TIME Laws

The CDC Has Less Power Than You Think, and Likes it That Way

Ebola isn’t likely to lead to a widespread quarantine but it certainly raises interesting constitutional questions

Director of the Centers for Disease Control and Prevention Tom Frieden has come under fire in recent days for what some charge is the agency’s stumbling response to the appearance of Ebola in America. This week, reporters and lawmakers alike grilled Frieden over how two nurses in Texas contracted the virus and how one of them was able to board an airplane even after she reported a raised temperature.

Breakdowns in good practice notwithstanding, it’s important to remember that Ebola in the U.S. is largely contained and very unlikely to lead to any kind of significant outbreak. Still, the charges leveled against Frieden raise a question that leads to a surprisingly complicated answer: just what, exactly, can—and should—the CDC do?

Since time immemorial, public health officials’ main weapon against the outbreak of a disease as been to restrict the ability of people to interact with one another, also known as a quarantine. The term comes from the Latin “quadraginta,” meaning 40, and is derived from the 40-day period ships traveling from plague-stricken regions were kept at bay before being allowed to dock in medieval European ports.

Imposing a quarantine—effectively stripping innocent people of the most basic right to move freely in the world—is one of the most serious actions a government can take against its own citizenry. Partly for this reason, in the American federal system (designed from the outset to check the power of the national government) the power to quarantine resides largely with state and local authorities. Should Texas, or any other state, someday face the threat of a true epidemic, the states have broad authority to restrict the movement of people within their own borders. Public health codes granting the state power to impose quarantine orders vary from state to state, of course. Violating a quarantine order in Louisiana is punishable by a fine of up to $100 and up to a year in prison; in Mississippi the same infraction could cost a violator up to $5000 and up to five years in prison.

The federal government does have its own powers. The CDC, as the U.S.’s primary agency for taking action to stop the spread of disease, has broad authority under the Commerce Clause of the Constitution to restrict travel into the country and between states of an infected person or a person who has come in contact with an infected person, according to Laura Donohue, director of the Center on National Security and the Law at Georgetown Law School. Federal quarantine can be imposed, too, on federal property, like a military base or National Forest land. And as the preeminent employer of experts on public health crises, the CDC is always likely to get involved within any affected state in the event of a looming pandemic.

But its power to act is extremely restricted. The agency traditionally acts in an advisory role and can only take control from local authorities under two circumstances: if local authorities invite them to do so or under the authority outlined in the Insurrection Act in the event of a total breakdown of law and order.

And here the picture becomes murkier yet because authority does not always beget power.

“It’s not a massive regulatory agency,” said Wendy Parmet, a professor in public health law at Northeastern University in Boston. “They don’t have ground troops. They don’t have tons of regulators. They’re scientists. Even if the states asked them to do it it’s not clear how they would do it.

Even in the highly unlikely event that the CDC were called to respond to a—let’s reiterate: extremely-unlikely-to-occur—pandemic, quarantine and isolation would be imposed not by bespeckled CDC scientists but by local or federal law enforcement or troops. Most importantly, the CDC is extremely reluctant to be seen as a coercive government agency because it depends as much as any agency on the good will and acquiescence of citizens in order to respond effectively to a public health emergency. When the bright lights of the Ebola crisis are not on it, the CDC will still need people to get vaccinated, to go to the doctor when they get sick, and to call the authorities if they see trouble.

“Our public health system is built on voluntary compliance,” Donohue tells TIME. “If the CDC starts to become the enemy holding a gun to [someone’s] head and keeping them in their house, they lose insight.”

TIME ebola

Nurse Infected With Ebola in Dallas Now Being Treated in Maryland

Texas Nurse Infected With Ebola Transferred To Maryland
The airplane carrying Texas Health Presybterian Hospital nurse and Ebola patient Nina Pham takes off from Love Field airport October 16, 2014 in Dallas, Texas. Chip Somodevilla—Getty Images

Nina Pham now has a staff of 50-60 trained health care workers taking care of her at the National Institutes of Health

Nina Pham, the first person to be infected with Ebola in the U.S., arrived at the National Institutes of Health Special Clinical Studies Unit in Maryland just before midnight Thursday evening, the NIH said Friday.

Dr. Anthony Fauci, director of the NIH’s National Institute of Allergy and Infectious Diseases (NIAID), and Dr. Rick Davey, deputy director of NIAID’s division of clinical research, said Pham was in fair condition and resting comfortably. Davey will be the physician overseeing Pham’s care.

Fauci said that from the time when Liberian Ebola patient Thomas Eric Duncan became the first person diagnosed with the disease in the U.S., “we made very clear that we could make the highly specialized facility available if called upon. We were called upon to accept Nina and we did.”

The seven-bed NIAID unit in Rockville, Maryland was created in 2011 as part of the U.S.’s bio-terror preparedness efforts. It’s designed and equipped to care for patients with the most dangerous infectious diseases. The unit has a dedicated staff of 50 to 60 personnel who are specially trained in infection control for biohazards, and, said Fauci, retained continuously to keep their education up to date. The unit’s isolation unit has a separate ventilation system that directs air into specialized filters, and the unit has a dedicated system for removing patient waste and other biohazardous materials.

The center is not just a hospital, but also a research facility. Every patient treated there is also a research subject, and Pham will be no exception. Dr. H. Clifford Lane, clinical director of NIAID, said that Pham’s virus and her immune system’s response to it will be studied extensively. The researchers at the unit are also part of vaccine studies and are working on ways to intervene earlier in the disease’s course with better treatments. Such treatments may help not just Pham, but also the thousands in West Africa currently battling Ebola.

As far as what therapies Pham will receive, Fauci would only reveal that Pham has so far received, while in Dallas, plasma donated from Dr. Kent Brantly, the first American patient successfully treated for Ebola — Brantly was diagnosed while in Liberia before being flown to the U.S. for treatment. Pham is at all times being cared for by four to five nurses working 12 hour shifts; two of these nurses are allowed into her room at one time, with the remaining nurses serving support duties. One full-time infectious disease doctor and one critical care intensive care physician is also assigned to her care in rotating shifts.

TIME Crime

Florida Man Gets Life in Prison for Killing Teen Over Loud Music

Defendant Michael Dunn walks back into the courtroom after a short afternoon break during his trial in the Duval County Courthouse in Jacksonville, Fla. on Sept. 27, 2014.
Defendant Michael Dunn walks back into the courtroom after a short afternoon break during his trial in the Duval County Courthouse in Jacksonville, Fla. on Sept. 27, 2014. Bob Mack—AP

He shot at unarmed black teens 10 times

A Florida man has been sentenced to life in prison without the possibility of parole for the killing of an unarmed Florida teen after an altercation over the teen’s loud music, the Associated Press reports.

Michael Dunn, 47, was convicted of first-degree murder after a September trial. Earlier this year, a jury in February couldn’t agree on whether to accept Dunn’s claim that he acted in self defense when he fired his gun 10 times at a vehicle carrying 17-year-old Jordan Davis, who was shot and killed in the altercation. The jury in February did convict Dunn on three accounts of attempted murder, one for each of the passengers riding in the vehicle with Davis.

The racially-tinged case — Dunn is White and Davis was black — has drawn comparison to the shooting of other unarmed black teens like Trayvon Martin and Michael Brown.

In practical terms, Friday’s decision changes little for Duncan, who already faced a 60-year conviction for the attempted murder convictions. The prosecution did not seek the death penalty.

[AP]

TIME LGBT

Federal Judge Strikes Down Arizona’s Same-Sex Marriage Ban

Arizona is the latest state where gay marriage is legal following an earlier Supreme Court move

Arizona is now the latest state with legalized same-sex marriage after a federal judge on Friday struck down the state’s ban on the practice and ordered that his decision take effect immediately.

In a concise four-page decision, U.S. District Court Judge John Sedwick cited rulings from higher courts to dismiss Arizona’s ban as unconstitutional.

“It is clear that an appeal to the Ninth Circuit would not succeed,” Sedwick wrote, referring to the higher court that has jurisdiction over a potential appeal in the case. The judge added that the United States Supreme Court has suggested that it would not hear an appeal in the Arizona case.

Arizona is the latest in a slew of states where same-sex marriage was effectively legalized after the Supreme Court earlier this month declined to hear cases addressing the issue. The court’s move effectively brought the total number of states with same-sex marriage to 30, while paving the way for legalization in other states as well.

TIME Education

Campus Crime Reporting Requirements Expanded

(WASHINGTON) — A new government rule seeks to create more awareness of the extent of sexual assault on campuses.

Colleges and universities are required to compile and make crime statistics available on stalking, dating violence and domestic violence under a new rule announced by the Education Department.

The change falls under the Clery Act, which requires colleges and universities to report crime statistics on or near their campuses and provide warnings in a timely manner if safety is threatened. The Violence Against Women Reauthorization Act of 2013 signed by President Barack Obama amended the Clery Act. Victims’ advocates have said the statistics, as currently compiled, don’t provide a full picture of the extent of sexual crimes.

The rule goes into effect July 1.

TIME White House

Obama Appoints Ron Klain As Ebola Czar

Lawyer and politcal operative Ron Klain on May 13, 2008 in New York City.
Lawyer and politcal operative Ron Klain on May 13, 2008 in New York City. Andrew H. Walker—Getty Images

He's a longtime Democratic insider

President Barack Obama has appointed longtime insider Ron Klain to coordinate the administration’s global response to the Ebola epidemic, a White House official confirmed. The move came just hours after a Texas nurse diagnosed with Ebola after treating a patient with the disease was moved from Dallas to the National Institutes of Health Clinical Center in Bethesda, Maryland.

“The President has asked Ron Klain to take on the task of coordinating his administration’s whole of government Ebola response,” the official said Friday. “He will report directly to the President’s Homeland Security Advisor Lisa Monaco and the President’s National Security Advisor Susan Rice as he ensures that efforts to protect the American people by detecting, isolating and treating Ebola patients in this country are properly integrated but don’t distract from the aggressive commitment to stopping Ebola at the source in West Africa.”

Klain, who served as chief of staff to Vice President Biden and former Vice President Al Gore, helped to oversee the 2009 stimulus bill. He will now be tasked with coordinating both the domestic public health response and the international humanitarian and military efforts to stop the virus in West Africa. Klain will work out of the White House’s West Wing.

“Klain’s role is consistent with the view the President articulated in the Oval Office [Thursday] night that Monaco, Rice and others have done outstanding work in confronting this challenge so far – but given their management of other national and homeland security priorities, additional bandwidth will further enhance the government’s Ebola response,” the White House official said.

Republican lawmakers had been calling on the White House to appoint the so-called “czar” for weeks to lead the Administration’s response. The White House had been cool on the subject until Thursday, when Obama told reporters he was considering making such an appointment. Other Obama “czars” have coordinated the auto bailout and the Troubled Asset Relief Program, or TARP, to boost banks after the 2008 financial crisis.

 

 

TIME weather

Hurricane Gonzalo Charges Toward Bermuda

Hurricane Gonzalo NOAA

The Category 4 storm is scheduled to hit the island Friday afternoon

A dangerous weather system named Hurricane Gonzalo is expected to slam into Bermuda Friday afternoon, where officials warn it could cause serious damage and lead to significant coastal flooding.

The National Weather Service predicts the Category Four hurricane will hit Bermuda with maximum sustained winds near 130 mph with stronger gusts, alongside rain accumulations of between three and six inches. A “dangerous and life-threatening storm surge” is expected to hit the island, causing flooding and large, destructive waves along the coast.

The eye of the storm is projected to pass near Bermuda Friday afternoon or evening.

TIME ebola

Nurse With Ebola Releases Tearful Video From Isolation

Nina Pham asked that a video of her taken in isolation be shared with the world

A Dallas nurse who contracted Ebola after treating a patient with the disease asked that a video taken from inside her Texas hospital isolation unit be shared publicly.

“I love you guys,” says Nina Pham to her treating physician Gary Weinstein and another person, both of whom are wearing full protective gear.

In the video shot by Weinstein, the doctor thanks Pham for her work caring for Thomas Eric Duncan, the first Ebola patient diagnosed in the United States, who died of the disease Oct. 8.

“Thanks for getting well. Thanks for being a part of the volunteer team to take care of our first patient. It means a lot,” Weinstein says. “This has been a huge effort by all of you guys. We’re really proud of you.”

Pham was diagnosed with Ebola after helping to treat Duncan, who fell ill with the disease in Dallas after traveling to the U.S. from Liberia, one of three West African countries hardest hit by the recent global Ebola outbreak. Since the video was taken, Pham has been moved to a National Institutes of Health facility in Maryland for further treatment.

TIME ebola

Hospital Staffer Who May Have Had Ebola Contact Left U.S. on Cruise Ship

The Texas hospital employee has shown no indications of becoming sick

Updated Friday, Oct. 17

An employee of Texas Health Presbyterian Hospital in Dallas who may have come in contact with specimens taken from an Ebola patient left the United States aboard a cruise ship, the State Department said Friday. The revelation raises further questions about travel policies regarding health workers involved in treating Ebola patients after it came to light that a nurse later diagnosed with the virus was allowed to fly earlier this week despite self-reporting an elevated temperature.

The employee on the cruise did not have direct contact with the patient, is not contagious, and has shown no indication of having contracted the illness in the 19 days since she came into contact with the Ebola patient’s fluid samples. The individual is nonetheless being monitored by doctors aboard the ship and has remained along with a traveling partner in voluntary isolation in a ship cabin.

The hospital employee, who is a lab supervisor at the hospital where she works, according to Carnival Senior Cruise Director John Heald, left aboard a commercial cruise ship from Galveston, Texas, on October 12, before learning of new monitoring requirements from the Centers for Disease Control and Prevention.

“We are working with the cruise line to bring them back to the United States out of an abundance of caution,” the State Department said in a statement.

In a Facebook post published Friday, Heald said the cruise line learned that the guest was aboard the ship on Wednesday.

“It is important to reiterate that the individual has no symptoms and has been isolated in an extreme abundance of caution,” Heald said in his post. “We are in close contact with the CDC and at this time it has been determined that the appropriate course of action is to simply keep the guest in isolation on board.”

TIME ebola

A Dallas Hospital Worker Self-Monitoring for Ebola Left Texas on a Cruise

Health Care Worker In Dallas Tests Positive For Ebola Virus
A man dressed in protective hazmat clothing treats the sidewalk in front of an apartment where a second person diagnosed with the Ebola virus resides, in Dallas, Texas. Mike Stone—Getty Images

The staffer does not have any symptoms of illness and is in self-imposed quarantine in a cabin

A Dallas hospital employee, described as possibly having come into contact with fluid samples from the deceased Ebola patient Thomas Eric Duncan, left the U.S. on a cruise ship on Sunday, the State Department said early Friday morning.

The news follows the announcement of plans to keep at home all health care workers flagged as having encountered Duncan or his fluid samples, in an aggressive effort to contain the virus’ spread in the U.S. after a Dallas nurse was allowed to take a commercial flight just before getting diagnosed with Ebola, the Guardian reports.

Seventy-five staff members at Texas Health Presbyterian Hospital Dallas—where Duncan was treated and died—have been asked to sign legally binding agreements not to go out in public, Clay Jenkins, the Dallas County judge, told reporters on Thursday.

Any of the workers who refuse the sign the agreement would be subject to a legal control order, Jenkins said, though he added: “These are hometown healthcare heroes…They’re not going to jail.”

The State Department said the hospital employee who boarded a cruise ship from Galveston, TX, did not have direct contact with Duncan, but “may have processed the since deceased patient’s fluid samples.”

The unidentified employee, who was checked by a doctor on the cruise ship and is self-monitoring, does not have any symptoms of illness, according to the State Department. The employee and his traveling companion have agreed to a self-imposed quarantine in their cruise cabin.

“We are working with the cruise line to safely bring them back to the United States out of an abundance of caution,” read the statement.

The employee would have come into contact with the sample 19 days ago, according to the White House. Ebola symptoms can appear 2 to 21 days after initial exposure, according to the Centers for Disease Control (CDC), but on average they manifest 8 to 10 days after the illness is contracted.

U.S. officials have been rushing to contain the spread of Ebola after two Texas Health Presbyterian Hospital nurses who treated Duncan, Nina Pham and Amber Vinson, tested positive for the illness.

Numerous parties have been trading barbs over where to put blame for the infection of the two nurses and for the growing number of people who are believed to have come into contact with them and Duncan.

National Nurses United, a union not affiliated with Texas Health Presbyterian Hospital, has excoriated both the hospital and the CDC for failing to enact proper standards for treating the contagious patient and for keeping the hospital’s nursing staff safe.

Daniel Varga, senior vice president of Texas Health Resources, which owns Texas Health Presbyterian Hospital, on Thursday apologized to a House committee for the hospital’s failure to diagnose Duncan with Ebola sooner.

But the hospital has bristled at charges that it failed to protect its nurses and in a statement on Thursday put fault with the CDC for constantly changing its guidelines and failing to set clear protocols for treating Duncan.

U.S. lawmakers at the House hearing on Thursday also chastised the CDC for allowing Vinson, the second Dallas health worker to test positive for Ebola, to fly from Cleveland to Dallas after she self-reported a mild fever but had not yet been diagnosed with the virus.

Meanwhile, the international community is still reeling over how to contain the worldwide spread of Ebola, which has killed 4,493 people and is believed to have infected 8,997 in seven countries, according to the most recent WHO estimates.

The situation in Liberia, Guinea, and Sierra Leone, is “deteriorating, with widespread and persistent transmission,” the WHO said Wednesday, in its latest status update. Cases have been spiking in the Guinean capital of Conakry, the health organization said.

On Thursday, United Nations chief Ban Ki-moon urged U.N. member states to donate to the world body’s trust fund for Ebola, which currently stands at a lowly $100,000—all of it from just one nation, Colombia, and a pathetic fraction of the $1 billion the U.N. has said it needs to stop the outbreak, the BBC reports.

World governments have in total pledged just $20 million to the fund.

Read next: Here’s Who’s Blaming Who for Ebola

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