Federal health officials may be about to get greatly enhanced powers to quarantine people, as part of an ongoing effort to stop outbreaks of dangerous contagious diseases.
The new powers are outlined in a set of regulations the Centers for Disease Control and Prevention published late last month to update the agency's quarantine authority for the first time since the 1940s.
The outlined changes are being welcomed by many health lawyers, bioethicists and public health specialists as providing important tools for protecting the public. But the CDC's increased authority is also raising fears that the rules could be misused in ways that violate civil liberties.
The update was finalized at the end of the Obama administration and was scheduled to go into effect Feb. 21. But the Trump administration is reviewing the changes as part of its review of new regulations. So the soonest the changes could go into effect has been pushed to the end of March.
Under the old rules, the CDC's authority was primarily limited to detaining people entering the country or crossing state lines. The agency was also limited to quarantining people who had one of about a dozen diseases, including cholera, diphtheria, tuberculosis, plague, smallpox and yellow fever.
Yet even then, the CDC rarely exercised these powers and generally deferred to state and local health officials.
With the new rules, the CDC would be able to detain people anywhere in the country without getting approval from state and local officials.
The agency could also apprehend people to assess their health if they are exhibiting medical problems such as a high fever, headache, cramps and other symptoms that could be indicative of a dangerous infectious disease.
"Because of the breadth and scope of the definition of ill persons, CDC can target a much wider swath of persons to assess and screen," says James Hodge Jr., a professor of public health law and ethics at the Sandra Day O'Connor College of Law at Arizona State University.
Hodge says the new rules are "really necessary," given the potential threat that infectious diseases pose. Some others who have studied the issue agree.
"The CDC has been operating its infectious disease powers under really antiquated regulations," says Lawrence Gostin, a professor of global health law at Georgetown University.
But other attorneys say they fear the new rules give the CDC too much power — with insufficient safeguards to protect an individual's rights.
"It could represent a great danger to Americans' health and civil liberties," says Wendy Parmet, a health policy lawyer at Northeastern University.
For example, she says, the rules would allow the CDC to hold someone in quarantine for 72 hours before their case is subject to review. And that review would be conducted by the CDC itself instead of an outside, objective entity.
"The concern," Parmet says, "is that unless these regulations are carried out with care, and by people who [base their actions] on science, they can be used to trammel the civil liberties of Americans."
Parmet is especially concerned that the CDC's enhanced powers would take effect just as the Trump administration is assuming control over the agency.
"A lot of the signals we've received from President Trump suggests he may be inclined to not always listen to the science," Parmet says, "and to ground policy in what I guess we're now calling 'alternative facts,' instead of scientific facts. That's scary."
When contacted by NPR, officials at the federal Department of Health and Human Services would only confirm that the new rules are under review; they declined further comment. NPR also contacted the CDC, but the agency has not made anyone available to discuss the new quarantine powers.
"My worst fear is we have a replay of Ebola and we have, say, President Trump assert the policy he thought we ought to have when he was citizen Trump," says Scott Burris, a professor of law at Temple University.
During the 2014-2016 Ebola outbreak in West Africa, Burris points out, Trump tweeted that American health workers who got sick while treating victims should be prevented from returning to the United States for medical care.
Some public health specialists fear the CDC's new powers could backfire on efforts to prevent disease. For example, some sick people might hide their symptoms for fear of being detained.
"The worst-case scenario is that people may try to evade these procedures by, say, taking medicines to reduce their fever, or be afraid to report it if they are feeling ill on a plane," says Jennifer Nuzzo, a research epidemiologist at the Johns Hopkins Center for Health Security.
"We don't want to drive cases underground by putting measures in place that seem as though they carry some penalties associated with them," Nuzzo says.
Gostin agrees that the rules are imperfect and that quarantining anyone is a very serious step. "It's really a quite, I would say, draconian public health measure," he says. "The most draconian measure, because it allows you to literally imprison somebody who you don't know for sure is a danger to the public."
But quarantines also can be key to stopping an outbreak, Gostin says. He believes the new rules give the CDC much-needed flexibility.
"We know that the United States is vulnerable to a whole range of infectious diseases that are circulating around the world," Gostin says. "But we don't know which one will be next. And so when something sweeps up on our shores, we don't want to have delay and have political debate."
While he agrees the civil liberties protections in the new regulations should be even stronger, Gostin argues they're better than relying on the protections in the old rules. The new president is a self-described "germophobe," Gostin notes.
"If you're a germophobe, then you're going to overreact and the last thing we want in the face of a public health crisis is overreaction," he says. "And I think having rules in place that are modern at least will provide some buffer against the whims of an administration that may overreact."
RACHEL MARTIN, HOST:
Federal health officials may soon have strong, new powers to quarantine people in order to prevent or stop outbreaks of dangerous infectious diseases. The new powers are designed to help the Centers for Disease Control and Prevention protect the nation against threats like Ebola and SARS. But this new authority raises fears about violating people's civil rights. NPR health correspondent Rob Stein is in the studio to talk with me about this. Hi, Rob.
ROB STEIN, BYLINE: Oh, hey, Rachel.
MARTIN: The CDC has had this power - right? - before, the power to quarantine people for a long time.
STEIN: Yeah. Well, you know, Rachel, technically the CDC has had the power to quarantine people for decades, but the reality is that their powers have been pretty limited. Basically, they could only stop people from entering the country or crossing state lines and only for a very specific list of about a dozen diseases. And for the most part, the CDC didn't exercise the authorities it even had and generally would defer to state and local officials to take control in that kind of a situation.
MARTIN: OK. So is that not the case anymore? What has changed?
STEIN: Yeah, so what's changed is that the CDC has basically updated its quarantine regulations for the first time since, like, the 1940s and basically has changed the authorities in a lot of very significant ways. Now, the CDC, I should say, did not make anybody available to talk to me about this and is kind of downplaying it on their website. But I talked to a number of health law experts and bioethicists and doctors, and they said these changes are really significant and give the CDC broad new powers that it never had before.
For example, the CDC is no longer limited to just quarantining people when they come into the country or cross state lines. The CDC could under these rules swoop in anytime, anywhere in the United States and, you know, pull people off of trains or buses or subways if they feel the need to do that to stop an outbreak.
MARTIN: All right. So what does that mean in practice? What are the criteria the CDC uses to quarantine someone?
STEIN: Right. So under these new rules, they wouldn't necessarily be limited to a very specific list of diseases. They could detain someone just because they have symptoms that suggest they might be carrying a dangerous disease, symptoms that are pretty common, like a high fever, cramps or a headache.
MARTIN: Why? I mean, what's the rationale for these new broad powers?
STEIN: So most people I talked to said, look, the CDC needed to clarify how things would work if they needed to to stop an outbreak. And if you remember, during the Ebola outbreak, there was a lot of kind of chaos and confusion about exactly how someone could be and when they could be quarantined. And one big improvement people are saying about this is it does lay out specifically how people's civil rights could be protected if they were quarantined.
MARTIN: All right, but there are probably groups out there who are worried about civil rights and privacy protections in this.
STEIN: Right, and the concern is that the protections are in there, and that's good, but they don't go far enough. For example, one big concern is that the rules say somebody could be held for 72 hours before their case could get some kind of review. But the rules give the CDC itself several layers of review to determine whether they can continue to hold somebody. And people are saying, you know, that should be - some outside objective entity should be able to step in to make sure somebody isn't being held without good reason.
MARTIN: And is there any significance to this happening under the Trump administration?
STEIN: Well, obviously it does raise some additional concerns, especially from some of the things we've seen happen over the past week about the way the administration has dealt with immigrants and refugees, for example. And you also - you might remember during the Ebola outbreak, Trump put out a bunch of tweets saying that doctors and nurses who got sick in Africa shouldn't be allowed to come back into the country to get medical care. And Trump has described himself as kind of a germophobe. So there is a concern that if there ever was an outbreak, there might be an overreaction, and these new powers could be abused.
MARTIN: All right. So what happens next? When do they go into effect?
STEIN: They're being reviewed now as part of the Trump administration's broad review of new regulations, so the soonest they could go into effect would be the end of March.
MARTIN: Rob Stein, NPR health correspondent. Thanks, Rob.
STEIN: Oh, sure, nice to be here. Transcript provided by NPR, Copyright NPR.