1 Isolation and Quarantine Protocol Public Health Seattle and King County 2004

2 History of Quarantine n In the fourteenth century, to protect cities from plague epidemics, ships arriving in Venice from infected ports had to sit at anchor for forty days before landing. nQuarantine is derived from the Latin word quaresma, meaning forty.

3 Definitions:

4 Isolation: n The separation of someone whos infected or contaminated from others so that the infection or contamination is not spread

5 Quarantine n Limitation of freedom of movement of a well person whos been exposed to an infectious agent

6 Suspected Case n A person that the local health officer believes to be infected

7 What is an RCW? n This is the Revised Code of Washington n It is the state law of Washington

8 What is a WAC n A Washington Administrative Code n It is a rule of the state of Washington

9 What is the Difference Between Isolation and Quarantine? n An isolated person is known to be contaminated or infected n A quarantined person is suspected of being exposed but it is not known for sure whether they will go on to develop disease and become infectious themselves

10 What is Voluntary Compliance? n Voluntary compliance with isolation or quarantine means a patient cooperates and complies with Public Healths instructions to separate themselves from others in order to prevent the spread of disease.

11 What is Involuntary Detention? n This is what Public Health will pursue if patients do not voluntarily comply with an isolation or quarantine order.

12 What Does it Mean to be Isolated or Quarantined? n No contact with any new people n Can not leave home or place of containment n For evaluation and verification purposes patient needs to check in with Public Health

13 What are the Rules? n Local health officer may isolate or quarantine because: –a patient is sick, or thought to be sick, with a disease that could pose a serious risk to the publics health n Local health officer may: –request voluntary compliance –issue an emergency detention order for involuntary detention –petition the court for an order to involuntary detain the individual or the group

14 Who Can Enforce these Rules? n An order issued by the local health officer must be enforced by all local law enforcement

15 What are the Steps in Isolating or Quarantining a Patient or a Group of Patients?

16 First: n Find a good location n Activate the legal process n Initiate patient monitoring and service delivery n Educate patient, partners, media and public

17 Next: Figure out who in Public Health carries out these steps: n Incident commanders n Risk communications n Logistics n Infectious disease team n Public Health Legal team n Clinical Operations team

18 Finally n When should these groups be notified? n How long will it take for them to initiate a response? n At what point in the process do they play a role and what is that role?

19 When Public Health takes the action of isolating or quarantining then everyone involved becomes part of the legal process.

20 Three Different Options for Isolating or Quarantining a Patient: n I or Q Request for Voluntary Compliance n Emergency Detention Order n Superior Court Petition - ex parte

21 Request for Voluntary Compliance With Isolation or Quarantine Instructions

22 When Would a Request for Voluntary be Issued? n ID Section determines isolation or quarantine is needed n PH seeks compliance and cooperation from the patient

23 Responsibilities Under a Request for Voluntary Compliance

24 Infectious Disease Section n Initiate contact with patient and HCP n Explain nature of illness and intent to isolate or quarantine n Notify Public Health Teams n Develop request for voluntary compliance

25 Public Health Legal Team n Track all legal dates and timelines n Advise PH teams regarding legal issues n Notify PH/Law Enforcement I and Q team and PAO

26 Clinical Operations Section n Deliver I and Q info packet n Provide training for patient and family n Daily monitor patients compliance and health status n Assess and provide for patients needs n Provide ID section with daily updates n Assist with case and contact investigations n Support and staff I & Q facilities

27 Emergency Detention Order

28 What is an Emergency Detention Order? n Order issued by the local health officer requiring the immediate detention of an individual or group n Enforced by local law enforcement

29 What is the Time Frame for an Emergency Detention Order? n The order needs to be written and delivered to the patient within 12 hours of emergency detention n It can not last for more than 10 days

30 Petition to Superior Court

31 What is a Petition to the Superior Court Ex Parte? n Request by the Prosecuting Attorneys Office for a court order authorizing involuntary detention n Ex Parte means that the action is taken without the person having to be present n Enforced by local law enforcement

32 What is the Time Frame for a Petition to the Superior Court Ex Parte? n The court must hold a hearing within 72 hours n Similar to an Emergency Detention Order, it can not last for more than 10 days

33 What Questions Must be Answered Before an Emergency Detention Order or Petition to the Superior Court can be Pursued? n Is the person sick, or thought to be sick, and infectious with a disease that poses a serious risk to the public?

34 Questions continued n Is it necessary to isolate or quarantine the person to protect the publics health? n Has Public Health really tried to get the patient to cooperate? OR n Is the disease so dangerous that there isnt time to get the patients compliance?

35 Responsibilities Under an Emergency Detention Order or Petition to the Superior Court Ex Parte

36 Local Health Officer n Determine whether LHO or Superior Court should issue the order n Assess need to declare a public health emergency n Decide whether or not to activate Public Health ICS and EOC n Coordinate with and brief local law enforcement and elected officials

37 Public Health Legal Team n Coordinate legal process between Public Health Teams and PAO n Prepare emergency detention orders n Advise Public Health staff and partners when order will expire n Coordinate patient requests for legal assistance

38 Public Health/Law Enforcement Team n Work with Clinical Operations Team to learn how to protect themselves from disease n At time of detention explain disease and I & Q process n Within 12 hours hand deliver written emergency detention order

39 ID Section n Same responsibilities as with voluntary compliance with I and Q, except… –Legal Team develops all emergency detention orders

40 Clinical Operations Team n Same responsibilities as with voluntary compliance with I and Q, as well as…. –Support PH / Law Enforcement Team as needed

41 Continuation of Isolation and Quarantine Beyond 10 Days

42 Petition to the Superior Court for Continued Detention n An order is about to expire and its necessary to continue the I or Q n Continuation is needed up to 30 days n Coordinated by the legal team

43 Release from Isolation or Quarantine

44 How is Someone Released from Isolation or Quarantine? n The local health officer can release a person when: –we find out they never had the disease or –they get better and they no longer pose a risk to the health and safety of others or –an emergency detention order has expired, and the LHO determines that continued detention is not warranted

45 What are the Steps to Release Someone from I or Q? n Determine they no longer need to be contained n Communicate this to the person or group verbally and in writing n Document the release in the I and Q Registry and deactivate the case

46 ID Section n Make medical determination that the patient may be released from I or Q n Notify Public Health and partners that the patient should be released

47 Public Health Legal Team n Coordinate with appropriate sections and develop documentation stating the person is being released from I or Q

48 Clinical Operations Section n Verbally and in writing inform patient that they are released from I or Q n Document in I and Q Registry

49 Questions?