Fear, Politics, and Ebola

How Quarantines Hurt the Fight Against Ebola and Violate the Constitution

Recommendations

1.Do not quarantine or restrict the movement of individuals asymptomatic for Ebola who present no real risk of transmission.

Such quarantines are unnecessary, unwise, and unlawful. Ebola provides a case in point. Public health
experts overwhelmingly agree that quarantines of asymptomatic individuals are scientifically unjustified
and counter-productive, in that they hinder efforts to control Ebola transmission. Furthermore, given the
important liberty interests at stake—including an individual’s ability to work, travel, and carry out daily
activities—unjustified quarantines and movement restrictions are unconstitutional. The CDC should
update its guidelines on Ebola to make clear that quarantines of, or movement restrictions on, asymptomatic
individuals are unjustified.

2.Employ the least restrictive alternatives available to stem transmission of infection.

Public health authorities have a wide array of tools available to control disease transmission short of
quarantine. In the case of Ebola, these tools include self-monitoring, active monitoring, and direct active
monitoring. In any individual person’s case, public health authorities should implement interventions that
are scientifically justified for the level of risk posed by that individual and least restrictive of their liberty.
In the case of asymptomatic, compliant individuals who fall into the CDC’s Some Risk category for Ebola,
for example, it is sufficient to require active or direct active monitoring for the 21-day period following
potential Ebola exposure.

3.Provide robust procedural protections, including allowing individuals to contest their restrictions.

Given the serious liberty interests at stake whenever a government authority imposes movement restrictions
or quarantine, it must provide robust procedural protections to enable individuals to contest those
restrictions. Public health authorities must ensure that (1) each individual has timely and adequate notice of
the restrictions the state seeks to impose; (2) each individual is given a hearing before a neutral decisionmaker,
at which he or she can present evidence against the restrictions, with the assistance of counsel; (3) any such
hearing take place before the restrictions are imposed, or, if time does not permit, as soon as possible after
the restrictions are imposed; and 4) each individual be informed of, and permitted, a right to appeal the
decision to a judicial body if the initial hearing was not before a court.

4.Increase transparency about how often and for what reasons quarantines and movement restrictions are being imposed.

Public health authorities must be transparent about the policies and procedures they have for determining
when to implement movement restrictions or quarantines in the name of controlling the transmission of
disease. Public health authorities should make these policies explicit and public, and should include both
the substantive criteria and the procedures they will follow in determining individual restrictions. It is also
essential to ensure that public health officials do in fact apply the written policies, and that each individual
subject to a movement restriction or quarantine is given a written decision explaining the reasons for it, with
reference to those policies. Finally, there should be a public record of the implementation of quarantine or
other interventions used to control the spread of a disease. The fact that there is no public information on
the number of people subject to quarantine or other movement restrictions in the United States during the
Ebola scare is unacceptable.

5.Ensure humane conditions of confinement.

In those cases where a quarantine is scientifically and constitutionally justified, public health authorities
must ensure that individuals are provided with adequate conditions of confinement, which include ensuring
access to food, medical care, mental health support, and other necessities of life.

6.Protect privacy.

Public health authorities should avoid unnecessarily infringing on the privacy of individuals who have
potentially been exposed to transmissible diseases, especially given the potential for stigmatization in
communities and workplaces. For example, states should not affirmatively post signs or notices outside the
homes of individuals who have been subject to public health-related restrictions. Officials should be trained
in appropriate ways to protect privacy.

7.Provide income and job protections for individuals subject to quarantine and movement restrictions.

A quarantine is not a punishment, but a burden placed on behalf of society on people who, through no
fault of their own, are potential disease victims. States should ensure that their laws prohibit adverse action
by employers against employees unable to perform their ordinary job duties due to a quarantine or to
restrictions on movement, and should provide reasonable compensation to the individual for lost income
or other damages caused by the restriction.

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