What can we do to prevent outbreaks of infectious diseases from becoming epidemics or pandemic? In this course, you’ll learn the facts about infectious diseases and medical responses. We'll focus on the public health laws and policies that provide the framework for effective prevention, like quarantine laws, drug development policies, and bioterrorism and biodefense.
Week 4 Video 3: What legal Interventions Can be Used to Fight Infectious Disease?
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Del curso dictado por University of Pittsburgh
Epidemics, Pandemics and Outbreaks
207 calificaciones
De la lección
Week 4: Local Countermeasures
Welcome to Week Four! This week’s lesson introduces you to the legal interventions available to state and local public health practitioners to combat epidemics, pandemics and outbreaks. In addition to the law, we will look at some of the ethical and practical issues associated with disease reporting requirements, the effect of a declaration of an emergency, travel restrictions, quarantine and isolation.
Conoce a los instructores
Elena A. BaylisAssociate Professor
Law
Elizabeth Ferrell Bjerke, JDDirector, JD/MPH Program
Health Policy and Management
Amesh A. Adalja, MD, FACPSenior Associate
UPMC Center for Health Security
Ryan MorhardGuest Instructor
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Many scientists and medical professionals believe that it is not a question of if
a deadly epidemic will ever come to the United States but just a matter of when.
If an epidemic does come to our shores,
chances are that the first responders will be local in nature.
So what are some of the legally directed countermeasures available to states and
local agencies to combat diseases?
We will analyze several of these interventions,
namely requiring healthcare providers to report infectious diseases.
The effect an emergency or disaster declaration has, and
limiting travel to and from the United States.
Let's discuss these authorities using a fictional location, New Geneva,
a state located in the southern part of the US, and a pretend infectious disease
with origins in Europe, called European Respiratory Syndrome, or ERS.
How do you know if you are sick with ERS?
Well, people with ERS present with fever, cough and shortness of breath.
As with Ebola, there is a laboratory test to confirm if you have ERS.
How is ERS transmitted?
ERS is caused by a coronavirus that is similar to that
causing Middle Eastern respiratory syndrome.
ERS, though, is airborne meaning that it can spread through the air.
Most diseases that spread by aerosol are much more contagious than diseases
that are spread through contact, like Ebola or HIV.
In our pretend scenario, the CDC has determined that ERS has an R-naught of 18.
An R-naught is the number of cases an infected person will generate before he or
she is no longer contagious.
An R-naught of 18 is very high, similar to the R-naught of measles for
persons who have not been vaccinated.
By comparison, Ebola has an R-naught less than 2, meaning that for
every incidence of Ebola, about two or fewer people would become infected.
SARS is more contagious than Ebola, with an R-naught of about 4.
Recently, there was an international convention in the city of Metropolis,
the most populous city in the state of New Geneva.
Thousands of people from all over the world attended the conference in
Metropolis, including folks from Europe.
Three of the attendees, all of whom are new Metropolis residents,
have become seriously ill.
The three attendees are taken by ambulance to one of Metropolis's leading hospitals,
Metropolis General Hospital.
The three attendees are immediately examined in the hospital's
emergency department.
So what happens next?
All states have laws governing reporting requirements for infectious diseases.
But the states vary in terms of what types of diseases must be reported,
what method is used for reporting, and how quickly the reporting has to take place.
For example, hospitals in Alaska and
California must report cases of hemorrhagic fever,
such as Ebola, to governmental public health immediately by telephone.
In Kansas, hospitals are required to report such occurrences within four hours,
and the mode of transmittal is unspecified.
In Pennsylvania, a health care facility has 24 hours to report a case of Ebola.
Wisconsin requires reporting to a local health officer immediately, and
within 24 hours to the Electronic Disease Surveillance System.
This is the national center manned by the CDC that collects and
monitors disease trends and outbreaks.
Most states have, also have a catchall reporting category for
unusual occurrences of disease.
So, under our hypothetical ERS outbreak, Metropolitan General Hospital
would be required to report the incidences of ERS to the local and or
state health department.
The health department would then report the incidents to the Centers for
Disease Control and Prevention.
Reporting requirements are always in place and
are not depending upon whether an emergency is declared or not.
Now the CDC has noticed that New Geneva is not the only jurisdiction
with an outbreak of ERS.
In fact, many healthcare providers in many cities in New Geneva
have reported laboratory confirmed incidences of ERS.
Based upon this information,
the CDC has determined that there is an epidemic of ERS in New Geneva.
So what can the state of New Geneva do?
For one thing, the governor can declare an emergency.
If an epidemic does occur, it is almost certain that an emergency will be declared
at either the state or local level.
An emergency declaration is a legal document, and
its effect can be quite profound.
Usually an emergency is declared by issuing an order.
A recent example of this was the declaration of a flu emergency in 2009 and
2010 because of the H1N1, or swine flu, pandemic.
An emergency declaration sets forth the effective dates of the declaration,
its duration, the geographic areas affected by the declaration, and
which agencies are leading the response activities.
Often, legislative approval is needed to renew
an emergency declaration once it has expired.
All states give the governor the authority to declare an emergency.
Increasingly, though, the authority to declare an emergency is being given to
other executive branch agencies as well.
Such as governmental public health, departments of agriculture,
homeland security heads, environmental protection entities, and
emergency management agencies.
In California, the Governor and the Director of
the California Emergency Management Agency can declare a state of emergency.
The governing body of a state or county in California can declare a local emergency.
The director of California's Department of Health Services can declare a health
emergency epidemic.
So, getting back to our New Geneva case study,
let's say that in our hypothetical, the governor of New Geneva has declared
a public health emergency because of the ERS epidemic.
What does this emergency declaration allow him to do?
Well, for one thing, an emergency declaration suspends and
can change governmental functioning.
But, just like in disease reporting, there are differences between the states.
Some of these changes include the authority for a governor to suspend laws.
When laws are suspended, certain procedures can be waived
like procurement requirements for entering into governmental contracts.
Also, the governor can incur obligations, employ temporary workers, and
purchase supplies and materials without the usual formalities.
An emergency declaration can also allow a governor to use
all the available resources of the state or
local governments that are reasonably necessary to cope with the emergency.
The governor can also transfer personnel within state agencies and take or
use private or public property to cope with the emergency.
Some states mandate payment for such use.
As was done immediately before superstorm Sandy,
which slammed into the New York and New Jersey coasts in the Fall of 2013.
A government can require people to evacuate and
can control which routes are used, what modes of transportation are permitted,
and where the ultimate destination will be.
In addition,
a governor can control the movement of persons within a disaster area.
And finally, with an emergency declaration, the governor can suspend or
limit the sale of certain items, like alcohol, firearms, and explosives.
A declaration of an emergency also allows for federal aid under the Stafford Act,
and may trigger Emergency Management Assistance Compacts, or EMACs.
EMACs are agreements between the states and
some territories that provide financial aid, personnel, and other resources.
The governor of New Geneva is also fearful that travellers from Europe will keep
coming to his state and with them bring additional cases of ERS.
He wants to shut down travel between these countries to his state.
Can he do that?
Although the governor of New Geneva can control movement within his state,
whether travel should be restricted between states, or between the state and
the foreign country, is a decision that is made by the Federal Government.
In the United States, Immigration and
Border Patrol officers can deny entry of any non-US citizen
infected with a contagious disease of pubic health significance.
United States citizens, however, cannot be refused reentry into the country
even if they have a highly contagious disease like ERS.
Instead, the Federal Government can quarantine US citizens suspected of
being infected with a contagious disease,
such as Ebola, until they are no longer contagious.
Additionally, the Department of Homeland Security can screen individuals at points
of entry, such as was recently done at some major US airports for
incoming travelers from West Africa.
The governor of New Geneva is also concerned that many,
many more citizens of Metropolis may be carriers of ERS.
He is wondering if he can order people living in certain sections of the city
to stay home.
Can he do this?
We will explore the potential legal and ethical implications associated with
isolation and quarantine in our next video.
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