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Into the roots of the weeds of quarantine and isolation in Los Angeles

Into the roots of the weeds of quarantine and isolation in Los Angeles

My prior post suggesting that people should calm down about AB 262 because the law does not directly affect the public might have been too subtle or maybe just too abstract. I indicated that what the state and county can do to people during public health crises is determined by other state and country laws and regulations, not AB 262. But again, that might have been too abstract. So let’s get into the roots of the weeds, so you can read with your own eyes what, when and how a large county public health office can deal with a communicable disease based public health crises.

Here is the Los Angeles Communicable Disease Control Measure, Part 1 which sets out, among other things, the circumstances the country health department can quarantine and isolate people based on having or being exposed to certain communicable diseases.

http://publichealth.lacounty.gov/acd/procs/b73/B73p1.pdf

It’s a long document, but you should take a quick look just to see what are the reporting requirements for which diseases and so forth. But for the lazy, the ADD or if you’re just pressed for time, here is what and when LA Country Quarantines:

“SECTION 14: QUARANTINE (CCR, Title 17, Sections 2514, 2520; Health and Safety Code, Section 120175) A. DEFINITION: “Quarantine” is defined as the limitation of freedom of movement of persons or animals that have been exposed to a communicable disease for a period of time equal to the longest usual incubation period of the disease, in such manner as to prevent effective contact with those not so exposed. Contacts to cases with reportable communicable diseases may be subject to quarantine at the discretion of the SPA Medical Director. Quarantine shall be used routinely only for the diseases or circumstances listed in this section. The SPA Medical Director shall determine which contacts require quarantine, specify the place of quaran-tine, and issue appropriate instructions. B. Violations of quarantine or “pass” privileges must be reported immediately to the Chiefs of ACDC and Public Health Investigation. C. Contacts to cases of communicable diseases may be quarantined according to one of the following classifications. 1. COMPLETE QUARANTINE: This is defined as the confinement of persons or domestic animals exposed to a communicable disease for a period equal to the longest usual incubation period of the disease, in a manner that shall prevent contact with unexposed persons. Complete quarantine is required for contacts of persons with the following diseases. Viral hemorrhagic fever (e.g., Lassa, Ebola, Marburg, Crimean-Congo, etc.) Plague (until contacts, clothing, etc. have been disinfested and prophylactic medication administered) Relapsing fever, louse-borne (until disinfested) Typhus, louse borne (until disinfested) Control Measures for Complete Quarantine: a. Post the QUARANTINE PLACARD (H-734) at the site of quarantine. b. No passes shall be issued to a contact while a case patient with the disease in question is on the premises.c. The SPA Medical Director shall arrange for the daily observation of contacts, delivery of groceries, and other necessities and shall supervise the release of contacts from quarantine. d. When a case patient is off the quarantine premises, the procedures listed in Part IV for each disease shall be followed.”

Here is when a modified quarantine is initiated:

“2. MODIFIED QUARANTINE (CCR, Title 17, Section 2518): This is defined as a selective or partial confinement of persons or domestic animals that were exposed to a communicable disease, based on differences in susceptibility and potential for disease transmission. Modified quarantine is required for the following diseases and situations: Animal rabies, for an animal that has bitten a person in an unprovoked attack, and for a domestic animal bitten by a wild mammal capable of transmitting rabies. Post ANIMAL QUARANTINE PLACARD (H-733). Diarrhea in newborns (hospital nurseries only). Diphtheria. Post DIPHTHERIA QUARANTINE PLACARD (H-734). Staphylococcal disease (hospital outbreak only). 3. Release from complete or modified quarantine: To release from quarantine, follow procedures in Part IV foreach specific disease. 4. Dairy quarantine (CCR, Title 17, Sections 2528, 2530) a. A dairy quarantine is imposed when: a milk supply is suspected as the source of a communicable agent; or when a person who resides at a dairy has or is suspected of having a disease transmissible through milk.b. The County Health Officer, as an agent for the U.S. Department of Agriculture, shall prohibit the sale, use, or disposal of milk until the following measures are observed: The patient must be isolated. Water used in processing milk must be free of the agent. Household members must be free of infection and must not expose dairy workers or facilities used in processing milk. c. The milk must be pasteurized off the premises until (a) the patient is removed and the household contacts are cleared according to specific disease requirements; and (b) the producing herd is declared free of infection by the U.S. Department of Food and Agriculture.”

Here is when LA County isolates people:

“SECTION 15: ISOLATION PRECAUTIONS (CCR, Title 17, Sections 2515, 2516, 2518, 2530) A. DEFINITION: “Isolation” is defined as the separation of infected persons from other persons for the period of communicability of an agent, in such places and under such conditions that will prevent further transmission of the agent. Isolation may be strict or modified.Isolation measures depend on the mode of transmission of the disease and the potential threat to susceptible persons. See recommendations for each disease in Part IV. Modified isolation precautions may include: 1. Exclusion from school.
Exclusion from work in general or specific kinds of work (e.g., a cook with chronic typhoid infection) or exclusion from contact with specific populations (e.g., a daycare attendant with shigellosis). 3. Exclusion to avoid exposing pregnant women to communicable diseases with known risk to fetus (e.g., rubella, chicken pox). 4. Standard infection control precautions. 5. Abstinence from sexual contact, or proper use of protective measures during sex. B. Typhoid Fever Carrier Isolation 1. The SPA Medical Director shall issue specific written orders to the patient or contact who must comply. 2. The SPA Medical Director shall issue the TYPHOID CARRIER AGREEMENT (CDPH 8563, DHS 8563)(English, Spanish) to convalescent and chronic carriers. C. Isolation in Skilled Nursing Facilities 1. Patients with certain communicable diseases should not remain in skilled nursing facilities (SNFs).2. Asymptomatic carriers, e.g., typhoid carriers, are not permitted in SNFs unless prior written approval is obtained from the Chief, ACDC. D. Special Isolation Precautions A patient with a communicable disease may be confined to his home, a hospital, sanitarium, jail facility or other specified location. Cooperative patients may be voluntarily isolated at home or in a hospital. An ORDER OF ISOLATION (H-475) served by Public Health Investigation may be necessary for uncooperative patients. SECTION 16: OTHER RESTRICTIONS ON PERSONS OR ANIMALS A. Personal Surveillance (CCR, Title 17, Section 2522) 1. Observation as used in this manual, refers to the frequent check upon the person under observation in order to promptly recognize signs and symptoms of illness without restricting their movements. It does not mean the isolation or quarantine of the individual. 2. Diseases requiring personal observation (see Part IV for duration of surveillance for each disease): Yellow fever Cholera Smallpox Plague (after disinfestation and prophylactic medications are administered) B. Animal Restrictions for Diseases Other Than Rabies: For specific details concerning animal restrictions, consult with DPH Veterinary Public Health Program. 1. The possession of skunks and any mammal related to ferrets, weasels, and minks are illegal in California (CCR, Title 17, Section 2606.8; Fish and Game Code, section 2118[b], respectively). Such animals are a menace to public health and safety. 2. MUSSEL QUARANTINE: A seasonal quarantine from May 1 to October 31 prohibits the taking, sale or the offering for sale of all species of mussels from the ocean shore of California, except for use as bait. Mussels that are used as bait shall be broken at the time of taking or prior to sale. This quarantine applies to sport harvesting only; commercially harvested shellfish are regulated by other means.

For bird owners, here’s what you have to worry about:

“BIRD QUARANTINE: Birds having, or suspected of having, a disease transmissible to human shall be quarantined and placed on medicated feed for 45 days (California Code of Regulations Title 17, Section 2603).4. TURTLE RESTRICTIONS: It is unlawful to sell, offer for sale, or distribute to the public any live turtles with a carapace less than four inches in length (California Code of Regulations, Title 17, Section 2612.1).”

Here is how a quarantine and isolation are effectuated:

“SECTION 17: QUARANTINE AND ISOLATION PLACARDS A. Neither quarantine nor isolation is established legally until a placard is posted and/or written instructions are given to the patient or contact. B. When a residence is quarantined, the SPA Medical Director or designee shall attach a placard(s) at the front or principal entrance. Placards must identify the disease, name of the SPA Medical Director, signature of the deputy posting the placard, date of posting, and the address and telephone number of the district health center. C. The individual who establishes a quarantine or isolation by placard or issues passes shall report the details to the Chiefs of ACDC and Public Health Investigation. D. All correspondence with other health departments which concerns violations of quarantine or legal orders of isolation is handled by the Chief of Public Health Investigation.”

Here is how a quarantine/isolation ends:

“SECTION 19: RELEASE FROM ISOLATION OR QUARANTINE (CCR, Title 17, Section 2534) A. A Public Health Laboratory that is approved by the State Department of Health Services must perform laboratory tests that are required for release from quarantine or isolation. In Los Angeles County, laboratories of the County of Los Angeles Department of Public Health, the City of Pasadena Health Department, and the City of Long Beach Health Department are approved as such. B. The NOTICE OF RELEASE TO RETURN TO WORK (H-1066) shall be issued by the SPA Medical Director, a designee, or Public Health Investigation.C. The Chief of Public Health Investigation shall terminate an order of isolation in writing.”

I hope this helps put AB 262 in context.

Rick Jaffe, Esq.