Editor's note: Lawfare has also compiled an overview of state emergency authorities available to governors in responding to the pandemic. You can read that overview here.

On Jan. 21, the United States reported its first case of coronavirus infection. Since that confirmed first case in Washington state, the virus has spread to all 50 states, the District of Columbia and multiple territories, infecting more than 234,000 people in the United States. As the virus continues to spread, we have also started to see stories of exposed persons violating recommended self-quarantines. In New Hampshire, a patient who became the state’s first confirmed case ignored medical advice and attended an event at a crowded music venue. He was then ordered by the state’s health commissioner to isolate at home. In Missouri, two schools closed temporarily after close relatives of the state’s first coronavirus patient attended a dance with students, also in violation of instructions to self-quarantine at home. In Kentucky, a patient who had tested positive for the coronavirus checked himself out of the hospital against medical advice and refused to quarantine himself. Law enforcement surrounded his house to prevent him from leaving and spreading the virus. So what powers do these states have to order compulsory quarantine of infected or exposed persons? Below, we provide a review of relevant state law authorizing quarantine or isolation. The summaries for each state and inhabited U.S. territory are listed in alphabetical order.

A list of relevant statutory authority for all states is also available on the National Conference of State Legislatures (NCSL) website. The NCSL also provides the following definitions for quarantine and isolation:

Quarantine: Compulsory separation, including restriction of movement, of people who potentially have been exposed to a contagious disease, until it can be determined whether they have become sick or no longer pose a risk to others. This determination could be made, for example, based on the time elapsed from their potential exposure.

Isolation: Separation of people known or suspected (via signs, symptoms or laboratory criteria) to be infected with a contagious disease from those who are not sick to prevent them from transmitting the disease to others.

Alabama

Alabama state law code Sections 22-12-1 to 22-12-29 give the governor or the State Board of Health the power to “proclaim a quarantine.” Once a quarantine is declared, the governor, the State Board of Health, county boards of health and municipal boards of health all have the power to enforce a quarantine through any necessary rules or regulations. However, Section 22-12-2 ensures that “the quarantine authority of the state shall be paramount to that of any county, city or town therein.”

Even though the state of Alabama has final authority over county and municipal boards of health, Sections 22-12-14, 22-12-12, 22-12-13 and 22-3-2 give county and municipal boards a significant amount of discretion to obtain and enforce quarantines.

When a contagious or infectious disease exists in a part of a county or municipality, Section 22-12-14 allows that county or municipality’s board of health to establish a quarantine. Under Section 22-12-12, a quarantine is established when a county or municipal board of health recommends a quarantine, the State Board of Health approves the recommendation and a probate judge in that county proclaims it. Section 22-12-12 also gives a county or municipality’s mayor or chief executive officer the power to declare an emergency quarantine. But an emergency declaration is subject to approval, modification or withdrawal by that county or municipality’s board of health as well as the State Board of Health. Additionally, Section 22-12-17 requires that the local authorities responsible for declaring a quarantine report their actions to the State Board of Health.

Once a quarantine is declared in part of a county or municipality, Sections 22-12-13 and 22-12-15 entrust a quarantine’s enforcement to the municipal or county health officer. Section 22-3-2 outlines the health officer’s expected duties. They include supervising the enforcement of the health laws of the state; promulgating rules and regulations for administering the health laws of the state and the rules and regulations of the State Board of Health; investigating cases or outbreaks of any enumerated diseases; and enforcing such measures for the prevention or extermination of said diseases as are authorized by law.

To fulfill these duties, Section 22-12-18 gives these officers the ability to restrain any individual exiting a quarantined area from further travel and Section 22-12-26 expands these powers by giving any legal quarantine officer or guard the ability to conduct a warrantless arrest if an individual is attempting to violate a quarantine regulation. Section 22-12-19 also gives the municipal or county health officer the power to establish a place of detention in their municipality or county to detain individuals who attempt to leave a quarantined area. Additionally, Section 22-12-21 places the supervision of trains, buses, aircraft and watercraft affected by a quarantine under the supervision of the State Board of Health and the quarantine authorities of the relevant county, city, or town. Section 22-12-22 further disincentivizes third parties from knowingly helping others leave a quarantined zone by designating this action a misdemeanor offense that carries fine between $100 and $500.

But Alabama laws also give citizens the ability to petition their respective quarantine authorities for release. Section 22-12-29 allows any person prevented from leaving or entering a location by a quarantine officer or guard to make an affidavit presenting evidence that they have not been in any quarantined location. If this affidavit meets the standards set by the State Board of Health, that individual must be allowed to enter or leave their indicated location. This same section also provides that any person placed under quarantine may make an affidavit showing they have complied with the detention and disinfection requirements and should be released. If this affidavit meets the State Board of Health’s requirements, then that individual cannot be held. Section 22-12-29 adds that any quarantine officer or guard who violates these requirements can be guilty of a misdemeanor offense and fined between $50 and $100.

Alaska

Under Section 26.23.020(b) of Alaska’s Disaster Act, the governor can issue orders, proclamations and regulations with the force of law necessary to reduce Alaskan citizens’ vulnerability to damage, injury, and loss of life and property resulting from “a disaster.” Section 26.23.900(2) of this act contains five definitions of “a disaster.” One of these definitions is “an outbreak of disease or a credible threat of an imminent outbreak of disease that the commissioner of health and social services or a designee of the commissioner of health and social services certifies to the governor has a high probability of occurring in the near future.”

Section 26.23.020 of Alaska’s Disaster Act allows the governor to invoke his or her emergency powers by proclaiming “a disaster” has occurred or is imminent. This proclamation “activates the disaster response and recovery aspects of the state, local, and interjurisdictional disaster emergency plans applicable to the political subdivisions or areas in question.” However, the governor’s power to declare an emergency is limited by Section 26.23.025(c), which reserves the Alaskan legislature’s power to pass a law ending any disaster emergency.

During a disaster the governor “is commander in chief of the organized and unorganized militia and of all other forces available for emergency duty.” Section 26.23.020(g)’s subsections also give the governor broad powers, including the ability to:

Suspend the provisions of any regulatory statute prescribing procedures for the conduct of state business, or the orders or regulations of any state agency, if compliance would prevent, or substantially impede necessary actions to alleviate the disaster; use all available resources of the state government and of each political subdivision of the state as reasonably necessary to cope with the disaster emergency; commandeer or utilize any private property, except as limited by the act; direct and compel the relocation of all or part of the population from any stricken or threatened area in the state; prescribe routes, modes of transportation, and destinations in connection with necessary relocation; and, control ingress to and egress from a disaster area, the movement of persons within the area, and the occupancy of premises in it.

Once the governor declares a disaster emergency due to an outbreak of disease or a credible threat of an imminent outbreak, Alaska’s public health law Section 18.15.390 also gives the state Department of Health an additional set of emergency powers. These powers include:

completing the evacuation or decontaminate of any facility that may endanger the public health; controlling and regulating, the use, sale, distribution, or transportation of commodities, as may be reasonable and necessary to respond to the disaster; the ability to adopt and enforce measures to provide for the safe disposal of infectious waste or emergency appointment made under this paragraph for any reason.

In addition to these emergency powers, Section 18.15.385 of Alaska’s public health law gives state officials the ability to quarantine individuals or groups if doing so is “the least restrictive alternative necessary to prevent the spread of a contagious or possibly contagious disease to others.” However, Section 18.15.385(b) places significant restrictions on how and when this ability can be used.

To start, Section 18.15.385(d) requires the Department of Health to “obtain a written order from the superior court authorizing the quarantine, unless the individual consents to the quarantine.” This petition must disclose the identity of the person (or persons) to be quarantined, the premises where the quarantine will occur, the date the quarantine starts, the suspected disease, and a showing that the person (or persons) poses a risk to public health and is unwilling to behave so as not to expose other individuals to danger of infection. However, if the Department of Health has probable cause to believe that the delay involved in seeking a court order imposing quarantine would pose a clear and immediate threat to the public health and quarantine is the least restrictive alternative and is necessary to prevent the spread of a contagious contagious disease, then a state medical officer in the department may issue an emergency administrative order to temporarily quarantine an individual or group of individuals.

If a quarantine occurs, Section 18.15.385(b)(2) of the same act requires the Department of Health to quarantine a person in his or her own home unless there are exceptional circumstances. Sections 18.15.385(b)(3) and (5) also mandate that the Department of Health regularly monitor quarantined individuals to determine whether the quarantine remains necessary and immediately terminate a quarantine order when an individual or group poses no substantial risk of transmitting a contagious disease to others.

If the Department of Health issued an emergency administrative quarantine order, Section 18.15.385(f) gives the individual or persons listed in that order the right to a court hearing within 48 hours. If the Department of Health can show good cause, a court may postpone the hearing for up to five days. At the conclusion of the hearing, Section 18.15.385(h) allows the court to commit the individual or individuals to quarantine for not more than 30 days if the court finds, by clear and convincing evidence, that the isolation or quarantine is necessary to prevent or limit the transmission of a disease that poses a significant risk to the public health. Under Section 18.15.385(i), before the expiration of the order described in Section 18.15.385(h), the court may continue the quarantine for additional periods not exceeding 30 days upon a showing by the department, by clear and convincing evidence, that the action is still necessary to prevent or limit the transmission to others of a disease.

“Knowingly” violating a quarantine order is a Class B misdemeanor, punishable by up to 90 days in jail and a maximum fine of $2,000. Additionally, “intentionally” violating a quarantine order is a Class A misdemeanor, punishable by up to one year in jail and a fine of up to $10,000. Under Alaskan law Section 11.81.900, individuals “knowingly” violate an order when they are aware of a substantial probability that they are violating a law or their conduct is of a nature that might violate a law. Individuals “intentionally” violate an order when they are consciously aware that breaking quarantine is against the law.

American Samoa

American Samoa Public Health Act (Public Law No. 30 of 2007) regulates the public health of American Samoa and aims to strengthen the public health infrastructure of the territory. Under Section 13.0206, the Department of Health has the power to declare and enforce quarantine, to prevent, limit or modify attendance at school in the event of an imminent epidemic or serious outbreak of communicable disease and take precautionary measures such as embargoes, detention and removal of products; declaration of quarantine; provision of public health information and messaging; and promotion of efforts to detect and ameliorate disease.

Section 13.0209 and 13.0210 require the director of the Department of Health to establish a list of reportable diseases and conditions of public health importance, to distribute the list and to require every health care provider, physician, pharmacist, laboratory director, coroner, medical examiner and veterinarian with knowledge of a case of such a disease or condition to report the incident to the Department of Health in writing within a specified time period. Failure of these officials to report a required disease or condition within the specified time period is a Class A misdemeanor under Section 13.0211.

If the department receives a complaint or has reasonable belief supported by sufficient facts that a condition of public health importance exists, then the department may inspect and investigate under Section 13.0212. Under Section 13.0213, this may include methods of epidemiological investigation, including identifying individuals who may have been exposed or infected, interviewing and testing these individuals, and examining facilities or materials that may pose a public health threat. It may also include investigating potential sources of exposure and infection and ensuring proper control measures. The department may also close, evacuate or decontaminate any facility or destroy or decontaminate any material “when it reasonably believes that such facility or material may endanger investigators, other individuals, or the public's health.”

Section 13.0214 empowers the department to compel medical treatment, defined as “an appropriately prescribed course of medication,” for individuals who were or may have been exposed to a contagious disease posing significant risk to public health. The treatment must be “reasonably calculated to prevent, control, or ameliorate” the condition and the department personnel who examines or treats the person must instruct them about measures to prevent reinfection and disease transmission.

The director, or his or her designee, may order isolation or quarantine of an individual or group under Section 13.0215. The isolation or quarantine order must be the least restrictive means necessary to prevent spread of the disease and may include confinement to a private home or other private or public premises. The health status of the confined person must be regularly monitored to determine if continued confinement is necessary and the isolation or quarantine must be immediately terminated if the person no longer poses a substantial risk of transmitting a contagious disease to others.

While in quarantine or isolation, the needs of the confined individual must be addressed in a “systematic and competent fashion,” including providing adequate food, clothing, shelter, means of communication and competent medical care. In addressing these needs and establishing and maintaining the isolation or quarantine premises, the person’s cultural and religious beliefs are to be respected to the extent possible. The department may authorize access to the premises where necessary to meet the confined person’s needs, including medical care.

An isolation or quarantine order can be initiated on a temporary basis without notice under Section 13.0215(d). The director may issue such an order by written directive if delay in imposing the confinement would “significantly jeopardize the department’s ability to prevent or limit the transmission” of a contagious disease. The directive must specify the identity of the person, the premises, date and time and suspected contagious disease and a copy of the directive must be given to the individual or, if the directive applies to a group of individuals and individual delivery is impracticable, posted in a conspicuous place in the premises. Within 10 days of issuing a written directive for temporary isolation or quarantine, the director must petition for a court order authorizing continued isolation or quarantine.

Under Section 13.0215(e) the director may petition a court for an order authorizing isolation or quarantine. The petition must specify the identity of the person, the premises, date and time, the suspected contagious disease, a statement of compliance with the conditions and principles of isolation and quarantine, and a statement of the basis justifying the isolation or quarantine. The petition must be accompanied by a sworn affidavit by the director, or designee, attesting to the facts asserted in the petition; and notice must be given to the affected individuals. A hearing will be held on the petition as soon as practical after the petition is filed, but in extraordinary circumstances and for good cause the director may apply to continue the hearing for up to five days. The court shall grant the petition if isolation or quarantine is shown by clear and convincing evidence to be reasonably necessary to prevent or limit the transmission of the disease.

An order authorizing isolation or quarantine may not exceed 30 days unless continued by court order. For an order continuing the confinement for up to an additional 30 days, the director must move for such an order prior to the expiration of the isolation or quarantine. Such an order must identify the person, specify factual findings warranting the isolation or quarantine, and include any conditions necessary to ensure the isolation or quarantine is carried out within the statutory purposes and restrictions.

An isolated or quarantined person may apply to the court under Section 13.0215(g) for an order to show cause why isolation or quarantine should not be terminated. The court is to rule on the application as soon as practicable, but the director may move for an extension of time based on extraordinary circumstances. The court may not enjoin or stay an isolation or quarantine order. The court may grant a hearing for remedies regarding breaches of the conditions of isolation or quarantine.

Arizona

Arizona provides a general process of quarantine for any contagious or infectious disease and more specific process in the case of a declared state of emergency.

Any person aware of a case of contagious, epidemic or infectious disease must immediately report the name and location of the person to the board of health or health department. Knowingly withholding such information by any person or other violations of these provisions or of a rule, regulation, order, instruction or measure adopted pursuant to them constitutes a Class 3 misdemeanor. It is a Class 2 misdemeanor to knowingly expose oneself or another infected person in a public place, except if necessary to remove the person.

Upon notification of the existence of a contagious or infectious disease in its jurisdiction, the county health department or public health services district must investigate immediately and, if the disease is confirmed, immediately inform the state’s Department of Health Services and adopt quarantine or sanitary measures to prevent transmission of the disease. The local board of health and health department have authority to take control of any hospitals or other facilities where infectious or contagious disease exists or to provide temporary hospitals or facilities to receive infected persons. Arizona also provides for the disinfection or destruction of any contaminated property or articles and for reasonable compensation for such destruction.

Arizona provides further quarantine and isolation instruction in the event of a declared public health emergency. The governor may issue an “enhanced surveillance advisory” upon reasonable cause to believe that “an illness, health condition or clinical syndrome caused by bioterrorism, epidemic or pandemic disease or a highly fatal and highly infectious agent or biological toxin has or may occur.” The governor is to consider the least restrictive measures necessary, consistent with public health, and then to determine reporting requirements, patient tracking and testing, and information sharing. An enhanced surveillance advisory will last for 60 days only, unless the governor renews the order, and may be revised or terminated at any time by the director of the Department of Health Services. Enhanced surveillance advisories trigger increased reporting and information-sharing requirements and specific patient-tracking and specimen-testing capabilities.

The governor may declare a state of emergency due to the occurence or threat of an epidemic or pandemic disease posing a “substantial risk of a significant number of human fatalities or incidents of permanent or long-term disability.” The Department of Health Services will have primary jurisdiction, responsibility and authority during such a state of emergency over planning; coordinating; and organizing public health assessments, preparedness response, recovery and mitigation operations, and public information. The department also has authority to adopt a temporary professional licensing process for any professionals or health care institutions required to address the state of emergency. The governor can issue orders mandating medical examinations, rationing medicine and vaccines, and providing transportation or medical supplies.

During a state of emergency, the Department of Health Services or local health authority must investigate if there is reasonable cause to believe a highly contagious and fatal disease exists within the jurisdiction. The director of the Department of Health Services may order quarantine or isolation of any persons who have contracted or been exposed to the disease—by written directive detailing the person, conditions and reasons for confinement—if this is the least restrictive means to protect the public from transmission. Unless there is an immediate and serious threat to public health, a written order from the court is required to order quarantine or isolation. Within 10 days of issuing a written directive, the department or local health authority must file a petition for a court order authorizing the confinement, along with a sworn affidavit attesting to the facts. A hearing on the petition will be held within five days, or within 10 days if extraordinary circumstances necessitate, and the petition will be granted if the quarantine or isolation is shown by a preponderance of the evidence to be reasonably necessary to protect the public health. The court-ordered quarantine or isolation may not exceed 30 days; however, the department or the local health authority may move to continue it for an additional period of up to 30 days, upon the same standard as the first application.

Quarantine can occur in the residence of the individual or a place established and maintained by the Department of Health Services or local health authority for such purposes. The state will be responsible for providing adequate food, clothing, medicine, medical care, and means of communicating with persons inside or outside of confinement. Persons subject to quarantine or isolation must comply with any department or local health authority orders and may not go beyond the premises or come into contact with anyone other than a physician, health care provider or other authorized persons. Any person who enters premises placed under quarantine or isolation without authorization, and therefore poses a danger to public health, may also be placed in quarantine or isolation. Quarantine or isolation must be terminated if the department or local health authority determines that it is no longer necessary to protect the public health.

Arizona also provides due process for persons subject to quarantine or isolation during a state of emergency. Persons ordered quarantined or isolated have a right to counsel, at state expense, for the duration of their confinement. Individuals can request a court hearing regarding their treatment or conditions of confinement. The hearing must take place within 10 days of the request, and the court may provide remedies “appropriate to the circumstances of the state of emergency” if it finds the conditions do not comply with these statutory provisions.

Arkansas

Arkansas’s State Board of Health has the power to make all necessary and reasonable rules of a general nature for the health and safety of the public. This includes “the suppression and prevention of infectious, contagious, and communicable diseases” and “the proper enforcement of quarantine, isolation, and control of such diseases.” Section 20-7-110(a)(2) of the Arkansas Code gives the State Board of Health direction and control over all quarantine regulation and enforcement. Part (b) of this same section also gives the governor the power to present specific facts to the State Board of Health “whenever the health of the citizens of [Arkansas] is threatened by the prevalence of any epidemic or contagious disease in this or any adjoining state and, in the judgment of the Governor, the public safety demands action on the part of the board.”

Section 14-262-102 of the Arkansas Code allows municipalities and townships to have their own health boards. Under Subsection (c) of this law, city councils can give their health boards any powers necessary to “[s]ecure the city and its inhabitants from the evils of contagious, malignant, and infectious diseases.” Each municipality or incorporated town can also create a health officer, who is a legally qualified physician elected by the city or town council. Section 14-262-103(d)(3) requires these officers to “discharge and perform such duties as may be prescribed for him or her under the directions, rules, regulations, and requirements” of the State Board of Health and the relevant municipal or township board of health. Additionally, Section 14-262-103(d)(5) requires health officers to aid the state and municipal medical boards in the “enforcement of proper rules, regulations, and requirements” related to “sanitary laws, quarantine regulations, and vital statistics collection.”

Section 14-262-109(2) and (3) requires each county and district health department to “investigate and control the cause of epidemic and communicable disease affecting the public health” and “establish, maintain, and enforce isolation and quarantine” when necessary for the protection of the public health. When a state, county or municipal health officer has reasonable grounds to believe that any person has tuberculosis in an active state or in a communicable form and that person is refusing to seek a medical examination or treatment, Section 20-15-703(a) allows health officers to apprehend that individual and detain him or her for the necessary tests and examinations. If that person is found to have tuberculosis, part (b) of the same statute places a duty on the health officer to determine whether that person needs to be quarantined. Section 20-15-703 is phrased broadly, so it is unclear to what extent it applies to managing other communicable diseases.

Under Section 20-7-109(b), “if a patient can be treated with reasonable safety to the public health, he or she shall not be removed from his or her home without his or her consent.” However, section 20-15-704 states that if “the health officer finds that the circumstances are not suitable for proper isolation or contagious control of the case by any type of local quarantine” and the person is a source of danger to others, “then the health officer shall petition the circuit court of the individual’s county” to order the admission of the person to any state-owned and state-operated hospital.

Any firm, person or corporation that violates a quarantine order can be found guilty of a misdemeanor under Section 14-262-101. The penalty can consist of a fine between $100 and $500 and imprisonment of up to one year. Each day that a firm, person or corporation violates a lawful order pursuant to these laws counts as a separate offense.

California

According to the California Health and Safety Code, California grants a broad and fairly unstructured power to the state’s Department of Health Services to “adopt and enforce regulations requiring strict or modified isolation, or quarantine, for any of the contagious, infectious, or communicable diseases, if in the opinion of the department the action is necessary for the protection of the public health.” Local health officers also have broad authority to issue orders to other government entities in their jurisdiction in the event of “an outbreak of a communicable disease, or upon the imminent and proximate threat of a communicable disease outbreak or epidemic that threatens the public’s health.” Under California’s Communicable Disease Prevention and Control Act, these health officers include county, city and district health officers.

Only probable cause, or “reason to believe,” that an individual is infected with a communicable disease is required for a health official to institute a quarantine order. All health officials are required to enforce any order, rule or regulation issued by the department with regards to quarantine or isolation and to immediately report every known or suspected case of the disease to the department within 24 hours of discovery.

Local health officials are responsible for notifying and updating government entities regarding all relevant information, including location and number of cases and steps government could take to address the threat. All health care providers and clinics, as well as pharmacies, suppliers and distributors are required to disclose medical supplies and vaccines upon request of a local health officer.

In California, quarantines have been instituted in hospitals and jails, or by confining persons in their homes. A person subject to quarantine or strict isolation “shall not go beyond the lot where the building, house, structure, or other shelter is situated, nor put himself or herself in immediate communication with any person not subject to quarantine, other than the physician, the health officer or persons authorized by the health officer.” California law also prohibits teachers and students residing in a place subject to strict isolation or quarantine of contacts from attending school without written permission of the health officer.

All persons must obey any order, rule or regulation issued by a health official regarding quarantine or isolation. Noncompliance with any department rule, including violation of terms of quarantine or isolation, is a misdemeanor offense. It is also a misdemeanor offense for any person charged with performance of any duty relating to the preservation of the public health to willfully neglect or refuse to perform such a duty.

In the 1921 case of In re Culver, a minor child who had been exposed to diphtheria was ordered quarantined in her home. A police officer placed a warning placard on the door of the residence by order of the state board of health, but the child’s aunt removed the sign. The woman was prosecuted for the misdemeanor offense of violating an order of the board respecting a quarantine and the Supreme Court of California upheld the conviction. In the 1966 case of In re Halko, a patient with pulmonary tuberculosis was quarantined in a hospital where he was receiving treatment. The patient left the hospital in violation of the quarantine order and later was convicted for the violation. Prior to serving his sentence, he was served with a series of successive isolation orders returning him to the hospital due to his condition. He petitioned for writ of habeas corpus arguing that the state statute ordering his confinement was unconstitutional because he suffered a continual deprivation of his liberty without any ability to judicially challenge the health officer’s conclusion. The California Second District Court of Appeals denied his petition, upholding the statute as reasonable and necessary to protect the public health.

Colorado

Under Colorado’s Revised Statutes Section 25-1-506, each county or district public health agency is assigned a range of duties to protect the public health, including to “investigate and control the causes of epidemic or communicable diseases and conditions affecting public health” and to “establish, maintain, and enforce isolation and quarantine, and in pursuance thereof, and for this purpose only, to exercise physical control over property and over the persons of the people within the jurisdiction of the agency as the agency may find necessary for the protection of the public health.”

The Department of Public Health and Environment has similar powers and duties, including closing theaters, schools and other public establishments; forbidding gatherings of people; setting standards for diagnostic tests; purchasing and distributing vaccines and other products; establishing sanitary standards for the maintenance of public homes, facilities and spaces; disseminating public health information; and gathering and maintaining any necessary information and data. The department also has the ability to establish and enforce quarantine and isolation, and in pursuance of these orders, may exercise physical control over property and persons as necessary for the protection of the public health. In the event of a pandemic influenza, the department is authorized to enter into partnerships to purchase and stockpile antiviral therapies.

Under Section 24-33.5-704.5, the governor of Colorado has an expert emergency epidemic response committee, made up of officials such as the executive director, chief medical officer, chief public information officer, emergency response coordinator and state epidemiologist of the Department of Public Health and the attorney general, director of the division of homeland security and emergency management, and more. The governor will also appoint several categories of persons to the committee, including licensed physicians in infectious disease and emergency medicine, a medical examiner, a specialist in posttraumatic stress management, and more. The committee is charged with creating management programs regarding public health crises, including pandemic influenza and epidemics caused by novel and highly fatal infectious agents, and providing public health advice to the governor in the event of an epidemic.

If there is evidence of an occuring or imminent threat of an emergency epidemic, the governor can convene the committee to investigate. If the committee confirms the emergency epidemic, it will then advise the governor to declare a disaster emergency. Once the governor has declared a disaster emergency, the committee will continue to convene to advise the governor regarding reasonable, appropriate measures to initiate, by executive order, in order to reduce or prevent spread of the disease, including procuring or gathering medical supplies and vaccines, ordering transfer of patients, isolating or quarantining persons or property, assessing the adequacy of food and water supplies, and providing information and advice to the public and mental health support to affected persons.

Finally, under Sections 25-1.5-601-613, Colorado provides a set of regulations regarding volunteer health practitioners who are employed by disaster relief organizations while an emergency declaration is in effect.

Connecticut

If the Connecticut governor declares a public health emergency, under Conn. Gen. Stat. § 19a-131a, the governor can authorize the health commissioner to isolate or quarantine individuals. Section 19a-221 also gives local health directors the power to order quarantine or isolation when a director “has reasonable grounds to believe” an individual is “infected with a communicable disease.” The director must determine that the individual “poses a substantial threat to the public health” and isolation or quarantine must be “necessary to protect or preserve the public health.” However, if the governor declares a public health emergency pursuant to Section 19a-131a, local authorities must “comply with and carry out” orders the state commissioner issues in furtherance of the declaration of the public health emergency.

If the governor declares a public health emergency and an individual violates the provisions of a quarantine or isolation order or obstructs someone who is authorized to carry out such an order, the individual is subject to a fine up to $1,000, imprisonment up to one year, or both, for each offense. Additionally, if an individual refuses to comply with a quarantine or isolation order, the commissioner may also “direct any law enforcement officer to immediately take such individual into custody and place him or her into quarantine or isolation, as the case may be.”

Section 19a-131b provides the conditions for quarantine and isolation, the procedures the commissioner must follow when quarantining or isolating individuals, and the procedures for individuals to appeal an order and have a hearing. The commissioner may order an individual, group of individuals, or anyone “present within a geographic area” into quarantine or isolation. The commissioner must have “reasonable grounds” to believe that the individual is “infected with, or exposed to, a communicable disease” or is “at reasonable risk of having a communicable disease” or passing the disease to other individuals. The commissioner must determine that “such individual or individuals pose a significant threat to the public health[,]” that quarantine or isolation is “necessary[,]” and that such a measure is “the least restrictive alternative to protect or preserve the public health.”

The statute provides nine “conditions and principles” that the commissioner must adhere to when exercising the power to quarantine or isolate an individual or group of individuals. First, the measures themselves must be tailored to utilize the “least restrictive means necessary to prevent the spread of a communicable disease or contamination to others.” Second, individuals who are quarantined and those who are isolated must be “confined separately” from each other. Third, officials must frequently monitor the health status of individuals who have been quarantined or isolated “to determine if they continue to require quarantine or isolation.” Fourth, if a quarantined individual becomes infected “or is reasonably believed to have become infected with a communicable disease” after being quarantined, the individual must be moved to isolation.

Fifth, officials must immediately release individuals “when they are no longer infectious or capable of contaminating others or upon the order of a court of competent jurisdiction.” Sixth, officials must address the needs of those quarantined or isolated “in a systematic and competent fashion.” This includes “providing adequate food, clothing, shelter, means of communication with those in quarantine or isolation and outside those settings, medication and competent medical care.” Seventh, the premises officials use for quarantine and isolation must be kept safe and hygienic and “be designed to minimize the likelihood of further transmission of infection or other harms to individuals quarantined or isolated.” Eighth, officials must keep family members and members of a household together “to the extent possible without jeopardizing the public health.”

Finally, officials must consider cultural and religious beliefs “to the extent possible” when addressing individual needs and “establishing and maintaining premises used for quarantine and isolation.” If an individual in quarantine or isolation wants to be treated “by prayer or spiritual means without the use of any drugs or material remedies, but through the use of the principles, tenets or teachings of any church incorporated under [a chapter of the statutes] or any other religious or spiritual practice,” the individual has the right to be treated in this manner.

When the commissioner issues a quarantine or isolation order, it must be in writing. Among other items, it must include the period of time that the order will remain effective, “the basis for the commissioner’s belief regarding the presence of a communicable disease,” and “other terms and conditions as may be necessary to protect and preserve the public health.”

When determining the time period of the order, the commissioner must consider “to the extent known, the length of incubation of the communicable disease or contamination, the date of the individual’s exposure and the individual’s medical risk of exposing others to such communicable disease or contamination.” The order may not be effective for more than 20 days, though further orders may be issued for successive periods of no more than 20 days.

A quarantine or isolation order must also inform individuals subject to it that they have the right to consult an attorney and the right to a hearing. It must include “clear instructions on how to request a hearing,” and that if an individual does so, the individual has the right to be represented by counsel at the hearing. If the individual cannot afford counsel, the state must provide counsel. At a hearing, the individual also has the right to cross-examine testifying witnesses. Court fees must be waived for such a hearing.

If the order applies to a group of individuals present in a geographic area, the court can appoint one or more attorneys to represent everyone in the area “where there is a commonality of interests of such individuals.” However, “an individual may choose to be represented by his or her own attorney on an individual basis.”

An individual who is subject to a quarantine or isolation order may appeal the order to the Probate Court for the district in which the individual is quarantined or isolated, though the request does not stay the quarantine or isolation order. If the individual requests a hearing, the court must hold the hearing no later than 72 hours after receiving the request, though the “court may extend the time for a hearing based on extraordinary circumstances.” There is also no fee to file an appeal.

All parties, including the Probate Court, must have access to all records prior to the hearing. Records that relate to the individual’s condition are admissible at the request of any party or the court at the hearing. Parties are permitted to timely object to the “admissibility of evidence in accordance with the rules of civil procedure.”

At the hearing, the commissioner has the burden of showing that the necessary conditions of the statute are met by a preponderance of the evidence. If the court finds that the conditions are met, it must order either the continued quarantine or isolation of the individual “under such terms and conditions as the court deems necessary to prevent the exposure of others to a communicable disease” until the commissioner determines that releasing the individual “would not constitute a reasonable threat to the public health,” or the release of the individual “under such terms and conditions as [the court] deems appropriate to protect the public health.” If the court finds that the conditions have not been proved, it must order the individual’s immediate release.

An individual may move the court to terminate or modify its order every 30 days. If the individual does so, another hearing will be held. The court may modify its order if it determines that the condition for quarantine or isolation still exists but a different remedy is appropriate.

“Any person aggrieved” by a Probate Court order may appeal to the Superior Court.

Section 19a-221, which describes the mechanisms for local authorities quarantining or isolating individuals, provides for essentially identical procedures.

Delaware

In Delaware, Title 20 Section 3115(a) makes the governor “responsible for addressing the dangers to life, health, environment, property or public peace within the State presented by emergencies or disasters.” Section 3102 defines an emergency as “any situation which requires efforts and capabilities to save lives or to protect property, public health and safety, or to lessen or avert the threat of a disaster in Delaware.” Section 3115(b) allows the governor to declare a state of emergency after it is found that “an emergency or disaster has occurred or that such occurrence ... is imminent.” A state of emergency can “continue until the Governor finds that the threat or danger has passed or the emergency or disaster has been dealt with to the extent that conditions necessitating a state of emergency no longer exist.” However, no state of emergency can exceed 30 days without being renewed.

During an emergency, Section 3116 allows the governor to:

Utilize all available resources of the state government as reasonably necessary to cope with the emergency or disaster. Employ such measures and make such recommendations to state or local health agencies, authorities or boards as may be reasonably necessary. Direct and compel the evacuation of all or part of the population from any stricken or threatened area within the State if this action is necessary for the preservation of life. Prescribe routes, modes of transportation, and destinations throughout the State in connection with evacuation. Control ingress and egress to and from a disaster area, the movement of persons within the area, and the occupancy of premises therein.

In addition to the governor, Title 16 Section 130(a) makes the secretary of health and social services or a designee initially responsible for implementing all measures designed to address potential contagious diseases or infectious diseases. Subsections (b) and (e) require health care providers, veterinarians and livestock owners to report all cases of any illness or health conditions that may be potential causes of a public health emergency. Section 505 allows the director of the Division of Public Health or the director’s designee to:

declare certain diseases to be communicable and may by regulation lay down the procedure which is to be followed by the patient or person suffering therefrom, the parents of the patient, the householder, by the physician attending on the patient or any individual brought into contact with or responsible for the care or maintenance of the patient in order that the transference of the disease to other individual or individuals may be prevented.

This regulation can provide for the quarantine or isolation of any person or persons who have been exposed to the disease or carry the disease, any other matter relating to the care of and due to the illness of the patient from the communicable disease, and any other matter or procedure of interest in the protection of the public.

During a state of emergency, Title 20 Section 3136 allows the Delaware governor to activate several isolation and quarantine procedures. When these powers are activated, Section 3136(1)(c) acknowledges that “all reasonable means shall be taken to prevent the transmission of infection among the isolated or quarantined individuals.” But this section also requires the governor to use the “least restrictive means necessary to protect the public health.” Under Subsection (2) of this section, “[p]ersons shall be isolated or quarantined if it is determined by clear and convincing evidence that the person to be isolated or quarantined poses a significant risk of transmitting a disease to others with serious consequences.” This same section also stipulates that “[i]solation or quarantine of any person shall be terminated when such person no longer poses a significant risk of transmitting a disease to others with serious consequences.”

Subsection (4) of this section mandates that:

[a] person subject to isolation or quarantine shall obey the public safety authority’s rules and orders, shall not go beyond the isolation or quarantine premises, and shall not put himself or herself in contact with any person not subject to isolation or quarantine other than a physician or other health care provider, public health authority, or person authorized to enter isolation or quarantine premises by the public safety authority.

Additionally, Subsection (4)(b) prevents any nonauthorized personnel from entering quarantined premises.

Subsection (3) of the section requires “adequate food, clothing, medication and other necessities and competent medical care” be provided to individuals who are isolated. Subsection (3)(c) also requires “the health status of isolated and quarantined individuals be monitored regularly to determine if their status [has] changed.” Additionally, Subsection (5) outlines a series of due process protections for individuals subject to a quarantine order. To start, Subsection (5)(a) requires the public safety authority to “petition the Superior Court for an order authorizing the isolation or quarantine of an individual or groups of individuals.” Under Subsection (5)(b), the petition must specify:

The identity of the individual or group of individuals subject to isolation or quarantine; The premises subject to isolation or quarantine; The date and time at which the public safety authority request isolation or quarantine to commence; The suspected contagious disease, if known; A statement of the basis upon which isolation or quarantine is justified. A statement of what effort, if any, has been made to give notice of the hearing to the individual or group of individuals to be isolated or quarantined, or the reason supporting the claim that notice should not be required.

But under Subsection (2), “a person’s refusal to accept medical examination, vaccination or treatment ... shall constitute prima facie evidence that said person should be quarantined or isolated.” If necessary, Subsection (5)(d) allows the public safety authority to temporarily quarantine individuals prior to a hearing. When this occurs, Subsection (5)(e) requires the court to have a hearing within 72 hours after an individual or group of individuals has been isolated or quarantined. Subsection (6) also allows a quarantined individual to file a petition for a court hearing, which must occur within 10 days of the petition. Subsection (7) gives the petitioner the right to be represented by counsel or other lawful representative and requires the state to provide counsel to indigent persons.

Subsections (6)(c) also provide remedies for individuals wrongfully quarantined. Specifically, if “the Court finds that the isolation or quarantine of the individual is not warranted under the provisions of this section, then the person shall be immediately released from isolation or quarantine.” Furthermore, if the court finds that these individuals were not quarantined properly, it may “fashion remedies appropriate to the circumstances.” Additionally, Subsection 6(d) prevents Delaware-based employers from permanently terminating anyone placed in quarantine.

Finally, Title 16 Section 107(a) makes refusing or failing to perform the duties required under the above laws punishable by a fine of not less than $100 and not more than $1,000 plus the costs these actions imposed.

District of Columbia

D.C. Code Section 7-131 provides that the mayor may “issue rules to prevent and control the spread of communicable diseases” upon the advice of the director of the Department of Health. These rules can include “[r]equirements and procedures for restriction of movement, isolation, and quarantine.” If the mayor consults with the director and has “probable cause” to believe that an individual has a communicable disease and the individual’s “presence in the general population is likely to cause death or seriously impair the health of others[,]” the mayor may order that the individual be removed for isolation, quarantine or treatment. The order must be in writing and state the location of the detention. The mayor can do the same for groups of people.

The written order constitutes the authority to detain an individual or group until it expires. It expires within 24 hours of issuance unless a Superior Court judge “continues its force and effect for a longer period.” The judge can do so “if the judge finds that probable cause exists to believe that the detained person’s presence in the general population is likely to cause death or seriously impair the health of others.”

If the judge does continue an order, individuals or groups may petition for a hearing to determine whether they are affected with a communicable disease, and if they are, whether their release “into the general population is likely to cause death or seriously impair the health of others.” The hearing must take place as soon as it is “practicable” to do so “but no later than 10 days after the court receives the petition.”

The mayor must order medical examinations of individuals who are detained to determine whether they have a communicable disease and immediately discharge anyone who does not. The diagnosis resulting from the exam must be in writing and the examining physician must sign it. Authorities may detain anyone who has been diagnosed as “affected with a communicable disease” for as long as it is “necessary to protect the public health.” An individual who has been detained pursuant to this authority may petition the Superior Court at any time for a discharge hearing. The individual who petitions for a hearing must be provided with counsel if the individual cannot afford counsel.

It is unlawful for a detained individual to leave any place or institution that the mayor has ordered the individual to remain in unless the individual is discharged pursuant to the manners described.

The Superior Court may issue a warrant for the arrest of an individual based on probable cause to believe that the individual has a communicable disease to aid the mayor in the removal and detention of the individual. If the individual has been detained pursuant to such a warrant, the individual may only be discharged in the second manner described, where detention is authorized for as long as necessary to protect the public health and the individual may petition the court for a discharge hearing.

The warrant may only be issued if there is probable cause, if it is supported by an affidavit or affidavits particularly describing the individual, and if the affidavit(s) set forth the facts supporting the application or probable cause for believing that the facts exist.

Any Metropolitan Police Deparment officer can execute the warrant. The officer is permitted to “break open any outer or inner door or window of a house, or any part of a house,” or anything within the house, to execute the warrant, but only if the individual refuses to admit the officer after the officer gives “notice of his authority and purpose.” A warrant is valid for only 10 days after the court issues it.

There is a statutory exemption for individuals who rely on spiritual or religious means to cure disease “in good faith.” Health officers are permitted to confine such individuals to a hospital or other medical institution only if “no other place for quarantine of such person, minor child or ward can be secured.” Additionally, health officers cannot compel individuals relying on spiritual means to submit to any medical treatment.

The final provision in the subchapter on the prevention of the spread of communicable diseases is on construction of the preceding provisions. It states that all provisions in the subchapter “shall be constructed liberally in aid of the powers vested in the public authorities looking to the protection of the public health, comfort, and welfare and not by way of limitation.”

Florida

Florida provides very little specification for the process and conditions of isolation or quarantine, instead providing broad discretion to the state’s Department of Health and its agents.

Under Section 381.00315 of the Florida code, the state health officer, who is also the state surgeon general, is “responsible for declaring public health emergencies, issuing public health advisories, and ordering isolation or quarantines.” The Department of Health has the duty and authority “to declare, enforce, modify, and abolish the isolation and quarantine of persons, animals, and premises as the circumstances indicate for controlling communicable diseases or providing protection from unsafe conditions that pose a threat to public health.” Any such order will be immediately enforceable by law enforcement.

The department is empowered to create rules specifying conditions and procedures of isolation or quarantine, including closure of premises; movement of persons or animals exposed or infected; tests or treatment, including vaccination, required before employment, admission to premises or to comply with an isolation or quarantine; testing or destruction of animals suspected of infection dangerous to humans; access by the department to isolated or quarantined premises; disinfection of isolated or quarantined animals, persons or premises; and methods of isolation or quarantine.

The department is also authorized to bring “all proper and necessary actions and proceedings” to enforce these rules, including for temporary or permanent injunctions restraining a person from violating any of these provisions or for proceedings to compel performance of any act specifically required of a person, officer or board by any public health law. The department may request warrants directing any sheriff, deputy, or police officer to assist in carrying out the purpose and intent of these provisions in any way. All state and county attorneys, sheriffs, police officers and other appropriate city and county officials have a duty, upon request by the department or its agents, to assist in enforcing these public health laws and rules. Additionally, during a public health emergency, any person who assists the state health officer at his or her request on a volunteer basis is entitled to benefits granted in Section 110.504.

Section 381.00315 also grants the state health officer power to declare a public health advisory or, if the disease “results or may result in substantial injury or harm to the public,” a public health emergency. During a public health emergency, the state health officer may take actions necessary to protect the public health, including directing drug manufacturers to give priority to shipping specified drugs to pharmacies and health care providers within specific geographic areas; directing pharmacists employed by the department to compound bulk prescription drugs and provide these drugs to physicians and nurses of county health departments or any qualified person authorized by the state health officer; temporarily reactivating inactive licenses of certain health care practitioners, if they are needed to respond to the public health emergency; and ordering an individual to be examined, tested, vaccinated, treated, isolated or quarantined for dangerous, communicable diseases.

Violation by any person of any rule or requirement adopted under these provisions or any isolation or quarantine order constitutes a second-degree misdemeanor.

Georgia

The Georgia Department of Community Health and all county boards of health are empowered to “from time to time, require the isolation or segregation of persons with communicable diseases or conditions likely to endanger the health of others.” The department may also require quarantine or surveillance of individuals who have or are suspected of having an infectious disease.

The department must also ascertain the existence of an “epidemic or pandemic” illness or illness caused by “novel and highly fatal infectious agents or toxins” which “may pose a substantial risk of a public health emergency.” A public health emergency occurs when an “infectious agent or biological toxin” causes an illness or health condition (or an imminent threat of one) and there is a high probability that there will be a large number of deaths, a large number of “serious or long-term disabilities” or “[w]idespread exposure to an infectious or toxic agent that poses a significant risk of substantial future harm to a large number of people.” The department must then investigate any cases to determine their sources and “provide for proper control measures.”

The department and county boards of health may also require individuals to get vaccines, “whether or not the disease may be an active threat,” although there is an exception for when a person submits an objection on religious grounds outside an epidemic. The department may also require “such other measures to prevent the conveyance of infectious matter from infected persons to other persons as may be necessary and appropriate.”

Georgia Rule 511-9-1-.05 further describes the procedures Georgia authorities will follow for quarantine or isolation measures. First, an administrative order will be issued—presumably by the department or county board of health, though the rule does not specify—“when voluntary measures are deemed impracticable or ineffective.” These orders are effective when they are issued. An order may be issued orally if not doing so immediately would pose a “serious imminent danger to the public health.” A written order must also be issued as soon as possible, but no later than 24 hours after the oral order. The subject of the order must also receive notice of it.

An administrative order can include confinement in a location, “conditions on travel or behavior[,]” and “exclusion of individuals or groups from certain places.” The regulation provides for certain items the order must include, such as the grounds for believing the individual has been exposed or infected with a communicable disease and notice of the right to challenge the order.

When an individual is isolated or quarantined, the governmental authority ordering the measure must “preserve and facilitate the ability” of the person to “communicate with the outside world, and in particular to exchange confidential communications with legal and medical advisors of their choice.”

The regulations provide for the procedures for an appeal from an isolation or quarantine order pursuant to O.C.G.A. § 31-5-3, the general appeals statute for public health matters. Once the person who signed the order receives notice of the appeal, they must “immediately provide the Office of General Counsel and the subject of the appeal with a copy of all documents pertaining to the decision to issue the order and the grounds therefore.” The individual may request a hearing, but this request will not stay the order. If there is a hearing from an order issued by a county board of health, the Office of General Counsel designates the person who will hear it.

However, different “due process procedures” apply to vaccination or quarantine programs instituted during a public health emergency. The statute provides that the department must “permit access to counsel in person or by such other means as practicable that do not threaten the integrity of the quarantine.” This appeal can be pursued by an individual or a class, before “any available judge of the superior courts in the county where the individual or a member of the class resides or in Fulton County,” where the state capital of Atlanta is located.

When an individual appeals a vaccination or quarantine order, the burden of proof is on the state to show that “there exists a substantial risk of exposing other persons to imminent danger.” In vaccination cases, the state must meet this by clear and convincing evidence. In quarantine cases, the burden is a preponderance of the evidence. Rules of evidence that apply to civil cases will apply “to the fullest extent practicable.”

Additionally, all parties “have the right to subpoena and cross-examine witnesses,” though the court may consider any emergency circumstances when deciding to enforce such subpoenas. Any party may then immediately appeal to the Georgia Supreme Court, which will consider the appeal on an expedited basis. The statute states that these provisions will not “be construed to limit or restrict the right of habeas corpus under the laws of the United States.”

Notably, Georgia regulations also contain a catch-all provision for a state of emergency, during which “the Department shall establish any other public health control measures necessary to prevent and suppress disease and conditions deleterious to health as directed by the Governor.”

Guam

In Guam, the Division of Public Health and Social Services has the authority to impose isolation on any individual who has or is reasonably suspected of having a communicable disease and may impose quarantine on anyone who has come into contact with that individual.

The extent, location, duration and conditions of the restrictions imposed in any given case are at the discretion of the Division, “depending on the disease.” The period of restriction must match the minimum incubation period for the specific disease that is provided by the CDC, but should also include an additional period of time to test and confirm that the individual no longer has the disease. The Division must ensure that the restricted individuals are medically observed during that period.

This authority exists regardless of whether the individual gives their consent to be restricted.

The Division may place signs around the isolation or quarantine premises that warn the public not to enter, and no one may remove or deface those signs.

If the Division requests their assistance, the Guam Police Department must enforce any conditions of isolation or quarantine and may use “such force as may be reasonably necessary.”

If the Division deems it necessary, it may disinfect the premises of any quarantine or isolation, including the contents inside. In the event that the Division cannot safely disinfect any possessions like clothing or bedding, it may destroy them, but must provide a receipt to the individual detailing what items were destroyed. The individual may then use that receipt to request compensation.

In Guam, it is illegal for any person to conceal an individual who has a communicable disease; this prohibition extends to parents or guardians concealing infected children.

All health practitioners, directors of hospitals and laboratories, owners of hotels and inns, and captains of ships or airplanes must report to the Division any patients, clients or passengers who have or are suspected to have a communicable disease. They must report within 48 hours of discovery or diagnosis.

In a public health emergency, certain other conditions apply to quarantine and isolation imposed by the Division. First, isolation and quarantine must be implemented using the least restrictive measures necessary. If a quarantined individual subsequently becomes affected, they must be moved to isolation. The needs of restricted individuals, including food, clothing, shelter and communication with the outside world must be addressed in a “systematic and competent fashion.” To the extent possible, the restricted individual’s cultural and religious beliefs should be considered.

Any person who enters an area of quarantine or isolation without authorization from the Division is guilty of a misdemeanor offense and may be subject to isolation or quarantine themselves.

During a public health emergency, the Division may temporarily isolate or quarantine an individual or group through a written directive if delay in imposing the restriction would “significantly jeopardize” the Division’s ability to control the transmission of a contagious disease. The directive must state the identity of the affected individuals, the premises of restriction, the time at which the restriction begins, the suspected contagious disease and the relevant legal authority permitting the restriction.

Within 10 days after issuing the directive, the Division must file a petition for a court order authorizing the continued restriction of the individual(s). If it does not issue a directive, the Division must also file a petition before restricting anyone. The petition must include the identity of the affected individuals, the premises of restriction, the time at which the restriction begins, the suspected contagious disease, a statement of compliance with the relevant legal authority, and a summary of the factual basis for the restriction.

The Division must provide notice to the relevant individual or group within 24 hours of filing the petition. A hearing must be held within five days of the filing of the petition; in extraordinary circumstances and after showing good cause, the Division may ask to continue the hearing date for up to 10 days. The court may grant that continuance in its discretion but must consider the rights of the individuals, the protection of public health, the severity of the emergency, and the availability of necessary witnesses and evidence.

The court shall grant the petition if the Division shows, by a preponderance of the evidence, that the restriction is necessary to control the transmission of a contagious disease. The order lasts for no more than 30 days and must identify the relevant individual or group, specify the factual findings justifying the order, include all relevant conditions, and be served on the affected individual or group. Prior to the order’s expiration, the Division may request a continuance for another 30 day period, which the court may grant according to the standard laid out above.

A restricted individual or group may apply to the Superior Court of Guam for an order to show cause why they should be released. The court must rule on the application within 48 hours of its being filed and, if it grants the application, the court must schedule a hearing within 24 hours of issuing the order to show cause. The order to show cause does not stay the isolation or quarantine order.

A restricted individual or group may also request that the Superior Court of Guam hold a hearing for “remedies regarding breaches to the conditions of isolation or quarantine.” Such a hearing does not stay the isolation or quarantine order. If extraordinary circumstances justify the immediate granting of relief, the court must schedule a hearing within 24 hours of receiving the request; if there are no extraordinary circumstances, the hearing must be scheduled within five days of receiving the request.

Any proceedings brought before a court must be held on the record. If parties cannot participate in person, the proceedings may be conducted by their authorized representatives or held via remote means that allow “all parties to fully participate.”

The court must appoint counsel to all parties who are not otherwise represented; appointed counsel will be paid by the government of Guam. The Division must provide adequate means of communication between affected individuals or groups and their counsel.

Any court may order the consolidation of individual claims into groups when the number of individual claims would make separate hearings impractical, there are questions of law or fact common to each claim, the group rights claimed are typical of the individual’s claims, and the group as a whole will be “adequately represented in the consolidation.”

Hawaii

The state code of Hawaii grants the governor and, in certain cases, mayors broad emergency management powers. Section 127A-12 of the code allows the governor or any mayor to “restrict the congregation of the public in stricken or dangerous areas or under dangerous conditions.” They may also direct and control the “non-compulsory evacuation of the civilian population.”

Once a state of emergency has been declared, Section 127A-13 goes further still and allows the governor to “require the quarantine or segregation of persons who are affected with or believed to have been exposed” to any communicable disease that is, according to the governor, “dangerous to the public health and safety.” The governor may also designate as public nuisances any conduct that is “dangerous to the public health.”

The governor’s powers extend even further than those two functions, however. Section 127A-13 endows the governor with the abilities to suspend any law that “impedes or tends to impede” the execution of emergency functions and to “direct and control the mandatory evacuation of the civilian population.”

The statute grants Hawaii mayors similarly broad authority during a local state of emergency, including the power to suspend any county law that “impedes or tends to impede” the execution of emergency functions and to also “direct and control the mandatory evacuation of the civilian population.”

Chapter 325 of the Hawaii state code specifically addresses communicable diseases, with Section 325-8 detailing the procedures for the quarantine of infected individuals. In order to quarantine an individual, the Department of Health must obtain a written, ex parte order from the state circuit court with jurisdiction over the individual’s residence. The court may grant the order upon finding that probable cause exists to justify the quarantine. The department must provide a copy of the order to the individual and notify them of their right to a hearing if they wish to contest the order.

That procedure may be suspended if “any delay in the quarantine of the individual would pose an immediate threat to the public health.” Following such a quarantine, the Department of Health must immediately obtain an ex parte order from the relevant court retroactively authorizing the procedure.

Individuals who wish to exercise their right to a hearing must file a written request with the court that issued the subpoena. The hearing will be held within 14 days of that filing, but such a request will not lift the restrictions of the quarantine. At the hearing itself, the Department of Health must demonstrate with clear and convincing evidence that the quarantine is justified for the court to continue its order.

All individuals subject to quarantine must stay within the designated premises and not come into contact with anyone other than a health care provider. Violating that restriction is a misdemeanor offense. Moreover, no one is allowed to enter the quarantine premises without permission from the Department of Health. Anyone who enters a quarantine premises without permission is also subject to quarantine and has also committed a misdemeanor offense. Additionally, Section 325-2 requires that all medical professionals treating patients with confirmed or suspected cases of a dangerous disease must report the incidence to the Department of Health. Failure to report may result in a fine of up to $1,000.

The Department of Health must provide the quarantined individual with food, clothing, medication, access to counsel, the ability to communicate with the outside world and competent medical care. The department must also consider the individual’s cultural and religious beliefs “to the greatest extent possible.”

Section 325-9 allows for the Department of Health to quarantine a person in the home in which they reside if the department determines that removing the person from their home would endanger their life or the health of the department’s agents. In such a case, the department may remove the residents of the surrounding neighborhood and take “any such other measures” that it deems necessary for the public health and safety. All local law enforcement officers are required to assist department officials in this process.

Idaho

Idaho’s state code gives state, regional and municipal authorities overlapping power to pursue quarantines and other measures relating to public health.

The director of the state Department of Public Health and Welfare has the power to “impose and enforce orders of isolation and quarantine” to prevent the spread of infectious diseases. A state isolation or quarantine order is subject to a de novo judicial standard of review, meaning that the court gives the agency’s expertise no specific deference. The reviewing court must affirm an isolation or quarantine order if it appears that, by a preponderance of the evidence, the order is “reasonably necessary to protect the public from a substantial and immediate danger.” Violating an isolation or quarantine order is a misdemeanor offense.

In addition to the state health department, Idaho is divided into seven public health districts. Each district shares the same quarantine powers endowed to the state health department. Cities may also establish their own separate boards of health and pass regulations affecting a quarantine within five miles of their city limits.

The state’s administrative code spells out its isolation and quarantine restrictions with slightly more specificity. At the time of issuing an isolation or quarantine order, the responsible entity—either the state Department of Public Health and Welfare or a local public health district—must determine “the least restrictive timeframe of quarantine that effectively protects” the public. The same entity will withdraw the order when it determines that the individual or premises under restriction no longer pose a significant threat to public health.

No individual under isolation or quarantine may travel or be transported without the permission of the issuing entity. Finally, officials from the state Department of Public Health and Welfare may enter private or public property in order to administer or enforce all state public health regulations, including those relating to infectious diseases.

Illinois

Illinois provides detailed procedures in this area. The state’s Department of Public Health has “general supervision of the interests of the health and lives of the people of the State.” The department has “supreme authority” over quarantine and isolation and may establish or modify either. Local authorities must enforce the rules, regulations and orders that the state department adopts. Counties also have power to “make and enforce such rules and regulations tending to check the spread of the disease within the limits of the county or town as may be necessary” and the board of health may quarantine any house or houses or place. And municipalities have jurisdiction to enforce health and quarantine ordinances and regulations.

The Department of Public Health has the authority to order quarantine or isolation for an individual or group or order a place closed until the situation can be “corrected” or there is no longer a “substantial danger to the public’s health.”

Illinois, however, provides that quarantine or isolation of a person or closure of a place cannot occur without either the consent of the person or owner of the place or a prior court order. There is an exception for this if the department reasonably finds that “immediate action is required to protect the public from a dangerously contagious or infectious disease.” If the department makes this kind of immediate order, it must obtain consent or request a court order “as soon as practical,” but within 48 hours at the latest.

To receive a court order, the department must prove by clear and convincing evidence that

the public’s health and welfare are significantly endangered by a person or group of persons that has, that is suspected of having, that has been exposed to, or that is reasonably believed to have been exposed to a dangerously contagious or infectious disease ... or by a place where there is a significant amount of activity likely to spread a dangerously contagious or infectious disease.

It must also demonstrate that any reasonable alternatives have been exhausted and there are no less restrictive options available.

The statute provides that any individuals “who are or are about to be ordered to be isolated or quarantined and owners of places that are or are about to be closed and made off limits to the public shall have the right to counsel.” If these individuals are indigent, the court must appoint counsel.

Individuals must be provided with written notice of any order pursuant to this statute. The notice must be fairly detailed: It must include “(1) notice of the right to counsel; (2) notice that if the person or owner is indigent, the court will appoint counsel for that person or owner; (3) notice of the reason for the order for isolation, quarantine, or closure; (4) notice of whether the order is an immediate order, and if so, the time frame for the Department to seek consent or to file a petition requesting a court order as set out in this subsection; and (5) notice of the anticipated duration of the isolation, quarantine, or closure.”

Illinois further authorizes the department to order physical examinations and tests and gather laboratory specimens that are not reasonably likely to result in serious harm to an individual. It further permits the department to “order the administration of vaccines, medications, or other treatments as necessary” and these treatments also may not be reasonably likely to result in serious harm. It may also order monitoring and observation.

It is a Class A misdemeanor for anyone to “knowingly or maliciously disseminate[] any false information” about the existence of a contagious disease “in connection with the Department’s power of quarantine, isolation and closure or refuse[] to comply with a quarantine, isolation or closure order.”

The department is also tasked with investigating the causes of contagious diseases, “especially when existing in epidemic form,” and working to suppress such diseases. If it finds that a local board of health or local authorities are not properly responding to a disease that may become or is becoming an epidemic, it “may enforce such measures as it deems necessary to protect the public health,” and the locality will pay all “necessary” expenses.

Additionally, Illinois provides that, to prevent the spread of a disease, the department and local authorities will have emergency access to medical records on the condition that the government authorities protect the privacy and confidentiality of such records.

In a 1994 case, Moore v. Lumpkin, an Illinois court found that the statute committed broad discretion to the department to determine the measures it takes to investigate and to suppress contagious diseases.

Indiana

In Indiana, the power to establish quarantines rests with the state Department of Health, but a public health authority may request one from a local judge. In the case of a public health emergency, or if the department believes that a local health authority is not enforcing the laws and regulations necessary to protect public health, the department may enforce the powers of the local health authorities as well as its own.

If a public health authority believes that an individual has been infected with or exposed to a dangerous communicable disease, and that the individual might infect other people without some form of movement restriction, the authority may petition a circuit or superior court for a quarantine or isolation order. The petition must include a brief factual summary of the facts underlying the request, including any efforts by the authority to obtain the individual’s “voluntary compliance” with isolation or quarantine measures.

The individual in question is entitled to proper notice and an opportunity to be heard before the court issues the order. The court may restrict the individual’s physical appearance at this hearing if it believes that such an appearance would contribute to infecting another person. The public health authority must prove that a quarantine or isolation is required by clear and convincing evidence. When issuing the quarantine or isolation order, the court must detail the conditions of the restriction, including its duration.

If the public health authority believes that the individual will likely cause further infections before having an opportunity to be heard, it may file a verified petition for emergency quarantine or isolation, which must include the same information mandated for a nonemergency quarantine petition. In such an instance, the public health authority must, in a nonadversarial setting such as by telephone or in a recorded hearing, prove to the court by clear and convincing evidence that the emergency order is necessary. If the court grants the emergency order, it will remain valid for 72 hours, excluding weekends and legal holidays.

Once the court grants the petition or emergency petition, the public health authority may file a petition for renewal if it determines one to be necessary. The petition for renewal must also include a brief factual summary of the facts underlying the request, as well as any efforts by the authority to obtain the individual’s “voluntary compliance” with the extended restrictions.

Additionally, the public health authority must provide the individual with at least 24 hours’ notice of the renewal hearing. The individual may again appear before the court at the hearing, unless the court deems that appearance to risk the spread of the disease. At the renewal hearing, the individual is allowed to cross-examine any witnesses that the public health authority calls. As with the initial petition, the public health authority must prove the necessity of the renewal petition by clear and convincing evidence.

The state must appoint an attorney for an indigent individual who is the subject of a petition for quarantine or isolation. The public health authority that imposes a quarantine order not in the individual’s home must, if the individual is a child, allow the individual’s parent or guardian to remain with the child in quarantine. If the individual is an adult, the public health authority may allow another adult to remain with the individual in quarantine.

If an individual who is placed under quarantine is the sole guardian of one or more children, the children will be placed in the care of a relative, according to the guidance of the guardian when possible.

Any violation of an order of quarantine or isolation is a Class A misdemeanor.

Iowa

The power to quarantine or isolate rests in Iowa with the state and local boards of health. Any health care provider treating a person with a reportable disease must immediately notify the State Board of Health. The health care provider must provide a host of demographic information about the patient, including the patient’s name; address; date of birth; marital status; and, if the patient is female, whether or not she is pregnant. The patient’s identity shall remain confidential, but the state health board may release anonymized information about the patient to the public.

At their discretion, the state and local boards of health may impose and enforce isolation and quarantine restrictions, by force if necessary. The type and length of isolation or quarantine imposed for a specific disease “shall be in accordance with rules adopted by” the State Board of Health. In addition to isolating or quarantining specific individuals, the state board may impose an area quarantine that restricts entrance into or exit from a designated building or physical space, albeit by the “least restrictive means necessary.” The state board must also place signs around the premises of any individual quarantine or isolation or an area quarantine, marking the appropriate boundaries.

If individuals under isolation or quarantine are “financially unable to secure proper care, provisions, or medical attendance,” the local board of health must provide those resources during the period of restriction.

Individuals removed to a separate house or hospital may, at their own expense, employ the health care provider of their choice and provide the supplies necessary for that treatment.

Individuals who violate an order of quarantine or isolation are guilty of a simple misdemeanor.

Kansas

In Kansas, local health officers share the authority to isolate or quarantine with the state Department of Health and Environment. Local health officers must report the incidence of contagious diseases to the state, and those reports must remain confidential. If local officers neglect to properly isolate or quarantine people infected with contagious diseases, the department “may quarantine any area in which [the disease] may show a tendency to become epidemic.”

Violating a local health officer’s order of quarantine or isolation is punishable by a fine of $25 to $100 for each offense. Violating an order of quarantine or isolation issued by the state Department of Health and Environment is a Class C misdemeanor.

If the local health officer or the state Department of Health and Environment issues an order of isolation or quarantine, the order must specify the identity of the individual or group, the “premises subject to isolation or quarantine,” the date and time at which the restriction begins, the suspected disease causing the outbreak, the factual basis upon which the restriction is justified and the “availability of a hearing to contest the order.”

The order must be provided in writing unless the issuing officer determines that written notice would be impractical because of the number of individuals or the scope of the affected geographic area. In that case the issuing officer is expected to fully inform the relevant individuals “using the best possible means available,” including posting the order in “a conspicuous place in the isolation or quarantine premises.”

Anyone subject to an order of quarantine or isolation may request a hearing in district court to contest the restriction. The request for a hearing does not stay the order. Upon receiving a request for a hearing, the court must conduct a hearing within 72 hours of receipt, unless the issuing officer demonstrates that “extraordinary circumstances” justify an extension of the order and a delay in scheduling the hearing. In considering the officer’s request for an extension, the court must consider the affected individual, the protection of the public health, the severity of the health emergency, and the availability, if necessary, of witnesses and evidence.”

If an individual cannot appear personally before the court, the court may conduct the hearing provided that the individual’s authorized representative is present and the individual is allowed to fully participate through other means.

The court may consolidate individual claims into group claims if “the number of individuals involved or affected is so large as to render individual participation impractical, there are questions of law or fact common to the individual claims or rights to be determined, the group claims or rights to be determined are typical of the affected individual's claims or rights, and the entire group will be adequately represented in the consolidation.”

The court must appoint counsel to all individuals or groups who are not otherwise represented.

The court must grant the request for relief unless it determines that the restriction is “necessary and reasonable to prevent or reduce the spread of the disease.” It may consider the “means of transmission, the degree of contagion, and, to the extent possible, the degree of public exposure to the disease.”

A court order authorizing the isolation or quarantine must identify the relevant individuals or group, specific the factual findings justifying the order, and be distributed in writing, unless it is impractical to do so. If it is impractical to do so, it must use the best possible means necessary to alert the relevant individuals. The court order cannot last longer than 30 days.

Public and private employers are prohibited from firing an employee only because the employee or an immediate family member is under an order of quarantine or isolation. Employers that do so are guilty of a Class C misdemeanor.

Kentucky

Kentucky’s quarantine and isolation regime is not well defined. Section 214.020 of the state’s code gives the state Cabinet for Health and Human Services the power to establish and maintain quarantine and isolation when it believes “that there is a probability that any infectious or contagious disease will invade this state.”

City-county boards of health in the state also have the power to quarantine, but the statute that endows that authority generically covers a wide array of public health responsibilities.

A 1911 Kentucky Court of Appeals case, Allison v. Cash, affirmed the quarantine power of city-county boards of health. A local business owner sued the Lyon County Board of Health for closing and fumigating her shop in Eddyville, which they deemed necessary after she brought her son to the premises from Kuttawa, a city that was experiencing a smallpox outbreak. The business owner had obeyed the health board’s order that she and her son leave the city and quarantine themselves, but she refused to close her store upon leaving; the health board disinfected the shop and then closed it for four weeks, ruining her merchandise in the process.

The court denied the business owner’s suit and upheld the statutory power of the Lyon County Board of Health to quarantine the shop owner and to close her shop, holding that both the state and county boards of health were “invested by law with broad powers for the protection and safety of the public health.”

A recent case in which a Kentucky man who tested positive for COVID-19 but initially refused treatment illustrates how state and local authorities are implementing their quarantine powers in practice. The man resided in Nelson County, Kentucky, where the county judge-executive declared a state of emergency that, according to local news reports, “allowed him to impose a curfew and quarantine on the man and other residents in his home.” The county attorney told reporters that the county requested and received a confidential circuit court order concerning one of the residents of the man’s house but did not provide further details.

Louisiana

Louisiana law dictates that the state health officer and the state Department of Health have exclusive “jurisdiction, control, and authority to isolate or quarantine for the care and control of communicable disease within the state.”

If any segment of the state reports an incidence of a communicable disease that threatens to spread throughout the state, the state health officer must issue a proclamation summarizing the situation and order the infected “parish or municipality or the infected portion thereof” quarantined. The state health officer must also order all local health officers to “quarantine against the locality” and establish and promulgate rules and regulations governing any interactions with that locality.

The state health officer also has the authority to order quarantines over much smaller geographic areas, including individual rooms in a home or apartments in a building.

The state health officer also has the power to bar any individuals from entering the “infected portion of the state” if he or she deems that their introduction “would increase the prevalence of the disease.”

Any individual who has been or is suspected of having been exposed to a communicable disease must either submit to medical examination and testing or be placed in isolation or quarantine as long as their status “remains undetermined.”

Violating an order of isolation or quarantine is punishable by a fine of $50 to $100 and imprisonment of up to two years.

Beyond a criminal prosecution, if the local state health officer or the Louisiana Department of Health believes that an individual has violated the state sanitary code and will facilitate the spread of an epidemic or otherwise poses an “imminent menace to the public health,” they may request that the local district attorney petition the district court to restrain that individual by a permanent or temporary injunction. The district court may grant that petition if it finds that there is cause to do so.

Maine

Under Title 22 Section 802, Maine grants the Department of Health and Human Services the authority to designate and classify communicable diseases; establish reporting and surveillance requirements; investigate cases and epidemics of communicable diseases; and establish procedures for the control, detection and treatment of such diseases, including public immunization and contact notification programs.

The department has authority to declare a health emergency in the event of an actual or threatened epidemic and to adopt emergency rules for the protection of public health. Such rules may include procedures for isolating and treating infected persons, disinfecting or destroying contaminated property and establishing temporary facilities for treating infected or exposed persons. All agents of the department, as well as local health officers and law enforcement, are authorized to enforce the department’s rules and the department may order any person who neglects or violates any of these rules to cease and desist, and may seek an injunction or civil fine against the person if they continue to refuse to obey the order.

The department has authority to establish an investigative team and procedures to pursue detection and treatment of infected individuals and may issue subpoenas requiring persons to disclose information or records relevant to such investigation to the department. If, based on epidemiologic evidence or medical evaluation, the department finds probable cause that a person has a communicable disease but that person is unwilling to submit to a physical exam made available to the department, then the department may petition the district court for an order directing the exam or releasing the results. Upon such petition, the district court will hold a hearing and, if the court finds by a preponderance of the evidence that there is probable cause to believe the person has the communicable disease and that the person has willfully refused the department’s request, then the court shall order examination or release of such results.

The department can also petition for an immediate custody order in the event that the person presents a “clear and immediate public health threat,” demonstrated by clear and convincing evidence. A hearing on such a petition must be held within 72 hours, and notice of the hearing must be served at least 24 hours before it occurs. The notice must also inform the person of their right to appear at the hearing, pres