detecting, tracking, and isolating all cases," said Dr. Nancy Messonnier, who leads the CDC's respiratory diseases center. "I understand this whole situation may seem overwhelming and that disruption to everyday life may be severe. But these are things that people need to start thinking about now."
Since then, the state of California has declared the first case of COVID-19 community spread in the US.
"Community spread means spread of an illness for which the source of infection is unknown," according to a CDC release.
Community spread is the third standard used by health officials to declare a pandemic, Messonnier said. The first two—that COVID-19 spreads from person to person and that it can cause death--have already been met by this outbreak.
Community spread was first noted in China, but has now emerged in several other countries around the world as infection rates rise in South Korea, Japan, Iran, and Italy.
When Can Health Authorities Detain You?
Health departments in the U.S. have broad authority to stop a contagious disease when the public health is threatened.
When health authorities detain an ill person, this is called "isolation," and when they detain well people who may develop or spread an illness, this is called "quarantine." Under federal regulations, the CDC is authorized to detain, medically examine, and release persons arriving into the United States and traveling between states who are suspected of carrying serious, communicable diseases.
The loopholes this creates have already been tested. When a group of nearly 200 people flown from China to March Air Force Base in California were quarantined for COVID-19, one of them tried to leave.
The CDC had the authority to detain the travelers when they entered the country. But once on U.S. soil, the health authority’s power devolved to the local health department. To keep the unwilling detainee in quarantine required a signed order from the Riverside County health department, which was issued. The quarantine has since been lifted, with none of the quarantined people developing COVID-19.
However, since that time, several other quarantines—both voluntary and mandatory—have been enacted in the US.
Thousands Currently Quarantined
Currently thousands of Americans are bunkering down in self quarantine. In California 7,600 people were asked to stay home last week, said ABC 10 Sacramento. This week in Massachusetts more than 200 people submitted to self-quarantine at health officials' request, according to the Boston Herald. Hundreds of other quarantine cases were reported in Michigan in the past two weeks.
But while voluntary quarantines are uncommon, mandatory quarantines have not been seen in the US since the CDC took over responsibility for them in 1967. Before that, 1963 was the last time it was enacted in the case of a woman suspected of carrying smallpox. This decades-long break ended Jan. 31 when the Trump administration announced an emergency coronavirus declaration, prompting the current quarantine situation. White House officials have described the quarantines as temporary, although they have not said when they might end.
Some of the Americans currently forced into quarantine have spoken out against the practice. They include Karey Maniscalco, 44, a Utah woman who was held with her husband in a 14-day mandatory quarantine onboard the Diamond Princess cruise ship in Japan. She stated her objection after being informed she would undergo an additional 14-day mandatory quarantine once she arrived back in the US, according to the Washington Post.
"That's basically a month of our lives we are being held captive," she told the Post. "And without just cause — we didn't commit a crime."
Meanwhile a proposed quarantine center has provoked protests in California. Residents of Orange County protested the federal decision to designate a Costa Mesa health facility as a destination for COVID-19-positive patients. That decision has been briefly postponed on the orders of a judge.
MedicineNet author Charles Patrick Davis, MD, PhD said COVID-19 causes flu-like symptoms that worsen to fever, coughing, and shortness of breath. "Complications may include high fever, severe cough, difficulty breathing, pneumonia, organ failure, and death," he states.
"People may prevent or lower the risk of this viral infection by good hygiene, avoiding contact with infected people, not going into an outbreak area, and by leaving an outbreak zone," Dr. Davis concludes.
Anyone who has flu-like symptoms should reach out to their health care team for proper evaluation, diagnosis, and treatment.
COVID-19 Treatment, Complications, Prevention
There is currently no specific antiviral drug or vaccine to treat infected individuals. Treatment is supportive in nature, and it may be necessary for a medical professional to administer treatments in a hospital. Complications may include: