Nahid Bhadelia: The best defense against disturbing new diseases

Federal quarantine orders, however, are implemented and enforced by state health authorities, not federal officials. That means state and local health departments provide the labor, set the rules, monitor people who might have been exposed to the virus, and trace the contacts of those who fall ill. The federal quarantine order for the 195 evacuees from Wuhan? That order was able to prevent them from leaving the plane they arrived in. The federal government could also order the quarantine of an entire cruise ship at one of the nation’s seaports—as Japan has done. But otherwise, federal quarantine orders have a pretty limited effect. When one of the Wuhan evacuees wanted to leave the military base in California where the group was under quarantine, a state-level quarantine order was necessary to prevent that from happening. This is because the quarantined group was no longer at a point of entry, or in an airplane, and was thus subject to the jurisdiction of the local health department where they were quarantined.

Despite extensive federal measures to protect the U.S. from threats originating abroad, inevitably a virus will get through screening (as indeed the Wuhan coronavirus already has). This is where the weakness of a federalist system of national health defense is exposed. States may choose to ignore federal quarantine guidelines, or they may decide that more drastic measures are required, such as a lockdown against a neighboring city or region. Extreme measures may be necessary in a public-health emergency, but the variation from one location to another could also make an epidemic worse as each state makes its own rules, looks out for its own interests, and relies on its own resources. Jurisdictional boundaries are enforced, among other reasons, to preserve limited budgets.

This unique brand of public-health federalism can make implementing a national strategy in the event of a threatened epidemic very difficult. During the 2014 Ebola scare in the U.S., fierce public debate ensued about what measures to take. Panic set in as political leaders squabbled and it became clear that there was no single, national plan to follow. State and local health officials are the final authority on what preventive measures to take within their jurisdiction. With this setup, having an effective national strategy when one is needed is complicated if not impossible.

Does the U.S. Constitution in fact prevent a larger role for the CDC in setting quarantine policy within the country? At least when this question was previously asked, more than a century ago, Congress thought the answer was no.

The question emerged in the late 19th century, when yellow-fever epidemics in the southern U.S. sent panicked citizens fleeing, and cities and towns throughout the region closed their borders to one another. The nascent U.S. Public Health Service set up camps in Alabama and Florida for refugees, as they termed them, who had nowhere to go but did not wish to return to a place in the midst of an epidemic. After long debate, Congress responded with the 1890 Epidemic Diseases Act, providing federal authority over state and local quarantine, though many senators at the time did vote against it, believing it to be unconstitutional. As a result (on paper at least), the federal government may impose (or lift) quarantines in the interior whenever specified contagious diseases threaten to spread “from one state … into any other state.” The CDC’s modern-day interstate authority is limited primarily to “do not board” orders to prevent air travel within the U.S. by persons known to be ill, and relies on state health departments to request the order.