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ACRP AIRPORT COOPERATIVE RESEARCH PROGRAM REPORT 5 Sponsored by the Federal Aviation Administration Quarantine Facilities for Arriving Air Travelers: Identification of Planning Needs and Costs

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ACRP OVERSIGHT COMMITTEE* TRANSPORTATION RESEARCH BOARD 2008 EXECUTIVE COMMITTEE* CHAIR OFFICERS James Wilding CHAIR: Debra L. Miller, Secretary, Kansas DOT, Topeka Independent Consultant VICE CHAIR: Adib K. Kanafani, Cahill Professor of Civil Engineering, University of California, Berkeley EXECUTIVE DIRECTOR: Robert E. Skinner, Jr., Transportation Research Board VICE CHAIR Jeff Hamiel MEMBERS MinneapolisSt. Paul Metropolitan Airports Commission J. Barry Barker, Executive Director, Transit Authority of River City, Louisville, KY Allen D. Biehler, Secretary, Pennsylvania DOT, Harrisburg MEMBERS John D. Bowe, President, Americas Region, APL Limited, Oakland, CA Larry L. Brown, Sr., Executive Director, Mississippi DOT, Jackson James Crites DallasFort Worth International Airport Deborah H. Butler, Executive Vice President, Planning, and CIO, Norfolk Southern Corporation, Richard de Neufville Norfolk, VA Massachusetts Institute of Technology William A.V. Clark, Professor, Department of Geography, University of California, Los Angeles Kevin C. Dolliole David S. Ekern, Commissioner, Virginia DOT, Richmond UCG Associates Nicholas J. Garber, Henry L. Kinnier Professor, Department of Civil Engineering, University of Virginia, John K. Duval Charlottesville Beverly Municipal Airport Jeffrey W. Hamiel, Executive Director, Metropolitan Airports Commission, Minneapolis, MN Angela Gittens HNTB Corporation Edward A. (Ned) Helme, President, Center for Clean Air Policy, Washington, DC Steve Grossman Will Kempton, Director, California DOT, Sacramento Oakland International Airport Susan Martinovich, Director, Nevada DOT, Carson City Tom Jensen Michael D. Meyer, Professor, School of Civil and Environmental Engineering, Georgia Institute of National Safe Skies Alliance Technology, Atlanta Catherine M. Lang Michael R. Morris, Director of Transportation, North Central Texas Council of Governments, Arlington Federal Aviation Administration Neil J. Pedersen, Administrator, Maryland State Highway Administration, Baltimore Gina Marie Lindsey Los Angeles World Airports Pete K. Rahn, Director, Missouri DOT, Jefferson City Carolyn Motz Sandra Rosenbloom, Professor of Planning, University of Arizona, Tucson Hagerstown Regional Airport Tracy L. Rosser, Vice President, Corporate Traffic, Wal-Mart Stores, Inc., Bentonville, AR Richard Tucker Rosa Clausell Rountree, Executive Director, Georgia State Road and Tollway Authority, Atlanta Huntsville International Airport Henry G. (Gerry) Schwartz, Jr., Chairman (retired), Jacobs/Sverdrup Civil, Inc., St. Louis, MO C. Michael Walton, Ernest H. Cockrell Centennial Chair in Engineering, University of Texas, Austin EX OFFICIO MEMBERS Linda S. Watson, CEO, LYNXCentral Florida Regional Transportation Authority, Orlando Sabrina Johnson Steve Williams, Chairman and CEO, Maverick Transportation, Inc., Little Rock, AR U.S. Environmental Protection Agency Richard Marchi EX OFFICIO MEMBERS Airports Council International--North America Laura McKee Thad Allen (Adm., U.S. Coast Guard), Commandant, U.S. Coast Guard, Washington, DC Air Transport Association of America Joseph H. Boardman, Federal Railroad Administrator, U.S.DOT Henry Ogrodzinski Rebecca M. Brewster, President and COO, American Transportation Research Institute, Smyrna, GA National Association of State Aviation Officials Paul R. Brubaker, Research and Innovative Technology Administrator, U.S.DOT Melissa Sabatine George Bugliarello, Chancellor, Polytechnic University of New York, Brooklyn, and Foreign Secretary, American Association of Airport Executives Robert E. Skinner, Jr. National Academy of Engineering, Washington, DC Transportation Research Board Sean T. Connaughton, Maritime Administrator, U.S.DOT LeRoy Gishi, Chief, Division of Transportation, Bureau of Indian Affairs, U.S. Department of the SECRETARY Interior, Washington, DC Edward R. Hamberger, President and CEO, Association of American Railroads, Washington, DC Christopher W. Jenks Transportation Research Board John H. Hill, Federal Motor Carrier Safety Administrator, U.S.DOT John C. Horsley, Executive Director, American Association of State Highway and Transportation Officials, Washington, DC Carl T. Johnson, Pipeline and Hazardous Materials Safety Administrator, U.S.DOT J. Edward Johnson, Director, Applied Science Directorate, National Aeronautics and Space Administration, John C. Stennis Space Center, MS William W. Millar, President, American Public Transportation Association, Washington, DC Nicole R. Nason, National Highway Traffic Safety Administrator, U.S.DOT James Ray, Acting Administrator, Federal Highway Administration, U.S.DOT James S. Simpson, Federal Transit Administrator, U.S.DOT Robert A. Sturgell, Acting Administrator, Federal Aviation Administration, U.S.DOT Robert L. Van Antwerp (Lt. Gen., U.S. Army), Chief of Engineers and Commanding General, U.S. Army Corps of Engineers, Washington, DC *Membership as of January 2008. *Membership as of May 2008.

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AIRPORT COOPERATIVE RESEARCH PROGRAM ACRP REPORT 5 Quarantine Facilities for Arriving Air Travelers: Identification of Planning Needs and Costs Hollis Stambaugh Daryl Sensenig TRIDATA, A DIVISION OF SYSTEM PLANNING CORPORATION Arlington, VA WITH Rocco Casagrande GRYPHON SCIENTIFIC Takoma Park, MD Shania Flagg TRIDATA, A DIVISION OF SYSTEM PLANNING CORPORATION Arlington, VA Bruce Gerrity SYSTEM PLANNING CORPORATION Arlington, VA Subject Areas Planning and Administration Safety and Human Performance Aviation Security Research sponsored by the Federal Aviation Administration TRANSPORTATION RESEARCH BOARD WASHINGTON, D.C. 2008 www.TRB.org

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AIRPORT COOPERATIVE RESEARCH PROGRAM ACRP REPORT 5 Airports are vital national resources. They serve a key role in trans- Project 11-02/Task 5 portation of people and goods and in regional, national, and inter- ISSN 1935-9802 national commerce. They are where the nation's aviation system ISBN: 978-0-309-09940-0 connects with other modes of transportation and where federal respon- Library of Congress Control Number 2008904485 sibility for managing and regulating air traffic operations intersects with the role of state and local governments that own and operate most 2008 Transportation Research Board airports. Research is necessary to solve common operating problems, to adapt appropriate new technologies from other industries, and to introduce innovations into the airport industry. The Airport Coopera- COPYRIGHT PERMISSION tive Research Program (ACRP) serves as one of the principal means by Authors herein are responsible for the authenticity of their materials and for obtaining which the airport industry can develop innovative near-term solutions written permissions from publishers or persons who own the copyright to any previously to meet demands placed on it. published or copyrighted material used herein. The need for ACRP was identified in TRB Special Report 272: Airport Research Needs: Cooperative Solutions in 2003, based on a study spon- Cooperative Research Programs (CRP) grants permission to reproduce material in this publication for classroom and not-for-profit purposes. Permission is given with the sored by the Federal Aviation Administration (FAA). The ACRP carries understanding that none of the material will be used to imply TRB or FAA endorsement out applied research on problems that are shared by airport operating of a particular product, method, or practice. It is expected that those reproducing the agencies and are not being adequately addressed by existing federal material in this document for educational and not-for-profit uses will give appropriate research programs. It is modeled after the successful National Coopera- acknowledgment of the source of any reprinted or reproduced material. For other uses of tive Highway Research Program and Transit Cooperative Research Pro- the material, request permission from CRP. gram. The ACRP undertakes research and other technical activities in a variety of airport subject areas, including design, construction, mainte- nance, operations, safety, security, policy, planning, human resources, NOTICE and administration. The ACRP provides a forum where airport opera- tors can cooperatively address common operational problems. The project that is the subject of this report was a part of the Airport Cooperative Research Program conducted by the Transportation Research Board with the approval of the The ACRP was authorized in December 2003 as part of the Vision Governing Board of the National Research Council. Such approval reflects the Governing 100-Century of Aviation Reauthorization Act. The primary partici- Board's judgment that the project concerned is appropriate with respect to both the pants in the ACRP are (1) an independent governing board, the ACRP purposes and resources of the National Research Council. Oversight Committee (AOC), appointed by the Secretary of the U.S. The members of the technical advisory panel selected to monitor this project and to review Department of Transportation with representation from airport oper- this report were chosen for recognized scholarly competence and with due consideration ating agencies, other stakeholders, and relevant industry organizations for the balance of disciplines appropriate to the project. The opinions and conclusions such as the Airports Council International-North America (ACI-NA), expressed or implied are those of the research agency that performed the research, and the American Association of Airport Executives (AAAE), the National while they have been accepted as appropriate by the technical panel, they are not Association of State Aviation Officials (NASAO), and the Air Transport necessarily those of the Transportation Research Board, the National Research Council, or the Federal Aviation Administration of the U.S. Department of Transportation. Association (ATA) as vital links to the airport community; (2) the TRB as program manager and secretariat for the governing board; and Each report is reviewed and accepted for publication by the technical panel according to (3) the FAA as program sponsor. In October 2005, the FAA executed a procedures established and monitored by the Transportation Research Board Executive Committee and the Governing Board of the National Research Council. contract with the National Academies formally initiating the program. The ACRP benefits from the cooperation and participation of airport The Transportation Research Board of the National Academies, the National Research professionals, air carriers, shippers, state and local government officials, Council, and the Federal Aviation Administration (sponsor of the Airport Cooperative Research Program) do not endorse products or manufacturers. Trade or manufacturers' equipment and service suppliers, other airport users, and research orga- names appear herein solely because they are considered essential to the clarity and nizations. Each of these participants has different interests and respon- completeness of the project reporting. sibilities, and each is an integral part of this cooperative research effort. Research problem statements for the ACRP are solicited periodically but may be submitted to the TRB by anyone at any time. It is the responsibility of the AOC to formulate the research program by iden- tifying the highest priority projects and defining funding levels and expected products. Once selected, each ACRP project is assigned to an expert panel, appointed by the TRB. Panels include experienced practitioners and research specialists; heavy emphasis is placed on including airport pro- fessionals, the intended users of the research products. The panels pre- pare project statements (requests for proposals), select contractors, and provide technical guidance and counsel throughout the life of the project. The process for developing research problem statements and Published reports of the selecting research agencies has been used by TRB in managing cooper- AIRPORT COOPERATIVE RESEARCH PROGRAM ative research programs since 1962. As in other TRB activities, ACRP are available from: project panels serve voluntarily without compensation. Primary emphasis is placed on disseminating ACRP results to the Transportation Research Board Business Office intended end-users of the research: airport operating agencies, service 500 Fifth Street, NW providers, and suppliers. The ACRP produces a series of research Washington, DC 20001 reports for use by airport operators, local agencies, the FAA, and other interested parties, and industry associations may arrange for work- and can be ordered through the Internet at shops, training aids, field visits, and other activities to ensure that http://www.national-academies.org/trb/bookstore results are implemented by airport-industry practitioners. Printed in the United States of America

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COOPERATIVE RESEARCH PROGRAMS CRP STAFF FOR ACRP REPORT 5 Christopher W. Jenks, Director, Cooperative Research Programs Crawford F. Jencks, Deputy Director, Cooperative Research Programs S.A. Parker, Senior Program Officer Eileen P. Delaney, Director of Publications Maria Sabin Crawford, Assistant Editor ACRP PROJECT 11-02/TASK 5 PANEL Field of Special Projects Robert P. Olislagers, Arapahoe County (CO) Public Airport Authority, Englewood, CO (Chair) H. Norman Abramson, Southwest Research Institute, San Antonio, TX (retired) Dave Cardenas, Los Angeles World Airports, Los Angeles, CA K. Scott Kimerer, City of Burien, Burien, WA Mike Mandella, Port of Seattle Fire Department, Seattle, WA Julie Raines, Northern Kentucky University, Highland Heights, KY Gina C. Wesley, University of Louisville, Louisville, KY Paul L. Friedman, FAA Liaison Katherine Andrus, Air Transport Association of America Liaison John V. Barson, Centers for Disease Control and Prevention Liaison Joseph Lafornara, U.S. Environmental Protection Agency Liaison Richard Marchi, Airports Council International-North America Liaison Joedy W. Cambridge, TRB Liaison Christine Gerencher, TRB Liaison

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FOREWORD By S.A. Parker Staff Officer Transportation Research Board ACRP Report 5: Quarantine Facilities for Arriving Air Travelers: Identification of Planning Needs and Costs, discusses facility issues, security considerations, and estimated costs (includ- ing operating costs) that would need to be considered by airport operators and policymakers in planning for the potential quarantine of arriving air travelers. The physical requirements of setting up a quarantine area are established along with an estimation of the costs for opera- tions and then for recovery. Planning considerations for the diverse needs of a population of 200 travelers are incorporated as part of the standard of care addressed in this report. This report presents the results of a study of the costs and considerations for establishing a quarantine facility at a U.S. international airport. The laws that govern quarantine and the nine diseases for which the federal government can order quarantine are addressed, along with examples of symptoms and incubation times. The physical requirements of space, pri- vacy, communications, food, water, and sanitary conditions are discussed. Operational con- siderations are described in the form of a standard of care to illustrate many of the issues that could develop if a diverse group of travelers was required to live together in close prox- imity under medical surveillance. Finally, estimates of the costs for an airport to establish a facility for quarantining up to 200 people for a maximum of 2 weeks are itemized. Quarantine laws have a long history in the United States; in 1796, the 4th Congress passed legislation authorizing the executive branch to provide assistance to states in enforcing state health laws. Federal, state, and local governments all have the power to order and enforce quarantines. The Public Health Service Act of 1944, as amended (codified at 42USC201) authorizes the "apprehension, detention, or conditional release of individuals" for the pur- pose of preventing the introduction, transmission, or spread of communicable diseases specified by Executive Orders of the President. Under Executive Order 13295, Revised List of Quarantinable Communicable Diseases (issued April 4, 2003), the federal government can declare quarantine for persons suspected of being ill with the following diseases: (1) cholera, (2) diphtheria, (3) infectious tuberculosis, (4) plague, (5) smallpox, (6) yellow fever, (7) viral hemorrhagic fevers, (8) SARS (Severe Acute Respiratory Syndrome), and (9) influenza, from a novel or re-emergent source. The Tri-Data (a division of System Planning Corporation) Center for Public Protection prepared this report for TRB under ACRP Project 11-02/Task 5. ACRP has the following related works in progress: ACRP Project 05-01, "Regionally-Coordinated Airport Emergency Plans for CBRNE (Chemical, Biological, Radiological, Nuclear, and Explosive) Events," and

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ACRP Project 04-04, "Exercising Command-Level Decision Making for Critical Incidents at Airports." Readers are advised to access capsule descriptions and links to a variety of emergency management, infrastructure protection, and security-related items published by TRB at www.TRB.org/SecurityPubs.

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CONTENTS 1 Summary 2 Chapter 1 Background 2 Introduction 2 What is Quarantine? 2 Laws Related to Quarantine 3 Federal Quarantine Stations 4 Role of State and Local Health Departments 5 Chapter 2 Phases of Quarantine 5 Phase 1. Decision to Quarantine 6 Phase 2. Establishment of Quarantine 6 Phase 3. Quarantine Operations 6 Phase 4. Demobilization 7 Phase 5. Recovery 8 Chapter 3 Planning Considerations for Airport Quarantine 8 Location 9 Accommodations 10 Supplies 10 Staffing 11 Services 12 Clean-Up and Disinfection (Post-Quarantine) 13 Chapter 4 Estimated Costs 13 Stand-By Costs 13 Activation Costs 13 Operational Costs 13 Recovery Costs 18 Annotated Bibliography 20 Appendix A CDC Disease Quarantines 23 Appendix B CDC Quarantine Station Jurisdictions and Contact Information