Can the United States government legally stop US citizens from traveling to certain "Ebola-affected" countries? Can the government restrict US citizens abroad who may have been infected with the Ebola virus from re-entering the country, as it can non-citizens? Can the government impose isolation or quarantine measures inside the United States in order to control Ebola?
The answer to all of the above is “yes,” according to a new analysis from the Congressional Research Service (withheld from online public distribution, but made available by the Federation of American Scientists’ Secrecy News).
Now that the United States is itself an "Ebola-affected country," with the return home of several infected health care workers and the first recorded Ebola death in Dallas this week, Congress has quietly begun to consider what legal measures the government can impose to contain any future spread of the deadly virus. Initial steps are already in place.
Beginning tomorrow, anyone entering the United States through JFK, Washington-Dulles, Newark, Chicago-O’Hare and Atlanta international airports – the five airports that receive more than 94 percent of travelers from Guinea, Liberia and Sierra Leone – will be subject to Enhanced Ebola Screening, and all travelers entering the US from “Ebola-affected countries” will be tracked as part of a new program designed to help stop the spread of the disease. The programs will be run by the Centers for Disease Control and Prevention (CDC) and the Department of Homeland Security’s Customs & Border Protection (CBP).
Enhanced screening is only a first layer of response, with several more restrictive options available depending on the outbreak’s progress.
A Public Health "No Fly" List
The CDC and the Department of Homeland Security may also place anyone suspected of having been infected – citizens and non-citizens alike – on a "Do Not Board" list that instructs airlines not to issue boarding passes on flights into and out of the US. The “DNB” is not a hypothetical tool; some 33 people with suspected or confirmed pulmonary tuberculosis (TB) were included on the list in 2007 and 2008 (Warscapes has asked the CDC whether anyone has been added to the list during the current Ebola outbreak, and will add that information when we receive a response). How does one get on the DNB list? US or international pubic health officials can request that CDC add someone to the list if he or she is likely to be contagious; unaware of or likely to be nonadherent with public health recommendations, including treatment; or will attempt to board a commercial aircraft despite exposure. An additional “lookout” alert then goes out to US Customs officers at land and sea points-of-entry.
The federal and state governments can also impose isolation and quarantine measures if the circumstances demand. As the Congressional Research Service report clarifies, “quarantine” refers to separating or restricting movement of individuals who have been exposed to a contagious disease but are not yet sick, while “isolation” refers to separating those who are sick from the uninfected population. States can impose either under certain police powers corresponding to public health emergencies, while the CDC has the power to “authorize the detention, isolation, quarantine, or conditional release of individuals” for diseases identified by an Executive Order of the President, of which Ebola is one.
If broad quarantines and isolation in North America sound far-fetched, recall that as recently as 2003, some 45 thousand people were quarantined in Toronto during the SARS outbreak.
Still, the current Ebola epidemic has been portrayed in most commercial US media as an “African disease,” spiking fear, perhaps, but blunting a coherent understanding of Ebola’s exponential spread.
“The tragedy of Ebola is not just its staggering toll. It's also the implicit racism that the deadly virus has spawned,” Robin Wright, a joint fellow at the Woodrow Wilson International Center and the U.S. Institute of Peace, wrote in a strong piece published yesterday. “In both the United States and Europe, Ebola is increasing racial profiling and reviving imagery of the ‘Dark Continent.’ The disease is persistently portrayed as West African, or African, or from countries in a part of the world that is racially black, even though nothing medically differentiates the vulnerability of any race to Ebola.”
Racism is a subset of ignorance. The current Ebola outbreak is unprecedented. From the time the first cases were reported in the forest areas of Guinea in December, the outbreak has expanded powerfully, with some 8,011 cases reported and 3,857 deaths (as of Wednesday). The number has been doubling every three weeks.
Congress just today lifted restrictions on the Pentagon’s ability to spend $750 million proposed by the Obama Administration to help fight the epidemic, with some 4,000 US troops to deploy to West Africa to provide logistical support. So long as those troops are not used for quarantine, containment or crowd control measures - public health restrictions only work when the affected community understands and buys into the measures - they will hopefully provide some much-needed relief to the deeply strapped NGO's that have been on the ground fighting the epidemic for months.
As Médecins Sans Frontières (MSF) put it recently, containing the epidemic is not only an international responsibility, but an urgent and uphill battle: “We cannot escape the need to rapidly and effectively contain this epidemic and provide the necessary care to patients, their families, and affected communities. As an international public health emergency, states with the capacity to help have the responsibility to mobilize resources to the affected countries, rather than watching from the sidelines with a naive hope that the situation will improve.”
Michael Bronner is a founding editor at Warscapes.