Isolation and Quarantine Workgroup

1. Isolation and Quarantine Workgroup March 17, 2006 1

2. PENNSYLVANIA DEPARTMENT OF HEALTH: Veronica V Urdaneta, MD, MPH (Chair) State Epidemiologist and Director Division of Infectious Disease Epidemiology Yvette Kostelac Attorney 4 Thomas McGroarty EMS Program Specialist Bureau of EMS John Bart, DO Public Health Physician Anne Evans Executive Director, South East District Office OTHER AGENCIES REPRESENTATIVES: Department of Military and Veteran’s Affairs: Lt. Col. Xavier Stewart (Co-Chair) Director, Military Support to Civil Authorities Deputy Director, J2/3 Pennsylvania Emergency Management Agency (PEMA) Richard D. Flinn Jr. Deputy Director for Operations Pennsylvania State Police John Lutz Department of Aging: Dan McGuire Department of Corrections: Alan Fogel Nicholas Scharff MD MPH Robert Dusel, Sr. Department of Education: Sarah Pearce Department of Homeland Security: Roland “Bud” Mertz Deputy Director for Homeland Security Department of Public Welfare: Jill Morrow-Gorton Medical Director, Office of Mental Retardation Workgroup Members

3. Constitutional Basis of Quarantine • Intrastate quarantine power • Considered a police power-- an inherent authority to protect health, welfare, and morals of citizens • Reserved to states (10th Amendment) • Foreign and interstate quarantine • Considered essential in regulation of foreign and interstate commerce • Federal authority (Commerce clause)

4. Diseases Subject to Quarantine (2005) • Cholera • Diphtheria • Infectious TB • Plague • Smallpox • Yellow fever • Viral hemorrhagic fevers • SARS • Potentially Pandemic Influenza Viruses • Others as determined by the Secretary of Health and Human Services

5. Management Strategies: Persons with Disease Isolation • separation and restricted movement of illpersons with contagious disease • often in a hospital setting • primarily individual level, may be applied to populations • often voluntary, but may be mandatory • fundamental, commonly used public health practice

6. Management Strategies: Contacts to Persons with Disease • Range of strategies designed to meet two objectives • Facilitate early recognition of symptoms should they develop • Reduce risk of transmission before progression to disease has been recognized • Applied at the individual or community level • Close clinical monitoring key to all contact management strategies

7. Management Strategies: Contacts to Persons with Disease Clinical monitoring • Assessment for signs and symptoms in well person(s) exposed to a contagious disease • May be passive or active • May be done with or without activity restrictions (quarantine)

8. Management Strategies: Contacts to Persons with Disease Quarantine • separation and restricted movement of wellpersons presumed to have been exposed to contagion • often at home, may be designated residential facility • may be voluntary or mandatory

9. Quarantine Dichotomy • “Quarantine” may have negative connotations • Black Death, Yellow fever, Pandemic Flu • Detention camps equate disease with crime • Stigmatizes victims (e.g.,foreign born) • Historical abuses of power • Quarantine works • As good or better than other tools to prevent spread of contagion • When combined with other techniques may result in more rapid control

10. Modern Quarantine A collective action for the common good predicated on aiding individuals infected or exposed to infectious agents while protecting others from the dangers of inadvertent exposure

11. Principles of Community Containment (1) Containment measures may need to be implemented when: • A person or group of people has been exposed to a highly dangerous and contagious disease • Exposed well persons need to be separated from ill cases How can YOU partner to assure resources are available to implement and support interventions at the local level: • Provide essential goods and services • Monitor health status (active vs. passive) • Provide immediate triage & medical care / isolation

12. Principles of Community Containment (2) Strategies that YOU can use for containment at the local level: • “Snow days” or “shelter-in-place” • Suspension or restrictions on group assembly • Cancellation of public events • Closure of mass public transit • Closing of public places • Restriction or scaling back of non-essential travel • Cordon sanitaire

13. Principles of Community Containment (3) Containment measures are more likely to be applied to small numbers of exposed persons in focused settings: • Exposed persons on conveyance containing ill passenger(s) • Exposed persons in a theater where an intentional release has been announced • Close contact to a person with Influenza

14. Principles of Community Containment (4) Implementation of containment measures require: • a clear understanding of public health roles at local, state, and federal levels • cooperation between public and private healthcare sectors • well-understood legal authorities at each level

15. Principles of Community Containment (5) Implementation of containment measures requires coordinated planning by many partners at all levels, especially at the LOCAL level: • Public health practitioners • Healthcare providers • Healthcare facilities • Transportation authorities • Emergency response teams • Law enforcement

16. Principles of Community Containment (6) To achieve trust and cooperation, the public must be: • Informed of the dangers of “quarantinable” infectious diseases before an epidemic/outbreak occurs • Informed of the justifications for quarantine when an outbreak is in progress • Informed of anticipated duration and endpoints of control measures

17. Where Are We? • Training of personnel is essential in tandem with educating the public before an event actually were to happen. • Identification and information, in each community in PA, on facilities needed for community isolation and quarantine.

18. What can YOU do? • Establish incident command structure at each level • Establish relationships with essential partners • Plan for monitoring and assessing appropriate response • Develop message strategies for various responses and groups

19. What can YOU do? • Ensure management protocols for I&Q are up to date • Establish supplies for non-hospital management of well and ill people • Establish telecommunications plan • Plan for ensuring essential day to day services

20. What can YOU do? • Ensure that necessary legal authorities and procedures are in place • Identify key partners and personnel for quarantine • Develop training programs and drills • Develop plans for mobilization and deployment

21. What can YOU do? • Identify community-based facilities for quarantine of contacts • Ensure procedures for assessment of sites are in place • Develop protocols for evaluation and management of arriving ill passengers

22. Conclusions • In the modern age, community containment • Represents a range of interventions • Will be resource- and labor-intensive • Is an important tool used in conjunction with other containment measures • Effective implementation of modern quarantine and other containment measures is impossible without planning and preparedness by every community in Pennsylvania.

23. Thank you for your Time! OPEN DISCUSSION