A Tale Of Two Viruses

On Oct. 1, Texas health officials issued orders of quarantine to four people who’d had contact with Thomas Eric Duncan after he was diagnosed with Ebola. When Duncan died the morning of Oct. 8., those four remained quarantined. For many Americans, this raised the question of who has the legal authority to monitor their movement and human contact, restricting the liberty of presumably innocent people.

Under Section 361 of the Public Health Service Act, the Secretary of Health and Human Services is authorized to take measures to prevent the spread of communicable diseases between states and from outside the country. The CDC is responsible for carrying out these functions.

Isolation and quarantine can also be imposed by states under their police-power functions, but in the event that states’ powers aren’t sufficient to stem the spread of a disease, the federal government can step in.

Isolating the ill–or the potentially ill–under hospital authority is another way to contain bugs, as health officials did in an Indiana hospital in September when they placed a girl with enterovirus, possibly the strain known as EV-D68, in isolation. Here’s a look at how that works.

THE U.S. STATIONS

U.S. quarantine stations are located at 20 ports and land borders where international travelers arrive. A dozen of these stations were added from 2004 to 2007 because of concerns about bioterrorism after 9/11 and the 2003 SARS outbreak.

[The following text appears within a map. Please see hardcopy or PDF for actual map.]

U.S. QUARANTINE STATIONS

In the 1800s, a black-and-yellow flag was flown to indicate quarantine aboard ships. Today, a solid yellow flag indicates that a ship is free of disease and is safe to enter a port.

THE EBOLA PROTOCOL

1

AIRPORT SCREENING

Passengers leaving Liberia must have their temperature taken and answer a health questionnaire. Duncan allegedly lied on his.

2

DIAGNOSIS AND ISOLATION

Once a patient is diagnosed with Ebola, he or she is put in isolation in a hospital and kept away from visitors and other patients.

3

CONTACT TRACING

After the patient is isolated, health officials locate all people who came into contact with the patient and monitor them for 21 days.

4

QUARANTINE

Some contacts may be given quarantine orders, which can be enforced by police. Breaking a federal quarantine can result in fines or imprisonment, and in most states breaking an order is a criminal misdemeanor.

5

21 DAYS AND AFTER

Contact tracers spend three weeks conducting daily checkups on the patient’s contacts. If someone develops symptoms, the whole process begins again.

THE HISTORY OF CONTAINMENT

Throughout U.S. history, to contain the spread of viruses, health officials have turned to isolation, which separates contagious patients from the healthy, and quarantine, which restricts still healthy people who may have been exposed to a communicable disease.

1907

Mary Mallon, immune to the typhoid bacillus, carries the illness and directly infects 51 people during her lifetime. Known as Typhoid Mary, she is quarantined from 1907 to 1910 and from 1915 until her death in 1938.

1918

Federal authorities incarcerate more than 30,000 suspected prostitutes near U.S. military bases during World War I in an effort to curb the spread of venereal disease. Most women are held for 10 weeks.

1918

The Spanish flu breaks out in the U.S. Cities like New York, which closed schools and isolated the sick, had lower death rates than those that didn’t impose such measures.

1940s

Public-health officials impose quarantines on homes and towns where polio cases are found. Children and adults diagnosed with the disease are placed in isolation wards at hospitals accepting polio patients.

1963

A woman arrives in the U.S. from Stockholm, where there was a smallpox outbreak, and fails to produce vaccination documentation. She is quarantined for 14 days out of concern that she is a possible carrier.

1969

Apollo 11 astronauts are quarantined for three weeks in a trailer upon their return to Earth to determine whether any medical problems stemmed from exposure to lunar material.

2003

During the global SARS outbreak, patients in the U.S. are isolated while symptoms persist and for 10 days thereafter.

2007

A 31-year-old Atlanta attorney is diagnosed with a drug-resistant strain of tuberculosis. He flies to Europe, causing an international health scare, and is isolated on his return to the U.S. It is later determined that he was misdiagnosed and that his tuberculosis is treatable.

2014

Four people who were believed to be in close contact with Thomas Eric Duncan, the first Ebola patient who was diagnosed and died on American soil, are in quarantine until the 21-day incubation period passes.

HOW THE TWO DISEASES DIFFER

[The following text appears within a chart. Please see hardcopy or PDF for actual chart.]

Enterovirus D68

CASES CONFIRMED IN THE U.S.

664

Ebola

1

Enterovirus D68

TRANSMISSION

The illness spreads when an infected person coughs, sneezes or touches a surface that is then touched by others. Enteroviruses can live on surfaces for days.

Ebola

The illness spreads through direct contact with body fluids such as vomit, saliva, and blood via broken skin or the eyes, nose or mouth. Ebola virus can live on surfaces for days

Enterovirus D68

SYMPTOMS

Fever, runny nose, body aches and coughing. Severe cases include wheezing.

Ebola

Fever, headaches, muscle pains, diarrhea, vomiting, abdominal pain and bleeding.

Enterovirus D68

VULNERABLE POPULATIONS

Children and teens. Asthmatics may have a higher risk.

Ebola

Family and others in close contact with patients.

Enterovirus D68

TREATMENT

Fluids, rest and over-the-counter medication to lower fever.

Ebola

Intravenous fluids and steps to maintain oxygen and blood pressure.

Enterovirus D68

AVAILABLE DRUGS

No vaccine or specific drug treatment.

Ebola

No vaccine or FDA-approved drug treatment. Experimental drugs such as ZMapp have been tried on some patients.

SOURCES: AP; CDC; INDYSTAR; ENCYCLOPAEDIA BRITANNICA; NEW YORK TIMES; NASA; WHO; NIH