Countries across the globe are on high alert as health workers race to contain an outbreak of the Ebola virus in Central and East Africa that has killed more than 100 people and infected almost 570, according to data from the World Health Organization, or WHO.
No cases associated with the recent epidemic have been reported in the United States, and “the risk to the general public remains low,” according to the Centers for Disease Control and Prevention.
But since deaths from the Bundibugyo strain of the Ebola virus were confirmed in the Democratic Republic of the Congo and Uganda on May 15, American leaders have enacted travel restrictions, enhanced health screenings and implemented other public health measures to prevent the spread of the disease.
“We cannot and will not allow any cases of Ebola to enter the United States,” U.S. Secretary of State Marco Rubio said in the Oval Office on May 27, roughly a week after the country had issued its first quarantine orders.
The United States also announced an agreement with Kenya to build a quarantine facility in the African country for Americans exposed to Ebola.
But protests against the facility have turned deadly, and the Kenyan courts have blocked the plan.
In the meantime, quarantine orders not only have to balance individuals’ rights with public health goals, they need to be done with care and nuance, be evidence-based and be explained, said Wendy Parmet, Matthews distinguished university professor of law and faculty co-director for the Center for Health Policy and Law at Northeastern.
Northeastern Global News spoke with Parmet, who wrote about quarantine law during the COVID-19 pandemic. She addressed whether the United States has the legal right to restrict entry to its citizens, the rights of Americans who may be caught up in the judicial dragnet and how quarantines can become controversial not just as a public health measure, but also as a political measure.
Can the US government legally restrict people from entering the United States for health reasons?
“There is statutory authority for quarantine and isolation,” Parmet said. “Whether the quarantine power could be used to quarantine someone for a limited period of time, a citizen, under the right circumstances, I think the answer would be yes.”
Parmet noted that in U.S. law, “quarantine” usually refers to both separating persons who have been exposed to an infectious disease and separating persons who are known to be infected, in addition to limits on travel. Public health practice distinguishes between a quarantine (separation due to exposure to a disease) and isolation (separation due to an infection).
On May 18, the CDC and Department of Homeland Security announced that noncitizens who had spent time in the DRC, Uganda or South Sudan in the past 21 days would not be allowed into the United States. The order was expanded four days later to include lawful permanent residents.
U.S. citizens and nationals who have traveled in DRC, Uganda and South Sudan are allowed back into the country after being rerouted to specific airports in the country and undergoing enhanced public health screening, according to the CDC. Nationals refers to “all U.S. citizens as well as persons who, though not citizens of the United States, owe permanent allegiance to the United States,” according to the U.S. Department of State.
Parmet said she supports quarantines and isolation, and said that “if somebody has Ebola, they should be in isolation.”
But she said the application of quarantine power might be problematic.
Parmet also had questions about the CDC’s screening process. A person can be exposed to Ebola but not be symptomatic for up to three weeks, according to the WHO. So what is an “enhanced health screening,” and is it effective? Are all people on a flight selected to be screened, or just sick people? Does screening involve self-reporting of symptoms?
Parmet recently traveled through Hartsfield-Jackson Atlanta International Airport, one of the airports screening U.S. citizens who have traveled from Central and East Africa, and observed huge crowds and long lines of impatient travelers.
“The idea that you could stop something by doing temperature screening at that airport is a little bit laughable,” Parmet said.
And these issues are not just a public health concern, but a legal one, she said.
“The arbitrariness of this really would undermine the government’s ability to sustain a court challenge,” Parmet said.
A spokesperson for Health and Human Services, which runs the CDC, did not respond to a list of questions from Northeastern Global News.
Are quarantines and travel bans actually effective health measures?
Parmet said quarantines go back millennia and can be warranted. But she said the application of the current quarantine restrictions is unclear and “performative.”
As for travel bans, they “are often ineffective and they’re deeply problematic,” she said. They can hamper the response to an outbreak by discouraging aid workers from traveling to help, as was the case during the 2014 Ebola outbreak, Parmet said. And it is emerging as an issue today, according to the WHO, because health workers are reluctant to leave their home country if they are unlikely to be allowed to return.
Countries subject to the travel ban can also feel like they are being punished for being transparent about an outbreak, Parmet said.
This current outbreak comes at a precarious moment for public health in the United States.
Parmet noted that Health and Human Services Secretary Robert F. Kennedy Jr. has spoken minimally about the Ebola outbreak. There has been similar silence surrounding the recent outbreak of hantavirus, an illness caused by contact with urine, feces or saliva from certain species of rats or mice, and for which the U.S. has also instituted quarantine measures, despite the fact that the sickness is not on the list of diseases for which the federal government can enact such a rule.
Further, there is no current surgeon general for the country. The director of the National Institutes of Health is the acting head of the CDC, an organization that also has no chief medical officer.
The Trump administration has also withdrawn from the WHO and dismantled the United States Agency for International Development (USAID), the lead international humanitarian and development arm of the U.S. government. Also, Kennedy cut $500 million in research funding for mRNA vaccines and withdrew from a global vaccine alliance (although Rubio has said the U.S. will return, The New York Times reported).
“The problem is not a lack of statutory authority; it’s not even the lack of regulatory authority,” Parmet said. “The problems are a lack of clear direction and a lack of explanation, so we don’t even know what the policy is.”
Ultimately, a performative response can be counterproductive.
“The best way to stop a disease like Ebola from coming is to lower the incidence of Ebola in an outbreak,” Parmet said.
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