Covid-19 — The Law and Limits of Quarantine

Wendy E. Parmet, J.D., and Michael S. Sinha, M.D., J.D., M.P.H. Covid-19 — The Law and Limits of Quarantine. N Engl J Med 2020; 382:e28. DOI: 10.1056/NEJMp2004211

Review written by:

Victoria Joseph, edited by Ava Kamb

Yellow - Perspective article published in New England Journal of Medicine by affiliates of Northeastern University School of Law and Harvard Medical School.

Over the past weeks, there have been many reports about many countries’ governments’ decisions to impose quarantines and travel bans. This article discusses the laws and limits of quarantine as well as solutions needed in order to garner a more effective response to COVID-19. The public health definition of quarantine differs from its definition in U.S. law. In public health, “quarantine” indicates the separation of individuals exposed to an infectious disease whereas in U.S. law it not only refers to this separation, but to isolation (which refers to the separation of known infected individuals) as well as limits on travel. Traditionally, isolation and quarantine orders have come from the states. Federal quarantine power is limited to prevent the spread of communicable diseases into the country or across state lines. In 2017, the CDC issued new quarantine regulations that no longer defer to the states. Under these new regulations, CDC officials have the power to isolate, quarantine, examine or ban travel of people they reasonably believe may bring a communicable disease into the country or spread it across state lines. Furthermore, these regulations require the CDC to provide medical care for detained individuals.

These state and federal quarantine powers must abide by crucial constitutional limitations. Firstly, racial motives must not be the basis for quarantine. Governments are obligated to have clear and compelling evidence that isolation and quarantine are the least restrictive measures to ensure public health protection. Detained individuals are entitled to judicial review and the government is required to ensure that they have access to basic needs such as health care, medication, food, and sanitation. Even though the regulations require the CDC to provide medical care for detained individuals, they are allowed to charge insurers for that care. Community transmission is taking place in most parts of the United States therefore, travel bans, and mandatory quarantines do not suffice in order for this outbreak to end. The authors have suggested a few constructive tools to convey a more effective response to COVID-19. Some of the tools included: allowing workers to telecommute if they can, reducing barriers to testing and care, and protecting non-citizens from unfavorable immigration consequences if they seek testing. At this point, the authors are emphasizing the need for public health laws focused on support rather than restriction.

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