The United States will face a greater threat from Ebola this winter as the epidemic in West Africa slowly turns into a potential worldwide pandemic and leads to outbreaks in cities across the country, according to a noted medical analyst.
In an opinion column for
Forbes, Dr. Scott Gottlieb says that during January and February, public health officials will have a tough time tracking the "contacts" of Ebola patients as dozens of possible cases pop up nationwide, especially with the spread of the flu adding to the confusion.
The sudden rise in people who may have had even minor exposure to the deadly virus will have a profound effect on the current controversy over forced quarantines in the U.S., the doctor says, noting that the number of potential contacts placed in isolation could number in the hundreds within months.
Gottlieb pointed out that the epidemic is accelerating in Guinea and Sierra Leone, and before long it will have outbreaks closer to the U.S., such as in Latin America, which would ultimately lead to more cases on American soil.
In turn, this could create a critical situation as federal and state authorities attempt to implement forced quarantines, says Gottlieb, adding, "As we have seen from recent events, that legal power is sweeping, intrusive, poorly defined, and absolute."
Currently, the federal government can
quarantine people arriving from outside the U.S. or between states, while states have the capacity to isolate individuals within state boundaries. (If a person gets off a plane from a foreign country such as Liberia, then he or she is traveling within the state.)
Under the law, federal and state authorities also must have good reason to believe that a person is suspected of possibly contracting a communicable disease, noted Gottlieb, who analyzes policy, regulation, and public health as a Forbes contributor.
The United States cannot quarantine an entire city, such as Dallas or New York, which have both had recent cases of exposure to Ebola. But it can isolate a planeload of passengers if evidence shows that an airborne pathogen like SARS or MERS was released during the flight. (Ebola is not yet an airborne disease.)
During the Bush administration, to prevent a public health emergency such as a bioterrorist act, rules were put in place to authorize forced quarantines. But the controls appeared too stringent to civil libertarians, and the current administration abandoned them.
"Instead of tightening some of the parameters around how quarantine would be used through a revised regulation, the Obama administration abruptly pulled the rule, and replaced it with nothing," wrote Gottlieb.
President Barack Obama signed a series of executive orders to give the Centers for Disease Control and Prevention clear quarantine authority over the then-emerging respiratory pathogens of SARS and MERS, but the doctor says that overall, the regulations are outdated.
"As a result, we are left with the worst of both worlds — a sweeping legal authority with no modern regulation laying out its terms. If there's confusion now amidst conflicting state Ebola policies, the Obama administration shares in the blame," Gottlieb wrote.
The Bush administration rules included a concept called "provisional quarantine" that allowed the federal government to isolate individuals for three days if the CDC believed they had been infected with a contagious disease.
The concept has now been adopted by
an increasing number of states, including California, Connecticut, New York, New Jersey, Illinois, and Maine, resulting in questions about whether such quarantines — now lasting up to 21 days — are in fact legal.
Gottlieb says that as the handful of current isolated cases in the U.S. possibly evolves into a minor outbreak this winter, government leaders may well overreach with their quarantine authorities by isolating people who have barely been exposed to Ebola.
"It sounds prudent until you're the one being isolated," he wrote. "In bigger outbreaks, quarantine could encompass hundreds of unsuspecting and otherwise healthy individuals.
"Before that day arrives, we should demand more clarity from the state and federal governments on exactly what rights people will be afforded, and the conditions of their detention.
"For a start, the Obama administration could resurrect the Bush quarantine rule, and start implementing the parts that people agree on."
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