CDC to be Granted Increased Authority in Quarantining

CDC to be Granted Increased Authority in Quarantining

The Centers for Disease Control and Prevention (CDC) has recently adopted new amendments which allow for an expansion of its authority to quarantine individuals in the hopes of preventing dangerous outbreaks of disease. [1,2] These revisions have been commended by public health officials alike due to the increased assurance that outbreaks can be prevented via action on the part of the CDC. [1] Yet, with the augmented authority given to the CDC, many worry that the government may misuse such power, threatening civil liberties and forcing perfectly healthy people into quarantine against their will. 

On January 19th, the Department of Health and Human Services (HHS) and the CDC published new legislative measures entitled “Final Rule for Control of Communicable Diseases: Interstate and Foreign,” which alters domestic and foreign regulations to better control the spread of communicable diseases. [3] These change were adopted in response to 15,800 comments from citizens and stakeholders during the 60-day comment period, which sprawled a variety of topics relating to quarantining. [3]

While the update of the agency’s role in quarantine is the first since the 1940s, the occurrence of the largest outbreak of Ebola virus in US history and the recent outbreak of Middle East Respiratory Syndrome have substantiated the need to alter policy. [1,4] The Final Rule, which will take effect on February 21st of this year, “improves [the] CDC’s ability to protect against the introduction, transmission, and spread of communicable diseases while ensuring due process,” according to the CDC. [3,4] Additionally, through these adjustments, the CDC hopes to increase its transparency with respect to its powers and methods. [4] Many experts see these changes in a positive light and view the agency’s adjustments as important for maintaining the best defense against infectious, dangerous diseases. Lawrence Gostin, a professor of global health law at Georgetown University, explained the need for change, stating, "The CDC has been operating its infectious disease powers under really antiquated regulations.” [1] 

Although the Final Rule serves to give the CDC the capabilities to better combat potential outbreaks, the adjustments have provoked unease over the possible threat to individuals’ rights and overstepping of boundaries on the part of the government. "It could represent a great danger to Americans' health and civil liberties," stated Wendy Parmet, a health policy lawyer at Northeastern University. [1] 

Under previous policy, the CDC was mainly limited to detaining people entering the US or crossing state lines, and individuals could only be quarantined for a handful of diseases such as cholera and smallpox. [1] Even with this previous authority, quarantine cases were typically addressed at the state and local levels, which have primary responsibility over the health of their residents.2 However, with the new legislative adjustments, the CDC will be able to quarantine people from any area of the country without the official consent of state and local officials, and the agency can restrict interstate travel. [1,2] Yet, state and local governments, who already have lengthy experience establishing quarantine areas, dealing with patients, and providing appropriate staff for cases may be better equipped than the CDC to deal with quarantine cases. [2]

The adjustments to the CDC’s powers also pose a complication to prompt judicial review, which some view as a major threat to the rights of those under quarantine. Individuals are typically able to challenge a state-ordered quarantine immediately, and in some states, the government must receive judicial permission prior to detaining someone. [2] Under the new rules, however, the CDC can hold individuals for up to 72 hours before their case must be reviewed. [1] Additionally, the initial review will be conducted by the CDC itself rather than an impartial judicial entity, with up to three levels of internal review. [1,2] With no mandated time limit, a healthy person could be indefinitely kept in quarantine against their will, as federal, judges frequently wait until after the completion of an internal review to consider an appeal. [2] 
    Fearing potential detainment under the power of the CDC, sick individuals may try to hide their symptoms rather than seek treatment, in the process causing the attempts to prevent an outbreak to backfire due to public fear over the threat to personal rights. [1] "We don't want to drive cases underground by putting measures in place that seem as though they carry some penalties associated with them,” says research epidemiologist Jennifer Nuzzo of the Johns Hopkins Center for Health Security. [1] Lawrence Gostin also notes the seriousness of quarantine and the fear it can inspire within sick individuals, calling quarantine “the most draconian measure, because it allows you to literally imprison somebody who you don't know for sure is a danger to the public." [1]
    Some also worry that orders of quarantine may rely more on fear and external pressures than scientific evidence. During the 2014 Ebola outbreak, Donald Trump tweeted that American healthcare workers who got sick in countries with cases of the disease should be prevented from entering the US to get treatment, despite a dissenting opinion from Ebola experts. [2] Scott Burris, a law professor at Temple University, commented, "My worst fear is we have a replay of Ebola and we have, say, President Trump assert the policy he thought we ought to have when he was citizen Trump." [1] Wendy Parmet also expressed concern that Trump “may be inclined to not always listen to science,” which could pose an issue in the handling of a potential outbreak.1
The effectiveness of the CDC’s policy changes remains difficult to assess without an actual outbreak. While the threat to individual liberties amidst the CDC’s power increase remains an issue, many experts are still hopeful that the policy changes will give the CDC the flexibility it needs to do its job effectively. Amidst ongoing disagreements about the CDC’s new roles, the threat and unpredictability of outbreaks remains. “We don't know which [disease] will be next,” Gostin notes. “And so when something sweeps up on our shores, we don't want to have delay and have political debate." [1]

Sources:

  1. Stein, Rob. “CDC Seeks Controversial New Quarantine Powers To Stop Outbreaks.” NPR. Published February 2, 2017. http://www.npr.org/sections/health-shots/2017/02/02/512678115/cdc-seeks-controversial-new-quarantine-powers-to-stop-outbreaks
  2. Edwards, Kyle, Parment, Wendy, and Burris, Scott. “Why the C.D.C.’s Power to Quarantine Should Worry Us.” The New York Times. Published January 23, 2017. https://www.nytimes.com/2017/01/23/opinion/why-the-cdcs-power-to-quarantine-should-worry-us.html
  3. “Final Rule for Control of Communicable Diseases: Interstate and Foreign.” Centers for Disease Control and Prevention. Published January 19, 2017. https://www.cdc.gov/quarantine/final-rule-communicable-diseases.html
  4. “Control of Communicable Diseases.” Department of Health and Human Services. Published January 19, 2017. https://www.federalregister.gov/documents/2017/01/19/2017-00615/control-of-communicable-diseases
     
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