A New Hampshire man who’d recently returned from Italy and had symptoms of the coronavirus had been told to quarantine himself, but instead attended an event on Feb. 28 at the Engine Room in White River Junction, Vt. A few days later, he tested positive for Covid-19 and the New Hampshire Department of Health and Human Services issued an official order of isolation.
The man’s behavior raises all sorts of questions. What is self-quarantine? Who enforces it? And can people simply ignore it? The Globe spoke with public health and legal experts across the country to get answers.
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What is quarantine, and how is it different from isolation?
Quarantine, whether voluntary or mandatory, is for healthy people who have been exposed to a virus, while isolation is for people who have been infected by it and are actively showing symptoms, said Dr. Amesh Adalja, a senior scholar at the Johns Hopkins University Center for Health Security. The federal Centers for Disease Control and Prevention, the states, and local public health agencies all have the power to issue orders of quarantine and of isolation.
If you are in either quarantine or isolation, you shouldn’t go to work, school, or public areas, according to the CDC, and you should try to steer clear of other members of your household, using a separate bedroom and bathroom if possible.
What is self-quarantine?
Self-quarantine is voluntary, legal experts said, though it comes with “an implied threat” of mandatory quarantine if you don’t keep your distance from others, according to Wendy Parmet, a professor of health policy and law at Northeastern University’s Law School.
“There’s no law for violating advice," Parmet said. "But you might know that if you try to violate the advice, they’re going to come and slap the order on you.”
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In Massachusetts, more than 700 people are in self-quarantine, according to the state Health Department. That includes people who are voluntarily separating themselves from the general population for a range of reasons: They feel sick and personally decided to stay home; they have been told by their companies, schools, or universities to stay home; or they have been advised by their doctors to stay home.
But their quarantines are not legally mandated, and they aren’t violating the law if they decide to go to the grocery store.
So if someone violates self-quarantine, what happens?
You cannot be punished for disregarding a request to self-quarantine.
“There may be PR liability, but there’s no legal liability,” said Jack L. Caynon, a Portland, Ore-based attorney who specializes in health law.
But public officials can issue mandatory quarantines if they’re concerned about people who are breaking voluntary ones.
A number of universities in Massachusetts are urging students to self-quarantine after returning from areas where the coronavirus is prevalent; those schools are relying on students to cooperate.
“Universities have no power to quarantine,” said Lawrence Gostin, a professor of global health law at Georgetown University. But, he added, if a university was particularly concerned, it could call on the state Health Department to issue a mandatory quarantine.
If someone violates mandatory quarantine, what happens?
Issuing an order of quarantine or isolation is a “police power," and it can be enforced by the police, said Parmet. But practically, experts said, there’s a limit to law enforcement agencies’ ability to enforce mass quarantines. Local public health agencies and police departments are strapped for resources. And while someone who violates a quarantine could technically go to jail, it wouldn’t make much sense to put a person with a potentially communicable disease into the jail population, where it could spread.
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“The strategy has to focus more on how can we increase people’s willingness and ability to comply, as opposed to policing our way out of it," Parmet said. "Because we can’t police our way out of it.”
In Wuhan, China, where the coronavirus outbreak began, authorities shut down the city, conducted house-to-house checks, and quarantined masses of people into warehouse-like facilities. That likely won’t work here.
“Our population won’t stand for the kind of intrusive surveillance or social control that allows mass quarantines in China. If it became a lot of people, it would be very difficult to enforce," said Gostin, noting that we aren’t likely to have electronic bracelets, cellphone surveillance, or nurses who visit each day to make sure people stay at home.
At a certain point, experts said, enforcing a mass quarantine becomes both implausible and foolish.
“All of this is based on an idea that this is a containable virus. Community spreading [in the] United States shows us that it is not,” said Dr. Adalja.
Can you challenge a mandatory quarantine in court?
Yes. You have due process, and if you challenge a quarantine, the state needs to prove there is clear and convincing evidence that you pose a risk to the public, and that quarantine is the least restrictive means to achieve its public health goal.
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In 2014, a Maine nurse, Kaci Hickox, successfully challenged a state quarantine after she returned from treating Ebola patients in Sierra Leone. Maine wanted to impose a strict 21-day quarantine on Hickox, but she was not symptomatic and argued that a quarantine was not based on scientific evidence. The judge agreed with her.
“We’re balancing civil liberties against public health," said Gostin. “Civil liberties should not trump public health. But public health should operate in a way that is proportionate to the risk.”
Can you sue someone if they were told to self-quarantine, but attend a party with you and you get infected?
Yes, but you wouldn’t have an easy case, Parmet said. To prevail, you’d need to show that the person acted unreasonably, and you would need to prove that person caused you to get sick.
“The higher prevalence in the community, the more complicated that’s going to be,” she said. Ultimately, she said, scapegoating and blaming "is really counterproductive, even though it’s such an understandable human response.”
What other options are there to stop the spread of the virus?
A group of more than 800 public health and legal experts published an open letter to Vice President Mike Pence on Monday, offering far-reaching policy suggestions. Their recommendations had little to do with issuing mandatory quarantines.
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Instead, they urged policy makers to make health centers “immigration enforcement-free zones,” for example, so that undocumented immigrants could seek care and would feel comfortable cooperating if public health officials asked about recent contacts. The group also recommended that policy makers and employers provide an “explicit incentive” for workers to stay home, either with payments or compensation for lost wages.
“Individuals will not cooperate with self isolation or other voluntary social distancing measures if they are unable to provide for themselves and their families,” the letter said.
Providing employees with sick leave is essential, said Parmet, who signed onto the letter.
“Let people who have flu-like symptoms and are low-wage workers not go to work and not be afraid that they’re going to lose their job,” she said. “Instead of tracking down the guy who went to the party when he shouldn’t have, let’s do sick pay.”
Material from the Associated Press was used in this report.