WASHINGTON — As states wrestle with whether to quarantine health workers who handled Ebola patients, the federal government has stopped short of imposing a uniform national policy — largely because of limitations on such a rare and controversial act.
President Obama signaled this week that he would leave the decision up to states, while cautioning that “it’s crucial that we remain focused on the facts and on the science.”
The US government has limited authority to quarantine or override a state’s decision to impose one. While federal officials can isolate people entering the country or traveling between states, few cases exist.
“The Centers for Disease Control and Prevention doesn’t have a presence in all 50 states all the time,” said Wendy Parmet, a professor of health policy and law at Northeastern University’s Law School. “It’s really up to the state to decide whether or not to quarantine.”
Federal officials have acted in rare cases, such as when it suspected a man returning from Europe in 2007 had a drug-resistant strain of tuberculosis. Some officials called for quarantines during the initial onslaught of the AIDS epidemic, but they were not enacted. The last massive isolation measures date to the influenza pandemic nearly a century ago.
Calls for a quarantine of health workers who treated Ebola patients have come from governors in Florida to Maine.
The CDC announced guidelines Monday that recommend people at high risk of contracting Ebola avoid public settings and submit to regular monitoring. But the agency did not recommend a mandatory quarantine.
“Governors ultimately have responsibility to protect the public health of people within their borders,” Chris Christie, New Jersey’s governor, said this week on NBC’s “Today” show.
Christie declared a 21-day quarantine last week for those who may have had contact with Ebola patients. But this week he allowed the relocation to Maine of Kaci Hickox, a nurse returning from Sierra Leone who called her quarantine in New Jersey inhumane.
Governor Paul LePage of Maine has vowed to seek legal authority to enforce mandatory isolation on Hickox, who continued to fight a quarantine because she has no symptoms.
“The way [states] are exercising their authority in this case, I believe, is unethical, unlawful, and contrary to public health science,” said Lawrence Gostin, a Newton native and professor of global health law at Georgetown University, who has informally advised Hickox.
But others argue that local jurisdictions have that right.
“Health is not mentioned in the Constitution, so the states have primacy in all matters of health,” said Mary Guinan, a former Nevada state health officer who served as dean of the University of Nevada, Las Vegas’ School of Community Health Sciences.
The federal government does have clear authority in one realm: quarantining members of the military. The Pentagon said this week all troops returning from affected regions in West Africa would face a mandatory three-week quarantine, even though they are not supposed to interact with Ebola patients.
Jessica Meyers can be reached at firstname.lastname@example.org.