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From Leprosy To Ebola: Louisiana & The Law Of Quarantine.

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The American news media is currently enthralled in all things Ebola.

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The Ebola obsession comes on the heels of last week’s announcement by the CDC that the first United States’ case of Ebola was diagnosed in Dallas, Texas. Thomas Duncan, a native of West Africa, traveled from Liberia to Dallas on September 20, 2014 and fell ill on September 24th. Upon developing symptoms consistent with Ebola, Mr. Duncan sought treatment from Texas Health Presbyterian Hospital on September 26th and was admitted to the hospital on September 28th. After completing the necessary diagnostic tests, the Center for Disease Control and Prevention (CDC) announced on September 30th, that Mr. Duncan was the first confirmed diagnosis of Ebola in the U.S. On October 4th officials at Texas Presbyterian announced that Mr. Duncan was in critical condition.  On October 8th, Mr. Duncan tragically lost his fight with the disease.

Ebola - Hospital

Since the diagnosis, health officials at both the state and federal level have scrambled to identify individuals that may have been exposed to the virus. Officials have identified Mr. Duncan’s partner, Louise Troh, and her son and two nephews, as potentially at a high risk of developing the virus. As a result, the four have been quarantined to the apartment where they live. The family has been ordered not to leave or host any visitors until the 21-day incubation period for the virus has expired. During this quarantine period, police remain on the scene of the apartment complex while food and other necessities are delivered to the family.

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What Is A Quarantine?

A quarantine is essentially a state enforced period of isolation designed to prevent the spread of a communicable disease.

The practice of quarantine began as early as the 14th century in Italy as a means of protecting coastal cities from the plague. Ships arriving from infected areas were required to sit at anchor for 40 days before landing in port. The word “quarantine” was taken from the Italian words “quaranta giorni,” which mean 40 days.

For a century in the U.S., protection against the spread of imported diseases fell under local and state jurisdictions.   However, in 1878 Congress passed federal quarantine legislation in an attempt to control ongoing outbreaks of yellow fever. A cholera epidemic brought about in 1892 by passenger ships arriving from Europe, prompted a reinterpretation of the law and increased the authority of the federal government in imposing quarantines.

Ebola - Ship

In 1944, with the passage of the Public Health Service Act, the federal government’s quarantine authority was clearly established. The act vested responsibility for the prevention of the transmission of communicable diseases from foreign countries with the Public Health Service (PHS).

In 1967, the PHS was transferred to the agency now known as the CDC. When the CDC assumed the PHS, there were 55 quarantine stations and over 500 staff members. There were quarantine stations located at every port, international airport, and major border crossing.

In the 1970’s the CDC reduced the scale of the quarantine program and changed its focus from routine inspection to program management and intervention. By 1995, all U.S. ports of entry were covered by only 7 quarantine stations.  After the SARS (severe acute respiratory syndrome) epidemic in 2003, the CDC reorganized the quarantine system and expanded to 18 stations with over 90 field employees.

Louisiana’s History Of Quarantine In Carville.

Louisiana Governor, Bobby Jindal, stepped into the national Ebola debate last week when he called upon the Obama administration to impose a travel ban on flights to the U.S. from countries with Ebola outbreaks. Jindal, a likely 2016 presidential candidate, is one of the most prominent elected officials to call for the travel ban that the CDC claims is impractical.

Ebola - Jindal

Governor Jindal is not the first Louisiana elected official to wade into the politics of quarantine. Over 100 years ago, the Louisiana legislature wrestled with the issue of quarantine within the context of Hansen’s disease, commonly known as leprosy.

In the 1800’s, leprosy was thought to be both highly contagious and the wrath of God. Biblical references suggested that lesions and other skin deformities like those caused by leprosy, reflected God’s judgment of the infirmed. While scientists proved that bacteria caused the disfigurement and that it was no more contagious than other common diseases, the stigma associated with leprosy remained.

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In the early 1890’s, an expose was published in the daily New Orleans’ newspaper about leprosy in the city. The news coverage created an outcry amongst the public that “pest houses” in New Orleans that housed leprosy patients should be moved outside of the city limits.

In 1892, the Louisiana legislature passed a law mandating that all person’s diagnosed with leprosy in the state be quarantined to a selected location. In 1894, the first leprosy patients were transported from New Orleans by river barge to a deserted sugar plantation in Carville, Louisiana known as Indian Camp. The main plantation home was in such disrepair that the first patients were housed in former slave cabins. In 1896, a group of Catholic nuns from Maryland arrived at the plantation to help care for the patients of what would come to be called the Louisiana Leper Home.

Ebola - Slave Cabins

In 1905 the state of Louisiana purchased the plantation and assumed custodial care of the patients after public outcry prevented the Louisiana Leper Home from relocating to the New Orleans area.

In 1916, John Early, a patient from the Louisiana Leper Home, escaped from the facility and went on to testify before the U.S. Congress about the need for a U.S. hospital for leprosy. In 1917, the U.S. Senate passed an act establishing a National Leprosarium in Carville, Louisiana. In 1920, the Louisiana Leper Home was sold by Louisiana to the federal government for $35,000.

In 1921, the United States Public Health Service (USPHS) took over control of the Home and it became U.S. Marine Hospital No. 66…The National Leprosarium of the United States. Between 1940 and 1947, doctors at the hospital pioneered the use of sulfone drug therapy in the treatment of Hansen’s disease. In the 1970’s, doctors at the hospital defined the role of thalidomide in leprosy and introduced Rifampin as part of the multi-drug therapy.

Ebola - Molecules

In 1986, the facility at Carville was renamed the “Gillis W. Long Hansen’s Disease Center” after the U.S. Congressman who successfully lobbied to keep the facility open for leprosy patients when other Public Health Service hospitals in the U.S. were closed.

In 1998, the U.S. Congress passed a bill to relocate the renamed facility to Baton Rouge. Patients who voluntarily remained at the facility were given the choice of a lifetime medical stipend, remaining on site as an ambulatory care patient, or relocating with he hospital to Baton Rouge.

The Federal Law Of Quarantine.

In our modern fight against Ebola and other communicable diseases, the Executive Branch of the federal government possesses significant power.

The Surgeon General, with the approval of the Secretary of Health and Human Services, is authorized by law to make and enforce regulations that are deemed “necessary” to prevent the introduction, transmission, or spread of communicable diseases from foreign countries into the United States. 42 U.S.C.A § 264 (a).

The Surgeon General is specifically authorized to implement regulations that provide for the apprehension and examination of individuals with communicable diseases that travel to the U.S. from a foreign country. 42 U.S.C.A § 264 (c).

Ebola - Executive Branch

The Surgeon General is also authorized to implement regulations that provide for the apprehension and examination of individuals that are already within the U.S. Such regulations are authorized if:

  • The individual is reasonably believed to be infected with a communicable disease in a “qualifying stage;”
  • The individual is moving or about to move from one State to another State;
  • The individual is a probable source of infection to other individuals who will be moving from one State to another State.

42 U.S.C.A § 264 (d).

In other words, the Executive Branch has the power, through the Surgeon General, to promulgate regulations that provide for the detainment of U.S. citizens in the name of public health so long as such regulations are deemed “necessary” to prevent the spread of communicable diseases. That is extraordinary power.

In addition to apprehending and examining individuals in the name of public health, the Surgeon General may also implement regulations that specifically prohibit persons or property from other parts of the world from entering the U.S. so as to avert the danger of a communicable disease for a certain period of time. 42 U.S.C.A § 265.

The Surgeon General is also responsible for controlling U.S. quarantine stations and promulgating air navigation and aircraft regulations to prevent the introduction and spread of communicable diseases. 42 U.S.C.A § 267.

The violation of federal regulations pertaining to quarantine may be a punished by a fine of not more than $1,000, imprisonment for not more than one year, or both. 42 U.S.C.A § 271.

The Louisiana Law Of Quarantine.

Much like federal law, Louisiana law provides the Executive Branch with significant power when it comes to quarantines and public health. Specifically, the Executive Branch is granted “exclusive jurisdiction, control, and authority to isolate or quarantine for the care and control of communicable disease within the state.” La. R.S. 40 § 5.

In the event that a Louisiana parish or municipality becomes infected with a disease to such an extent as to threaten the spread of the disease to other parts of the state, the Executive Branch may issue an order declaring the parish or municipality quarantined. The state may then establish rules and regulations that govern how other parts of the state must interact with the quarantined area. La. R.S. 40 § 7.

Ebola - Louisiana

Louisiana law does provide some judicial oversight when dealing with issues of quarantine and public health. Neither parish nor state officials can force an individual to undergo a medical examination or confine him/her to a medical institution unless directed or authorized to do so by a judge in the parish where the individual is located. However judicial authorization is not required if the individual is infected or suspected of infection with smallpox, cholera, yellow fever, bubonic plague, or tuberculosis. La. R.S. 40 § 17.

The violation of Louisiana regulations pertaining to quarantine may be punished by a fine of not less than $50 and not more than $100, imprisonment for not more than two years, or both.   La. R.S. 40 § 18.

Remembering Carville In The Age Of Ebola.

Approximately 100 years after the Louisiana Leper Home was opened as a place to discard those considered plagued, the Carville National Leprosarium closed its doors as an internationally acclaimed facility of healing. I guess sometimes good things spring up despite our own bad intentions.

Our ancestors kind of got it wrong with leprosy. Really wrong. It ended up not being the wrath of God. It ended up not being as contagious as the media of the day led folks to believe. A group of Catholic nuns, quietly working in a deserted sugar plantation, began our slow slog back toward science and rational thought when it came to leprosy.

History has a way of providing us with some degree of perspective when we take the time to turn down the volume on all of the noise and just listen.

Ebola - History