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ASHEVILLE - While there are no reported cases of COVID-19 in Western North Carolina to date, some residents are curious and even fearful about the prospect of a quarantine if cases spike locally. What would quarantine in Buncombe County look like?

The Citizen Times reviewed Buncombe County's Isolation and Quarantine Plan, last revised Feb. 21. Here are the most important takeaways.

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First, an important distinction: Isolation separates the sick from the well, while quarantine separates and restricts the movement of people who may have been exposed to an infectious disease to see if they develop symptoms.

The Director of Public Health is the only person who can establish isolation and quarantine in Buncombe County

The director of public health is responsible for assessing suspected cases and the possible risk to the community at large. That office has been occupied by Jan Shepard since 2015, but Shepard announced her retirement on Feb. 25.

BCHHS Medical Director Dr. Jennifer Mullendore will step up as interim public health director on March 13, according to spokeswoman Stacey Wood.

The public health director will determine the scope and duration of any quarantine or isolation procedures, with support from other public health officials in the Communicable Disease team and Epidemiology Team.

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Isolation and quarantine are legally enforceable and can be involuntary

If someone refuses or violates a quarantine order, Mullendore can issue an emergency detention order for up to 10 days of involuntary confinement enforceable by local law enforcement. Detentions will occur in the least restrictive setting possible that doesn't endanger public health.

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There are 7 levels of isolation and quarantine

For individuals:

Passive monitoring. The subject of isolation or quarantine performs self-assessments (like temperature checks) at least twice a day and must contact BCHHS if symptoms occur. Active monitoring without explicit activity restriction. A health department staff member evaluates the subject at least once a day by phone or in person. Active monitoring with activity restriction. The subject is separated from others for a certain period of time depending on the suspected illness and is evaluated by health officials on a daily basis. They are restricted to their home or another appropriate facility. Working quarantine. Staff members — generally first responders like hospital and public health staff — are allowed to work but are on activity restriction when not on duty. They're monitored for symptoms before reporting for work and have to use appropriate personal protective gear while working (masks, gloves, etc.).

For groups and communities:

Focused measures to increase 'social distance.' Interventions targeted at specific groups who may have been exposed (for instance, workers in a building) meant to decrease interactions or transmissions. Examples of increasing social distance include limiting how many people can gather together, canceling events and closing buildings. Communitywide measures to increase 'social distance.' The same social distancing measures applied on a broader scale. "These range from simple messaging campaigns that remind people to keep at least 3 feet from their face to another's face to measures such as shutting down public venues or specific events," BC emergency preparedness coordinator Fletcher Tove told the Citizen Times. Widespread community quarantine, including "Cordon Sanitaire." A legally enforceable quarantine of a large area. "Cordon Sanitaire" refers to the restriction of movement in or out of an area in an effort to contain an illness's spread, as was employed in Wuhan and other Chinese cities. This is reserved for extreme cases and would require intervention beyond the public health director's authority.

Don't have housing appropriate for quarantine or isolation? You'll be lodged in a hotel or a designated shelter — and you don't have to pay

People who don't have housing suited for quarantine, including people experiencing homelessness and visitors whose accommodation is no longer appropriate, will be housed by Buncombe County Health and Human Services.

If there are few people who need quarantine housing, BCHHS will arrange for lodging in hotels.

If many members of the homeless community require isolation or quarantine, BCHHS will work with local shelters to designate one shelter as a quarantine facility, or open their own temporary shelter.

If a large group of people (such as tourists) require isolation or quarantine, BCHHS will work with the NC Department of Health to arrange for accommodation.

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"The public will not be responsible (for reimbursing) the county government for any lodging associated with isolation or quarantine," Tove said.

What if you run out of food or medicine while quarantined, or can't pay rent due to missed work?

The county will arrange for certain kinds of support — including emergency delivery of groceries and medications, financial assistance for housing and utility bills and medical services — for people under isolation and quarantine. Non-medical requests will be referred to human services agencies and community organizations like the American Red Cross, according to the plan.

"The county is currently working with (the Department of Social Services) and other community partners to anticipate financial strains and hardships that families may endure under isolation and quarantine and develop solutions to assist with that burden," Tove said.

Elizabeth Anne Brown is the trending news reporter for the Citizen Times. Reach her at eabrown@citizentimes.com, or follow her on Twitter @eabrown18.

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