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2 CHAPTER 1 Background Introduction Isolation is different from quarantine, though many peo- ple wrongly use the terms interchangeably. Isolation, as de- This report discusses facility issues, security considera- fined by the CDC, applies to people who have a specific in- tions, and estimated costs, including operating costs, that fectious illness. Their movements are restricted and they are would need to be considered by airport operators and policy- separated from individuals who are healthy (or at least not makers in determining how to plan for the potential quaran- symptomatic yet). Someone in isolation may be cared for at tine of arriving air travelers, whether facilities for this purpose home, in hospitals, or at another healthcare facility. Though should be located on airport property, and who should bear almost always voluntary, isolation can be mandated by the the cost of providing such facilities. The physical require- federal, state, or local government in order to protect the pub- ments of setting up a quarantine area are established along lic from disease. For example, a person arriving at an inter- with an estimation of the costs for operations and then for re- national airport who is exhibiting symptoms of one of nine covery. Planning considerations for the diverse needs of a designated diseases may be taken to an offsite medical facility population of 200 travelers are incorporated as part of the for treatment and isolation. The remainder of the passengers standard of care addressed in this report. and crew may then be quarantined to ensure that they do not, This report also includes the following information: in turn, become symptomatic and spread the disease. Here is an explanation about the terms "infectious" and A bibliography of research for existing quarantine studies "communicable": an infectious disease is caused by a virus or and potential applications bacteria that enters the body through one of a number of dif- Background information on quarantine laws ferent transmission modes. For example, harmful bacteria Locations of Federal Quarantine Stations could be present in food that is eaten and which then causes Listing and describing the diseases that qualify for quaran- "food poisoning." A communicable disease is an infectious tine under Executive Orders illness that is spread from one person to another. For exam- A literature review and bibliography of related publications ple, inhalation anthrax (as used in the 2001 terrorist at- Information needed for airport quarantine site identifica- tacks) is an infectious disease but is not communicable. tion and support Smallpox, on the other hand, is both infectious and commu- Labor requirements for quarantine operations nicable because it is spread from person to person. Information on costs, standards of care, planning consid- erations, and physical accommodations Laws Related to Quarantine Quarantine laws have a long history in this country. In What Is Quarantine? 1796 the 4th Congress passed legislation authorizing the ex- According to the Centers for Disease Control and Preven- ecutive branch to provide assistance to states in enforcing tion (CDC), quarantine is the "separation and restriction of state health laws.1 Federal, state, and local government all movement of persons, who, while not yet ill, have been ex- have the power to order and enforce quarantine. Federal posed to an infectious agent and therefore may become in- fectious." Quarantine is effective in preventing the spread of a contagious illness and can be carried out voluntarily or 1 CRS Report for Congress, "Federal and State Quarantine and ordered by government public health authorities. Isolation Authority" Library of Congress, August 16, 2006 page 3.