Coronavirus Quarantines Pose Tough Issues for State and Local Officials

SEATTLE — As they seek to curb the spread of the new coronavirus, state and local authorities around the U.S. are having to establish guidelines for what people should do if they have been exposed to the respiratory illness but are not showing any symptoms of it.

Here in King County, Washington, for instance, an epicenter for the outbreak, public health officials have advised people who have come into close contact with diagnosed patients to monitor their health, not go to school or work and avoid other public places for 14 days.

Voluntary self-quarantine measures like these provide a way for governments to limit the contact of people who may have the disease with the rest of the population. 

Brian Castrucci, president and CEO of the de Beaumont Foundation and an epidemiologist with 10 years of experience in state and local health departments, characterized these types of quarantines as one of the basic tools public health agencies have to control an outbreak.

But he also noted limits to what the quarantines can achieve that depend on the specific dynamics of a disease and pointed to the hardships that they can raise for the people who are isolated. 

“It’s a really, really complex issue that we’ve not really had to struggle with much,” Castrucci said. “It’s ultimately on the part of that person in voluntary quarantine to choose to adhere to what they have been instructed to do.”

“I think what we’re seeing unearthed right now are all the challenges that come along with a quarantine. How do I get food? How do I go to work?” he added. “If you do the right thing and self-quarantine, your landlord could still toss you at the end of the month when you don’t have enough money to make rent.”

In King County, which is home to Seattle, officials are not mandating that people who have been advised to self-quarantine stay in contact with the government on a recurring basis. 

“We ask people actually to check in with us once a day. When people are in quarantine, we want them to talk with us if they’re feeling symptomatic,” said Patty Hayes, public health director for Seattle and King County. “But we’re not gonna be forcing somebody to call us.”

As the outbreak escalates, it will become increasingly important for people to take personal responsibility for following self-quarantine recommendations, she added, noting that “it’ll become more and more difficult to individually monitor everyone.”

Hayes said that the health department was now monitoring between 300 and 500 people, but didn’t have an exact figure available at a Friday morning press conference.

The public health chief also said that her department was looking at ways to potentially use video call technology, like Skype, to oversee things like temperature checks for those who are quarantined.

“We’re working dynamically on what the protocol is,” she said.

The county offers a description of the kind of "close contact" that would make it advisable for someone to sequester themselves.

It includes scenarios like living with or caring for a person with a confirmed case of the virus, being within six feet of such person for about 10 minutes or more, or interactions like getting coughed on, kissed, or sharing utensils with someone known to have the illness.

As of Sunday, Washington state reported 136 confirmed cases of Covid-19, the respiratory disease that the new coronavirus causes. King County had 83 cases and 17 deaths.

Of the total King County cases, many were linked to a nursing home in Kirkland, east of Seattle. Almost all of the deaths also were associated with the facility, officials said.

State, local and federal authorities are all taking actions that are focused on this facility.

“We must prepare this region for the inevitable continued spread of this virus—at least in the short run,” King County Executive Dow Constantine said on Friday. 

“But we will do everything we can to slow its spread,” he added.

There was over 500 Covid-19 cases nationwide by Sunday, according to an online tracking tool created by researchers at Johns Hopkins University. So far, most of the deaths have been in Washington.

King County is not alone in confronting self-quarantine issues.

In New York, Gov. Andrew Cuomo said Friday the number of “precautionary” self-quarantines across the state was about 4,000, including around 2,700 in New York City and about 1,000 in Westchester County, north of the city. Cuomo said that the state also had a much smaller number of people under mandatory quarantine, while there were 44 confirmed Covid-19 cases as of Friday evening. 

The governor explained that the mandatory quarantine is for anyone who has tested positive for Covid-19, anyone who has been in direct contact with a person who tested positive, or for anyone who traveled to certain countries where the disease is present and has symptoms.

He also indicated that there could be other circumstances where health authorities determine someone should be subject to this type of quarantine.

The Centers for Disease Control and Prevention has said that experts believe that Covid-19 mostly spreads from person-to-person through "close contact," such as being near a coughing or sneezing individual.

But authorities have cautioned that it may be transmitted by a person touching a surface that has the virus on it and then touching their mouth or nose, which is why the CDC has recommended people refrain from touching their faces and frequently wash their hands.

Maryland state officials on Thursday reported that three people who had been on a cruise ship in Egypt on the Nile River had contracted the illness. All three, a couple in their 70s and a woman in her 50s, are from Montgomery County, which has about one million residents and is near Washington, D.C.

They had returned to Maryland on February 20 and officials emphasized that they are “doing well clinically.”

“There is no reason to panic and life as you know it should continue pretty much as it was before this became news with the caveats of what we are saying about precautions to take,” Montgomery County Executive Marc Elrich said at a Friday news conference.

“We have to be extra careful about what we do in the course of things to make sure the spread of this virus is contained,” he added.

Dr. Travis Gayles, head of public health services in Montgomery County, said local health workers are helping the state figure out the movements of the people with the illness before they were diagnosed. This “contact tracing” process is typical in a public health crisis, where health workers try to determine who may have been exposed to a disease.

Fran Phillips, a deputy health secretary, said at an evening news conference on Friday that at least five people who had contacts with the coronavirus patients will be told to get tested. A spokesman for the Maryland Department of Health said that people who had been in close contact with the three patients were being told to self-quarantine for 14 days, although he could not say how many people were being asked to isolate. 

One of the patients had been at a gathering in Pennsylvania with school children, resulting in the closure of five schools for the day in a suburban district outside Philadelphia. A patient also attended a party at a retirement community in late February. Phillips said the state health department would be working with that community to closely monitor the health of residents and staff.

Castrucci said that the effectiveness of self-quarantine measures tends to break down when cases of a disease start to arise that are not tied to travel in a place where there’s been an outbreak, or to direct contact with a person who was already known to have the illness. 

This is the point where policy makers may have to look at more extreme options, like canceling public gatherings, or calling for large segments of the population to stay home from work. 

“It’s less about quarantining the individual,” Castrucci said. “It’s about really implementing stringent, social-distancing principles.”

He stressed that public health officials can face tough decisions under the current circumstances because they’re still building up their knowledge about the virus and its spread. “I think right now, we’re doing the best we can with the information that we have,” he added.

One aspect of more aggressive measures to prevent the spread of a disease is that they can put a serious dent in commerce, something that must be balanced against public health goals.

“There are politicians who have to decide: what are we comfortable with and what is the risk to our economy?” Castrucci said.

Staff correspondent Kate Elizabeth Queram contributed to this report.

Editor's note: This story was updated on Sunday with new numbers of Covid-19 cases.

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