Chapter 11 Public Health Strategies for Epidemic diseases

Question 1

What are Lazarettos

Answer 1

Places of asylum which confined ID and insane in ancient Greece and Jerusalem

Question 2

Early quarantine laws

Answer 2

Earliest municipal ordinances in Boston in 1647

Question 3

Early federal quarantine laws

Answer 3

1796– First Federal quarantine law in response to yellow fever epidemic
1878–Federal quarantine act ‘to prevent the introduction of ID into US’
1893– expanded federal authority to international and interstate- federal preemption in this matter

Question 4

Historial definition of Quarantine

Answer 4

The detention and separation of persons suspected of carrying a contagious disease

Question 5

Origin of word quarantine

Answer 5

Italian quaranta- period of observation was 40 days assumed to be maximum duration of acute conditions

Question 6

Modern definition of Quarantine

Answer 6

the restriction of the movement of persons who have been exposed or potentially exposed to an ID during its period of communicability to prevent transmission of infection during the incubation period

Question 7

Define Isolation

Answer 7

Isolation is separation for the period co communicability of known infected persons in such places and under such conditions as to prevent or limit transmission of the infectious agent

Question 8

Two kinds of isolation statutes

Answer 8

Disease-based and behavior-based

Question 9

Critical evaluation criteria for isolation and quarantine

Answer 9

• what is the place of confinement
• how onerous are restrictions to movement,
• level of compulsion and intrusiveness of enforcement, how large is population confined,
• logistic, social, political and economic impacts,
• how health officials will monitor health and ensure needs are met,
• are benefits and burdens fairly distributed.

Question 10

Define Medical isolation

Answer 10

Segregation in a hospital or other healthcare setting of an infectious individual

Question 11

Define Home quarantine

Answer 11

Home-based segregation of exposed or potentially-exposed persons for the period of communicability of the disease

Also called self-quarantine or sheltering in place or snow days

Question 12

Advantages of home quarantine

Answer 12

less onerous
more socially and politically acceptable
logistically simpler
people dont mind

Question 13

Disadvantages of home quarantine

Answer 13

difficult to monitor and enforce
individuals may do daily activities- shop, work
can place households at risk because they are living in close proximity
government may have to ensure vulnerable people receive basic amenities (food, water, heating, clothing, healthcare)

Question 14

Define Work Quarantine

Answer 14

Persons permitted to work but have to follow home or institutional quarantine while off duty. Monitoring for symptoms and social distancing while at work.

Question 15

Advantages of work quarantine

Answer 15

minimize disruption of services

reduced staff for monitoring

Question 16

Disadvantages of work quarantine

Answer 16

healthcare providers can transmit infection to patients
require transport to and from work
need to maintain constant communication

Question 17

Quarantine of travelers

Answer 17

Isolation on an airplane or ship of travelers until the threat level has been established or the period of communicability has passed

Question 18

Advantages of quarantine of travelers

Answer 18

ease of monitoring

prevention of introduction of disease in a new area

Question 19

Disadvantages of quarantine of travelers

Answer 19

resource intensive, disrupts travel industry

Question 20

Define Geographic quarantine

Answer 20

legally enforceable order that restricts movement into or out of the quarantined community or neighborhood to reduce the likelihood of transmission to persons outside affected area

Question 21

Advantages of geographic quarantine

Answer 21

reduces need for urgent evaluation of large numbers

reduces spread of disease outside quarantined area

Question 22

Disadvantages of geographic quarantine

Answer 22

unlikely to be effective or politically acceptable
resource intensive
difficult to ensure basic needs
… pg 436

Question 23

State authority to compel isolation and quarantine within its borders are derived from —-

Answer 23

Police power

Question 24

Typically powers of detention are found in 3 kinds of ID laws–

Answer 24

STIs, TB and communicable diseases

Question 25

Center for law and Public Health at Georgetown and John Hopkins drafted two models–

Answer 25

Model State Emergency Health Powers Act

Turning Point Model Public Health Act

Question 26

MSEHPA is designed for

Answer 26

a large scale health event and its powers are triggered by a governor’s declaration of a public health emergency

Question 27

TP model Act reflects

Answer 27

modern mission and essential functions of health departments providing a set of powers and safeguards for day-to-day use.

Question 28

Federal government’s current quarantine authority is contained in (which act?)

Answer 28

Public Health Services act of 1944

Question 29

PHSA grants the secretary of HHS following powers

Answer 29

• make and enforce regulations to prevent the introduction, transmission or spread of communicable diseases into or within the US
• authorize inspection, fumigation, disinfection, sanitation, pest extermination, destruction of animals and articles
• to apprehend, detain, or conditionally release individuals for quarantinable diseases specified by the president in executive orders

Question 30

Courts in pre-civil rights era put 3 limits on civil confinement–

Answer 30

• The subject must be infectious
  Health authorities must demonstrate that the individuals have been exposed except prostitutes in OH and IL
• Safe and habitable conditions must be provided
  quid pro quo- must provide basic amenities in return for loss of autonomy or liberty.
• Confinement must be fair and just
  Jew Ho vs Williamson

Question 31

Constitutional review of isolation and quarantine in the modern era

Answer 31

-Compelling state interest
strict scrutiny- there must be danger of transmission, also treatment must be provided
-Well-targeted intervention

• Least restrictive alternative
• PDP

Question 32

Name some community containment strategies other than isolation and quarantine

Answer 32

• Community hygiene
  handwashing, disinfection, resp hygiene, PPE
  effectiveness unclear and depends on setting
• Increased social distance
  closures of schools, hospitals, factories, hotels
  -International border controls (pg 449)

Question 33

Pandemic influenza case study

Answer 33

H5N1- globalization, most resources to medical countermeasures, issues with vaccine supply, planning and. Marketing incentives, advance market commitment, sound regulation, intellectual property, liability and compensation NVICP, ethical allocation,