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What the Ebola Crisis Can Teach Us About Quarantines What the Ebola Crisis Can Teach Us About Quarantines
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Long before the coronavirus swept across the United States, pushing millions of Americans into some form of isolation, the state of Connecticut forced eight people into mandatory quarantine during the Ebola virus scare.Long before the coronavirus swept across the United States, pushing millions of Americans into some form of isolation, the state of Connecticut forced eight people into mandatory quarantine during the Ebola virus scare.
With Ebola raging across West Africa, two Yale graduate students and an immigrant family arrived from Liberia. The country had the highest death rate during the 2014 Ebola outbreak, but the two Yale students had not been directly exposed to any victims.With Ebola raging across West Africa, two Yale graduate students and an immigrant family arrived from Liberia. The country had the highest death rate during the 2014 Ebola outbreak, but the two Yale students had not been directly exposed to any victims.
In a case still on appeal and designed by a Yale Law School clinic partly to try to set a modern legal precedent on quarantine rights, they sued over their treatment in a case that raises far-reaching questions relevant to outbreaks, whether it is Ebola or the coronavirus or some other public health risk.In a case still on appeal and designed by a Yale Law School clinic partly to try to set a modern legal precedent on quarantine rights, they sued over their treatment in a case that raises far-reaching questions relevant to outbreaks, whether it is Ebola or the coronavirus or some other public health risk.
“You feel a bit like a pawn,” said Ryan Boyko, 36, then a Yale graduate student who was quarantined. “You don’t know what the outcome is going to be, and you don’t know when you will get your freedom back.”“You feel a bit like a pawn,” said Ryan Boyko, 36, then a Yale graduate student who was quarantined. “You don’t know what the outcome is going to be, and you don’t know when you will get your freedom back.”
The plaintiffs claimed that Connecticut failed to meet basic requirements, including providing services and the right to appeal. Legal experts warn that the lack of clear laws regarding mandatory quarantines will cause widespread confusion. As states face difficult choices while putting residents under coronavirus quarantine, they are bracing for the inevitable wrangling in the courts.The plaintiffs claimed that Connecticut failed to meet basic requirements, including providing services and the right to appeal. Legal experts warn that the lack of clear laws regarding mandatory quarantines will cause widespread confusion. As states face difficult choices while putting residents under coronavirus quarantine, they are bracing for the inevitable wrangling in the courts.
“There are real risks with mandatory measures like this,” said Amy Kapczynski, a Yale law professor who helped to bring the lawsuit. “In part because they are not implemented very often, they are difficult to implement well.”“There are real risks with mandatory measures like this,” said Amy Kapczynski, a Yale law professor who helped to bring the lawsuit. “In part because they are not implemented very often, they are difficult to implement well.”
The coronavirus is driving Americans into unexplored territory, in this case understanding and accepting the loss of freedom associated with a quarantine. Even if many people grasp the need for precautions, managing the upheaval caused by such extreme measures is an experience few have faced.The coronavirus is driving Americans into unexplored territory, in this case understanding and accepting the loss of freedom associated with a quarantine. Even if many people grasp the need for precautions, managing the upheaval caused by such extreme measures is an experience few have faced.
Quarantines were far more common more than 100 years ago for epidemics like cholera and other childhood illnesses. The experiences of the people forced into quarantine for two to three weeks over the Ebola virus underscore the thorny legal issues and the personal frustrations involved.Quarantines were far more common more than 100 years ago for epidemics like cholera and other childhood illnesses. The experiences of the people forced into quarantine for two to three weeks over the Ebola virus underscore the thorny legal issues and the personal frustrations involved.
Already, there are people confused and concerned about the move to quarantine for the coronavirus. In Westchester County, one household of eight people was put under quarantine when county nurses came to their house to test them and handed them a mandatory order. When they called a hotline number on the printed order repeatedly, they said they received different answers to their questions every time, with no explanation of why they had been forced to stay home in the first place.Already, there are people confused and concerned about the move to quarantine for the coronavirus. In Westchester County, one household of eight people was put under quarantine when county nurses came to their house to test them and handed them a mandatory order. When they called a hotline number on the printed order repeatedly, they said they received different answers to their questions every time, with no explanation of why they had been forced to stay home in the first place.
In Kentucky, Gov. Andy Beshear announced over the weekend that a court issued a quarantine order against a 53-year-old rural resident who refused to cooperate with health authorities after he tested positive and was told to isolate himself. The county sheriff stationed a deputy outside his house.In Kentucky, Gov. Andy Beshear announced over the weekend that a court issued a quarantine order against a 53-year-old rural resident who refused to cooperate with health authorities after he tested positive and was told to isolate himself. The county sheriff stationed a deputy outside his house.
“It’s a step I hoped I’d never have to take, but we can’t allow one person who we know has the virus to refuse to protect their neighbors,” Mr. Beshear said. “We will do it again if we have to.”“It’s a step I hoped I’d never have to take, but we can’t allow one person who we know has the virus to refuse to protect their neighbors,” Mr. Beshear said. “We will do it again if we have to.”
The man’s wife, who called a local television station but declined to identify herself because she said the family had been receiving death threats, expressed confusion, claiming that the test was negative. The court records were sealed.The man’s wife, who called a local television station but declined to identify herself because she said the family had been receiving death threats, expressed confusion, claiming that the test was negative. The court records were sealed.
Roughly nine million residents in Northern California counties have been ordered to “shelter in place,” facing fines if they do not. Designed to enforce social distancing, it is less draconian than a quarantine since it allows some moving around for groceries or other essentials. A quarantine is meant to completely separate people known to have been exposed from everyone else.Roughly nine million residents in Northern California counties have been ordered to “shelter in place,” facing fines if they do not. Designed to enforce social distancing, it is less draconian than a quarantine since it allows some moving around for groceries or other essentials. A quarantine is meant to completely separate people known to have been exposed from everyone else.
In the United States, the right to quarantine individuals is most widely held by states and local governments under their “police powers” to protect public health.In the United States, the right to quarantine individuals is most widely held by states and local governments under their “police powers” to protect public health.
Laws vary by state, but generally accepted medical guidelines suggest using quarantines as a last resort, informing those under quarantine of the reasons and ensuring the right of appeal. Adequate care is also essential.Laws vary by state, but generally accepted medical guidelines suggest using quarantines as a last resort, informing those under quarantine of the reasons and ensuring the right of appeal. Adequate care is also essential.
Every virus has different properties, and the coronavirus is already far more widespread than Ebola was in West Africa. At that time, given that Ebola only spreads via direct physical contact with the bodily fluids of someone infected, the Centers for Disease Control and Prevention recommended self-monitoring for the 21-day incubation period, not a quarantine.Every virus has different properties, and the coronavirus is already far more widespread than Ebola was in West Africa. At that time, given that Ebola only spreads via direct physical contact with the bodily fluids of someone infected, the Centers for Disease Control and Prevention recommended self-monitoring for the 21-day incubation period, not a quarantine.
But in October 2014, the state of Connecticut announced a mandatory quarantine as fears about the Ebola virus crested globally. “Even if it was justified, which it was not, the way in which the quarantine was imposed and maintained was unlawful,” said Michael J. Wishnie, also a Yale Law School professor.But in October 2014, the state of Connecticut announced a mandatory quarantine as fears about the Ebola virus crested globally. “Even if it was justified, which it was not, the way in which the quarantine was imposed and maintained was unlawful,” said Michael J. Wishnie, also a Yale Law School professor.
Mr. Boyko and Laura Skrip, both graduate students at the Yale School of Public Health, went to Liberia for three weeks in September 2014 to help build a central database for the Ministry of Health. They were not exposed to any victims, but after Mr. Boyko came down with two mild fevers, both students were forced into quarantine in New Haven, Conn. — even though he tested negative for Ebola.Mr. Boyko and Laura Skrip, both graduate students at the Yale School of Public Health, went to Liberia for three weeks in September 2014 to help build a central database for the Ministry of Health. They were not exposed to any victims, but after Mr. Boyko came down with two mild fevers, both students were forced into quarantine in New Haven, Conn. — even though he tested negative for Ebola.
Police officers stationed in front of their home turned people away, although Yale sometimes interceded to deliver supplies.Police officers stationed in front of their home turned people away, although Yale sometimes interceded to deliver supplies.
Nathaniel Sieh, his wife, Louise Mensah-Sieh, and their four children had just arrived from Liberia when they were also quarantined for three weeks in nearby West Haven — in one room in a relative’s chilly basement.Nathaniel Sieh, his wife, Louise Mensah-Sieh, and their four children had just arrived from Liberia when they were also quarantined for three weeks in nearby West Haven — in one room in a relative’s chilly basement.
Bishop Harmon D. Yalartai, a pillar of the Liberian immigrant community, hurried to welcome them with bags brimming with bread, milk, pastries and other groceries. A police officer ordered him to leave with the groceries.Bishop Harmon D. Yalartai, a pillar of the Liberian immigrant community, hurried to welcome them with bags brimming with bread, milk, pastries and other groceries. A police officer ordered him to leave with the groceries.
“It has a stigma and a lot of fear around it because everybody is afraid and they wanted to be cautious, and rightly so, but there can be too much misunderstanding,” said the cleric. “Maybe the same thing will happen with the coronavirus.” The problem then, which remains today, is that the legal parameters around a quarantine remain murky because they have not been challenged in recent decades.“It has a stigma and a lot of fear around it because everybody is afraid and they wanted to be cautious, and rightly so, but there can be too much misunderstanding,” said the cleric. “Maybe the same thing will happen with the coronavirus.” The problem then, which remains today, is that the legal parameters around a quarantine remain murky because they have not been challenged in recent decades.
The lawsuit, filed in federal court in Connecticut in February 2016, argued that the quarantine violated basic rights under the Fourth and 14th Amendments. Judge Alfred V. Covello dismissed the entire case in 2017.The lawsuit, filed in federal court in Connecticut in February 2016, argued that the quarantine violated basic rights under the Fourth and 14th Amendments. Judge Alfred V. Covello dismissed the entire case in 2017.
Citing an early 20th-century precedent, the judge ruled that the state could quarantine people coming from an area where some 11,000 people died, even if the eight did not show symptoms.Citing an early 20th-century precedent, the judge ruled that the state could quarantine people coming from an area where some 11,000 people died, even if the eight did not show symptoms.
In court documents related to the appeal, which was argued in 2018 but is still pending, both sides noted that the ruling found the old case laws underdeveloped. Often rooted in anti-immigrant biases, they lacked robust modern interpretations of civil liberties.In court documents related to the appeal, which was argued in 2018 but is still pending, both sides noted that the ruling found the old case laws underdeveloped. Often rooted in anti-immigrant biases, they lacked robust modern interpretations of civil liberties.
The problem, said Mr. Wishnie, the Yale professor, is that courts have not really established the constitutional boundaries. “We cannot rule out that politics, prejudice and other local circumstances might drive officials to make choices contrary to C.D.C. approaches, contrary to science and contrary to law,” said Mr. Wishnie. “That is the concern.” The problem, said Mr. Wishnie, the Yale professor, is that courts have not really established the constitutional boundaries. “We cannot rule out that politics, prejudice and other local circumstances might drive officials to make choices contrary to C.D.C. approaches, contrary to science and contrary to law,” Mr. Wishnie said. “That is the concern.”
In the Westchester County case, one day after Bill Roberts’s oldest daughter, Christina, drove to their hospital to be tested for the coronavirus, two nurses from the county health Department showed up in hazmat suits at their front door and requested to test the seven other people in the house. In the Westchester County case, one day after Bill Roberts’s oldest daughter, Christina, drove to their hospital to be tested for the coronavirus, two nurses from the county Health Department showed up in hazmat suits at their front door and requested to test the seven other people in the house.
Before leaving, the nurses distributed a four-page, Xeroxed mandatory quarantine order, barring all of them from leaving their home in North Salem for two weeks.Before leaving, the nurses distributed a four-page, Xeroxed mandatory quarantine order, barring all of them from leaving their home in North Salem for two weeks.
The pages included a long list of rules. More than 1,700 people are living under such mandatory quarantine across the state, said Gary Holmes, the spokesman for the New York Department of Health.The pages included a long list of rules. More than 1,700 people are living under such mandatory quarantine across the state, said Gary Holmes, the spokesman for the New York Department of Health.
“It has been strange — we had no idea that it was going to happen,” said Mr. Roberts, who designs and installs kitchens for a living.“It has been strange — we had no idea that it was going to happen,” said Mr. Roberts, who designs and installs kitchens for a living.
Mr. Roberts said he had called the hotline number listed on the quarantine order about 10 times and was told something different each time, no matter what topic he broached. The order said they would be provided with food and other services, but one person on the hotline suggested it would be quicker to ask neighbors for help, for example.Mr. Roberts said he had called the hotline number listed on the quarantine order about 10 times and was told something different each time, no matter what topic he broached. The order said they would be provided with food and other services, but one person on the hotline suggested it would be quicker to ask neighbors for help, for example.
Sometimes the written quarantine orders contradicted what the Westchester County nurses who came to test them said. The paper orders said they could go into the yard, but the nurses ordered them not to even open the door except to accept food. The order said to leave trash right outside. The nurses said to keep it inside and someone would collect it.Sometimes the written quarantine orders contradicted what the Westchester County nurses who came to test them said. The paper orders said they could go into the yard, but the nurses ordered them not to even open the door except to accept food. The order said to leave trash right outside. The nurses said to keep it inside and someone would collect it.
The eight people — including Mr. Roberts’s mother-in-law, 79, and an 18-month-old baby girl, the daughter of a family friend — share a small, one-story house of about 1,200 square feet.The eight people — including Mr. Roberts’s mother-in-law, 79, and an 18-month-old baby girl, the daughter of a family friend — share a small, one-story house of about 1,200 square feet.
Mr. Roberts’s daughter Christina, 20, was having problems breathing before she went to Putnam General Hospital on Thursday evening. The quarantine was imposed Friday afternoon. Her coronavirus test came back negative on Saturday, but she did have a respiratory infection.Mr. Roberts’s daughter Christina, 20, was having problems breathing before she went to Putnam General Hospital on Thursday evening. The quarantine was imposed Friday afternoon. Her coronavirus test came back negative on Saturday, but she did have a respiratory infection.
When Mr. Roberts inquired about an appeal, he said he was told to call the Legal Aid Society. The organization said it only handled criminal matters. The police questioned whether the quarantine order was legal. The problem, not limited to New York, seems to be that so many new regulations are being introduced at once that various government agencies do not coordinate the rules.When Mr. Roberts inquired about an appeal, he said he was told to call the Legal Aid Society. The organization said it only handled criminal matters. The police questioned whether the quarantine order was legal. The problem, not limited to New York, seems to be that so many new regulations are being introduced at once that various government agencies do not coordinate the rules.
Several days later, state officials told Mr. Roberts that his household ended up on a list for mandatory quarantine where the household did not belong, he said. With all their results negative, the quarantine was lifted. Several days later, state officials told Mr. Roberts that his household ended up on a list for mandatory quarantine where it did not belong, he said. With all their results negative, the quarantine was lifted.
Mr. Roberts expressed relief but remained rattled. “The confusion and inability to get any reliable info was the worst,” he wrote by text message. “Made us feel completely powerless.”Mr. Roberts expressed relief but remained rattled. “The confusion and inability to get any reliable info was the worst,” he wrote by text message. “Made us feel completely powerless.”
Neil MacFarquhar can be reached at neil@nytimes.comNeil MacFarquhar can be reached at neil@nytimes.com