Fighting Measles, LA Pulls a Classic Move: Quarantine

Hardly anyone actually has measles in Los Angeles (so far; thank goodness). Just five people who passed through the airports, and five residents of the county. Four of those residents are “linked cases,” meaning three got it from one. The problem is, one of those people infected with measles spent some time on the campus of the University of California, Los Angeles. Another one spent an afternoon in a library at Cal State LA. And measles is one of the most dangerous, most infectious diseases humans can get. That’s why LA’s Department of Public Health has quarantined hundreds of people who may have come into contact with the virus or its carriers.

In one sense, these instances of measles and exposure are part of a global outbreak. Despite the widespread availability of a safe, almost totally effective vaccine, instances of the disease have been rising for three years; in the first three months of 2019, reported cases were up 300 percent over the first quarter of 2018. In the year 2000, the CDC announced that measles had been eliminated in the United States; this year, with 626 cases of the disease across 22 states—thanks primarily to an aggressive , misinformed campaign against vaccination—America has managed to snatch defeat from the jaws of that victory.

Measles is dangerous, for sure—out of 1,000 people who get it, one or two will die and another will be permanently brain damaged. But it’s also wickedly infectious to the unvaccinated. Nine out of ten people who aren’t either immunized or otherwise immune (like if they had the disease already) will get sick if exposed. So when Los Angeles realized it had cases in the wild, and that they were at crowded universities, public health officials took action. “This is a legally binding order that’s issued when we want to prevent the increased risk of infection,” said Barbara Ferrer, director of the county Department of Public Health, at a press conference on Friday. “It tells a person or group of people they need to confine themselves to a particular location in order to prevent exposing others.” Stay home or somewhere else, don’t go to school or work, don’t see other people, don’t take public transit.”

With the help of the schools, public health workers identified 853 students and seven faculty members at UCLA who’d been exposed. Most of them had immunization records on file; 124 students and five faculty members got quarantine orders. As of Friday morning just 45 students and one faculty member are still quarantined; the rest either proved they’d had their shots or blood tests cleared them.

Cal State LA was a little more complicated. The county quarantined 215 people who’d been working in the campus’ North Library on April 11 between 11 am and 3 pm, when the person who became sick was wandering around. (Vectors gonna vector.) The school eventually figured out they could extract 660 more names by looking at who had used the library’s computers during that same time, and passed those on to the Department of Public Health Thursday night. Some of them have been cleared, but the county has also issued a blanket quarantine to anyone who was at the library during the zero hours, asking them to come forward and identify themselves.

So how many people are still quarantined? Not totally knowable. And if they don’t show symptoms or prove they’re immune, they’re stuck in their quarantine locations until April 30 (for UCLA) or May 2 (for Cal State). Luckily, almost everyone at the schools has been immunized; in fact, it’s a condition of enrollment. “We know quarantine is a hardship. We’d like to avoid it wherever possible,” Ferrer said. “But we do need to establish that immunity.”

And they’re allowed to do it, too. Quarantine is a power of government; the word itself comes from the 40 days the council of Venice made the crews of cargo ships wait in the lagoon before coming ashore in the 1340s. The Black Plague and the constant threat of smallpox and cholera led to extensive quarantine laws in 1700s colonial America—predating the Constitution, in other words.

Modern versions of those laws are on the books in almost every state. “They do have the power to declare an emergency, because they have an ongoing health threat that needs to be contained,” says Lawrence Gostin of Georgetown Law School, who literally wrote the book on US public health law, not to mention model legislation for most state’s public health and emergency health powers acts. “The order to students and faculty that they should stay home if they have the measles is lawful, ethical, and it’s absolutely necessary.”

The key is, these rules aren’t punitive—they’re not what lawyers call criminal powers. They’re civil, like inspections and other public health rules that protect communities. Penalties for disobeying the rules are generally things like fines, not imprisonment or forced injections. “These are powers that in my field are called police powers,” Gostin says. “That sounds like criminal enforcement, but the word derives from ‘polis.’” It’s the community, the political body of the city.

Because these kinds of infectious disease outbreaks are only now making comebacks after decades in abeyance, the real problem might be remembering how to do all this. Younger doctors may well never have seen a case of measles, as Ferrer said. And while some public health departments practice for outbreak response, quarantines can still seem like something from the Middle Ages, or zombie movies. “They’re kind of winging it, a lot of them,” Gostin says.

Now it’s a waiting game. Clear quarantined people who are immune; watch the ones who aren’t. Make sure people get their recommended two doses of the measles vaccine—none of the five people sick in LA had, though one of them had gotten a single dose. And hope nobody else gets sick.

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