5.30 ISOLATION AND QUARANTINE

• 5.31 Isolation and Quarantine Proceedings
• 5.32 Isolation and Quarantine Conditions and Principles
• 5.33 Sample Local Health Officer Emergency Detention Order
• 5.34 Federal Authority
• 5.35 Summary of State and Federal Authority for Isolation and Quarantine

5.31 Isolation and Quarantine Proceedings

Isolation and quarantine are historically-recognized public health techniques used to contain the spread of infectious diseases. See, e.g., Compagnie Francaise v. Louisiana Bd. of Health, 186 U.S. 380 (1902) (recognizing power of states to institute quarantine to protect their citizens from infectious diseases). Isolation and quarantine require the separation of infected and potentially infected persons, respectively, from the public. This separation is achieved by confinement of the infected and/or potentially infected person(s) to treatment facilities, residences, and/or other locations, depending upon the nature of the implicated disease and the available facilities.

In many cases, individuals will voluntarily undertake isolation and quarantine procedures. However, if individuals are unwilling to undertake isolation or quarantine procedures or become noncompliant with procedures already in place, court assistance may be required.

Communicable disease: An illness caused by an infectious agent which can be transmitted from one person, animal, or object to another person by direct or indirect means including transmission via an intermediate host or vector, food, water, or air. WAC 246-100-011(7).

Isolation: The separation, for the period of communicability or contamination, of infected or contaminated persons or animals from others in such places and under such conditions as to prevent or limit the direct or indirect transmission of the infectious agent or contaminant from those infected or contaminated to those who are susceptible or may spread the agent or contaminant to others. WAC 246-100-011(18).

Quarantine: The limitation of freedom of movement of such well persons or domestic animals as have been exposed to, or are suspected to have been exposed to, an infectious agent, for a period of time not longer than the longest usual incubation period of the infectious agent, in such manner as to prevent effective contact with those not so exposed. WAC 246-100-011(26).

Incubation period: The period of time between a disease agent’s entry into an organism and the organism’s initial display of disease symptoms. During the incubation period, the disease is developing. Incubation periods are disease specific and may range from hours to weeks. See Stedman's Medical Dictionary 889 (27th ed. 2000).

NOTE: This chapter discusses state statutes and rules that govern isolation and quarantine for diseases that would pose a serious and imminent risk to others. Appendix A discusses the statutes and rules that govern control of tuberculosis. Separate statutes and rules pertain to control of sexually transmitted diseases ( chapter 70.24 RCW; WAC 246-100-203).

A. General Powers of Isolation and Quarantine.

1. In whom powers vested.

   a. State Board of Health authority to adopt rules. The State Board of Health shall adopt rules for the imposition and use of isolation and quarantine. RCW 43.20.050(2)(d).

   b. Local health officer authority to implement isolation and quarantine. The State Board of Health has adopted rules governing implementation of isolation and quarantine by local health officers. See generally WAC 246-100-040 to -070.

2. Implementation.

   1. Person of group of persons. The State Board of Health rules governing isolation and quarantine apply to a person or group of persons. See generally Id.

B. Types of Detention.

1. Emergency detention.

   1. Basis for local health officer to initiate. The local health officer may initiate involuntary detention for purposes of isolation or quarantine when he or she:

      i. Has made reasonable efforts to gain voluntary compliance with requests for medical examination, testing, treatment, counseling, vaccination, decontamination of persons or animals, isolation, quarantine, and inspection and closure of facilities, or has determined that seeking voluntary compliance would create a risk of serious harm; and

      ii. Has reason to believe that the person or group of persons is, or is suspected to be, infected with, exposed to, or contaminated with a communicable disease or chemical, biological, or radiological agent that could spread to or contaminate others if remedial action is not taken; and

      iii. Has reason to believe that the person or group of persons would pose a serious and imminent risk to the health and safety of others if not detained for purposes of isolation or quarantine. WAC 246-100-040(1).

   2. Alternative procedures for emergency detention. The local health officer may:

      i. Issue an emergency detention order; or

      ii. Petition the superior court ex parte for an order. Id.

   3. Local health officer emergency detention order.

      i. Requirements for notice. See WAC 246-100-040(3).

      (A) Sample Emergency Detention Order is included infra § 5.33.

      ii. Enforcement of local health officer orders.

      (A) Distribution of written order. The local health officer shall issue a written emergency detention order as soon as reasonably possible and in all cases within twelve hours of detention. WAC 246-100-040(3)(b). The local health officer shall provide copies of the written order to the person or group, or if it is impractical to provide individual copies, post copies in a conspicuous place in the premises where isolation or quarantine has been imposed. WAC 246-100-040(3)(c).

      (B) Existence of statutory provision for enforcement. An order issued by a local health officer in accordance with chapter 246-100 WAC shall constitute the duly authorized application of lawful rules adopted by the State Board of Health and must be enforced by all police officers, sheriffs, constables, and all other officers and employees of any political subdivisions within the jurisdiction of the health department in accordance with RCW 43.20.050. WAC 246-100-070(1).

      (C) No explicit authority for arrest by law enforcement. Generally, police officers may arrest a person without a warrant for committing a misdemeanor or gross misdemeanor only when the offense is committed in the presence of the officer. RCW 10.31.100. However, the offense does not have to be in the presence of the officer if (s)he has probable cause to believe that the person has committed or is committing a misdemeanor or gross misdemeanor involving physical harm or threats of harm to any person or property. RCW 10.31.100(1).

      NOTE: It is not clear whether this provision would apply to enforcement of an emergency detention order issued by a local health officer.

   4. Court proceedings for emergency detention.

      i. Petition ex parte. The local health officer may petition the superior court ex parte for an order authorizing involuntary detention of a person or group of persons. WAC 246-100-040(3), (4). The petition shall specify:

      (A) The identity of all persons or groups to be subject to isolation or quarantine;

      (B) The premises where isolation or quarantine will take place;

      (C) The date and time at which isolation or quarantine will commence;

      (D) The suspected communicable disease or infectious agent if known;

      (E) The anticipated duration of isolation or quarantine based on the suspected communicable disease or infectious disease if known;

      (F) The measures taken by the local health officer to seek voluntary compliance or the basis on which the local health officer determined that seeking voluntary compliance would create a risk of serious harm;

      (G) The medical basis on which isolation or quarantine is justified. WAC 246-100-040(4)(a).

      ii. Declaration of local health officer. The petition shall be accompanied by the declaration of the local health officer attesting to the facts asserted in the petition, with any further information that may be relevant to the court’s consideration. WAC 246-100-040(4)(b).

      iii. Notice. Notice to the person or groups identified in the petition shall be accomplished in accordance with the rules of civil procedure. WAC 246-100-040(4)(c).

      iv. Hearing. The court shall hold a hearing on a petition for emergency detention within seventy-two (72) hours of filing, exclusive of Saturdays, Sundays, and holidays. WAC 246-100-040(4)(d).

      v. When court order proper. The court shall issue the order if there is a reasonable basis to find that isolation or quarantine is necessary to prevent a serious and imminent risk to the health and safety of others. WAC 246-100-040(4)(e).

      vi. Court order. A court order authorizing isolation or quarantine as a result of an ex parte hearing shall:

      (A) Specify a maximum duration for isolation or quarantine not to exceed ten (10) days;

      (B) Identify the isolated or quarantined persons or groups by name or shared or similar characteristics or circumstances;

      (C) Specify factual findings warranting isolation or quarantine;

      (D) Include any conditions necessary to ensure that isolation or quarantine is carried out within the stated purposes and restrictions of WAC 246-100-040;

      (E) Specify the premises where isolation or quarantine will take place. WAC 246-100-040(4)(f)(i) to (v).

      vii. Service of order. The court order shall be served on all affected persons or groups in accordance with the rules of civil procedure. WAC 246-100-040(4)(f)(vi).

2. Continued detention.

   1. Applies when necessary to continue detention of a person or group already detained under an emergency detention order. The local health officer may petition the superior court for an order authorizing continued isolation or quarantine of a person or group detained under WAC 246-100-040(3) or (4). WAC 246-100-040(5).

      i. Must be ordered by the superior court. A local health officer may not order continued detention. See Id.

   2. Proceedings for continued detention.

      i. Petition. The local health officer’s petition to the superior court for an order authorizing continued detention shall specify:

      (A) The identity of all persons or groups subject to isolation or quarantine;

      (B) The premises where isolation or quarantine is taking place;

      (C) The communicable disease or infectious agent if known;

      (D) The anticipated duration of isolation or quarantine based on the suspected communicable disease or infectious disease if known;

      (E) The medical basis on which continued isolation or quarantine is justified. WAC 246-100-040(5)(a).

      ii. Declaration of local health officer. The petition shall be accompanied by the declaration of the local health officer attesting to the facts asserted in the petition, with any further information that may be relevant to the court’s consideration. WAC 246-100-040(5)(b).

      iii. Statement of compliance with conditions and principles. The petition shall be accompanied by a statement of compliance with the conditions and principles contained in WAC 246-100-045. WAC 246-100-040(5)(c). See also infra § 5.32.

      iv. Notice. Notice to the persons or groups identified in the petition shall be accomplished in accordance with the rules of civil procedure. WAC 246-100-040(5)(d).

      v. Hearing. The court shall hold a hearing on a petition for continued detention within seventy-two (72) hours of filing, exclusive of Saturdays, Sundays, and holidays. WAC 246-100-040(5)(e).

      (A) Local health officer may apply to continue hearing in extraordinary circumstances. In extraordinary circumstances and for good cause shown, the local health officer may apply to continue the hearing date for up to ten (10) days. Id.

      (1) Court may grant continuance at its discretion. The court may grant the continuance at its discretion giving due regard to the rights of the affected individuals, the protection of the public’s health, the severity of the public health threat, and the availability of necessary witnesses and evidence. Id.

      vi. When court order proper. The court shall grant the petition if it finds that there is clear, cogent, and convincing evidence that isolation or quarantine is necessary to prevent a serious and imminent risk to the health and safety of others. WAC 246-100-040(5)(f).

      vii. Court order. A court order authorizing continued isolation or quarantine as a result of a hearing shall:

      (A) Specify a maximum duration for isolation or quarantine not to exceed thirty (30) days;

      (B) Identify the isolated or quarantined persons or groups by name or shared or similar characteristics or circumstances;

      (C) Specify factual findings warranting isolation or quarantine;

      (D) Include any conditions necessary to ensure that isolation or quarantine is carried out within the stated purposes and restrictions of WAC 246-100-040;

      (E) Specify the premises where isolation or quarantine will take place. WAC 246-100-040(5)(g)(i) to (v).

      viii. Service of order. The court order shall be served on all affected persons or groups in accordance with the rules of civil procedure. WAC 246-100-040(5)(g)(vi).

3. Additional period of continued detention.

   1. Local health officer may petition to continue isolation or quarantine. Prior to the expiration of a court order issued pursuant to WAC 246-100-040(5), the local health officer may petition the superior court to continue isolation or quarantine. WAC 246-100-040(6). See supra § 5.31.B.2.b.

   2. When court order proper. Isolation or quarantine may be continued when the court finds that there is a reasonable basis to require continued isolation or quarantine to prevent a serious and imminent risk to the health and safety of others. WAC 246-100-040(6)(a).

   3. Period not to exceed thirty (30) days. The order shall be for a continued period not to exceed thirty (30) days. WAC 246-100-040(6)(b).

4. Authority superseded in certain situations. The provisions of WAC 246-100-040 shall be superseded by state statutes and rules, and state and federal emergency declarations that contain:

   1. Procedures for detention, examination, counseling, testing, treatment, vaccination, isolation, or quarantine for:

      i. Specified health emergencies; or

      ii. Specified communicable diseases, including, but not limited to, tuberculosis and HIV. WAC 246-100-040(7).

C. Right to Counsel.

1. Right to be represented by counsel. A person or group of persons isolated or quarantined pursuant to WAC 246-100-040 has a right to be represented by counsel if they so elect. WAC 246-100-060.

   1. Court appointed counsel. If a person or group requests counsel and cannot afford counsel, the court shall appoint counsel consistent with the provisions of chapter 10.101 RCW. Id.

   2. Local health officer to provide means of communication. The local health officer must provide adequate means of communication between persons or groups and their counsel. Id.

D. Relief from Isolation or Quarantine.

1. Availability of hearings. A person or group of persons may seek relief from the superior court for:

   1. Detention by the local health officer. A person or group of persons detained by order of the local health officer pursuant to WAC 246-100-040(3) may apply to the court for an order to show cause why the individual or group should not be released. WAC 246-100-055(1).

      i. Ruling on application to show cause. The court shall rule on the application to show cause within forty-eight (48) hours of its filing. WAC 246-100-055(1)(a).

      ii. Hearing on order to show cause. If the court grants the application, the court shall schedule a hearing on the order to show cause as soon as practicable. WAC 246-100-055(1)(b).

      iii. Isolation or quarantine order not stayed or enjoined. The issuance of an order to show cause shall not stay or enjoin an isolation or quarantine order. WAC 246-100-055(1)(c).

   2. Remedies regarding breach of conditions. A person or group isolated or quarantined may request a hearing for remedies regarding breaches to the conditions required by WAC 246-100-045. WAC 246-100-055(2).

2. Isolation or quarantine order not stayed or enjoined. A request for a hearing shall not stay or enjoin an isolation or quarantine order. WAC 246-100-055(3).

3. Timing of hearing.

   1. In extraordinary circumstances. Upon receipt of a request alleging extraordinary circumstances justifying the immediate granting of relief, the court shall fix a date for a hearing as soon as practicable. WAC 246-100-055(4).

   2. Otherwise. Upon receipt of a request, the court shall fix a date for a hearing within five (5) days from receipt of the request. WAC 246-100-055(5).

   3. Local health authority may apply to continue hearing in extraordinary circumstances. In extraordinary circumstances and for good cause shown, the local health authority may move the court to extend the time for a hearing. WAC 246-100-055(6).

      i. Court may grant at its discretion. The court may grant the extension at its discretion giving due regard to the rights of the affected individuals, the protection of the public’s health, the severity of the emergency, and the availability of necessary witnesses and evidence. Id.

4. Infection control procedures. Any hearings for relief involving a petitioner or petitioners judged to be contagious will be conducted in a manner that utilizes appropriate infection control and minimizes the risk of disease transmission. WAC 246-100-055(7).

E. Consolidation.

1. Court may order consolidation. In any proceedings brought for isolation or quarantine, the court may order consolidation to promote the fair and efficient operation of justice and having given due regard to the rights of the affected persons, the severity of the threat to the public’s health, and the availability of necessary witnesses and evidence. WAC 246-100-065.

2. Criteria for consolidation. The court may order the consolidation of individual claims into group claims where:

   1. The number of individuals involved or to be affected is so large as to render individual participation impractical;

   2. There are questions of law or fact common to the individual claims or rights to be determined;

   3. The group claims or rights to be determined are typical of the affected persons’ claims or rights, and

   4. The entire group will be adequately represented in the consolidation. Id.

F. Consular Notification for Non-U.S. Citizens. Article 36(1)(b) of the Vienna Convention on Consular Relations provides that a non-U.S. citizen who is arrested or detained must be informed that consular officials of his or her country may be notified about the detention. If the detainee “so requests,” the consular officials must be notified of the detention. Article 36(1)(c) provides for access to detainees by consular officials. In addition, some bilateral consular agreements require notification. Detailed information is available at: http://travel.state.gov/law/consular/consular_753.html.

5.32 Isolation and Quarantine Conditions and Principles

A. Conditions and Principles. The local health officer shall adhere to the following conditions and principles when isolating or quarantining a person or group of persons:

1. Least restrictive means necessary. Isolation or quarantine must be by the least restrictive means necessary to prevent the spread of a disease to others and may include, but are not limited to, confinement to private homes or other public or private premises. WAC 246-100-045(1).

2. Separation of isolated individuals from quarantined individuals. Isolated persons must be confined separately from quarantined persons. WAC 246-100-045(2).

3. Monitoring of health status. The health status of isolated or quarantined individuals must be monitored regularly to determine if they require continued isolation or quarantine. WAC 246-100-045(3).

4. Placement into isolation of quarantined individuals who become infected. If a quarantined individual subsequently becomes infected or is reasonably believed to have become infected with a communicable disease that threatens other quarantined individuals, he or she must be placed in isolation. WAC 246-100-045(4).

5. Release as soon as practicable. Isolated or quarantined individuals must be released as soon as practicable when the local health officer determines that they pose no substantial risk of constituting a serious and imminent threat to others. WAC 246-100-045(5).

6. Addressing of needs of isolated or quarantined individuals. The needs of a person isolated or quarantined must be addressed to the greatest extent possible in a systematic and competent fashion, including but not limited to food, clothing, shelter, means of communication with persons in isolation or quarantine and outside these settings, medication, and competent medical care. WAC 246-100-045(6).

7. Maintenance of premises used for isolation or quarantine. Premises used for isolation or quarantine must be maintained in a safe and hygienic manner to minimize the likelihood of further transmission of infection or other harm to persons isolated or quarantined. WAC 246-100-045(7).

8. Addressing of cultural and religious beliefs. To the greatest extent possible, cultural and religious beliefs should be considered in addressing the needs of individuals and establishing and maintaining isolation or quarantine premises. WAC 246-100-045(8).

9. Right of persons to rely exclusively on spiritual means to treat a disease.

   1. Right not abridged by isolation or quarantine. Isolation or quarantine shall not abridge the right of a person to rely exclusively on spiritual means to treat a communicable disease in accordance with religious tenets and practices. WAC 246-100-045(9).

      i. Persons declining treatment may be isolated or quarantined. At his or her sole discretion, the local health officer may isolate infected individuals declining treatment for the duration of their communicable infection. Id.

   2. Person may choose private place for isolation or quarantine if approved by local health officer. A person relying on spiritual means to treat a disease is not prohibited from being isolated or quarantined in a private place of his or her choice provided it is approved by the local health officer. Id.

B. Isolation or quarantine premises. Entry into isolation or quarantine premises shall be restricted under the following conditions:

1. Entry may be authorized by the local health officer. The local health officer may authorize physicians, health care workers, and others access to individuals in isolation or quarantine as necessary to meet the needs of isolation or quarantined individuals. WAC 246-100-050(1)(a).

   1. Person not authorized may not enter. No person, other than a person authorized by the local health officer, shall enter isolation or quarantine premises. WAC 246-100-050(1)(b).

   2. Infection control precautions. Any person entering isolation or quarantine premises shall be provided with infection control training and may be required to wear personal protective equipment or receive vaccination. WAC 246-100-050(1)(c).

   3. Persons entering premises may be isolated or quarantined. Any person entering isolation or quarantine premises with or without the authorization of the local health officer may be isolated or quarantined. WAC 246-100-050(1)(d).

2. Applicability of rules of State Board of Health and orders of local health officer. Persons subject to isolation or quarantine and persons entering isolation or quarantine premises shall obey rules of the State Board of Health and orders of the local health officer. WAC 246-100-050(2).

   1. Penalties. Failure to do so shall constitute a misdemeanor consistent with the provisions of RCW 43.20.050(4) and 70.05.120. Id.

5.33 Sample Local Health Officer Emergency Detention Order

EMERGENCY DETENTION ORDER

___________________________, you are hereby ordered to detention at
(name of individual or group)

______________________________________ pursuant to WAC 246-100-040.
(premises subject to isolation or quarantine)

Your isolation or quarantine commences on ________________ and ____________.
                                                                             (date)                          (time)

This order will remain in effect until ________________ and ____________
                                                                     (date)                          (time)

unless otherwise rescinded, but not to exceed 10 days.

Suspected Communicable Disease or Infectious Agent if Known:

__________________________________________________________________________________

Measures taken by the Local Health Officer to seek voluntary compliance OR basis on which Local Health Officer determined that seeking voluntary compliance would create risk of serious harm:

__________________________________________________________________________________

__________________________________________________________________________________

Medical basis on which decision to isolate or quarantine is justified:

__________________________________________________________________________________

Special Instructions:

Failure to comply with this Emergency Detention Order is a misdemeanor pursuant to RCW 70.05.120.

It is very important for the protection of your own health and that of others that you abide by this Emergency Detention Order. If you have any questions about this order or need assistance in complying, please call __________________.

If isolation or quarantine is necessary beyond the ten-day period allowed under this order, the Health Officer may petition the Superior Court for an order authorizing continued isolation or quarantine for a period up to 30 days.

_____________________________________

Director and Health Officer

___________________________________

Disease Control Officer

------------------------------------------------------------------------------------------------------------

IMPORTANT NOTICE:

You have the right to petition the Superior Court for release from isolation or quarantine in accordance with WAC 246-100-055. You have a right to legal counsel. If you are unable to afford legal counsel, then counsel will be appointed for you at government expense and you should request the appointment of counsel at this time. If you currently have legal counsel, then you have an opportunity to contact that counsel for assistance.

5.34 Federal Authority

A. Federal Authority to Control Communicable Disease.

1. International and interstate transmission. The Secretary of the U.S. Department of Health and Human Services is authorized to make and enforce regulations to prevent the introduction, transmission, or spread of communicable diseases:

   1. From foreign countries into the United States or possessions; or

   2. From one state or possession into another state or possession. 42 U.S.C. § 264(a).

2. Detention for quarantinable diseases. Regulations may provide for the apprehension, detention, or conditional release of individuals only for the purpose of preventing the introduction, transmission, or spread of communicable diseases specified in Executive Orders of the President, upon the recommendation of the Secretary of the U.S. Department of Health and Human Services. 42 U.S.C. § 264(b).

3. Persons moving interstate.

   1. Apprehension and examination. Regulations may provide for the apprehension and examination of any individual reasonably believed to be infected with a communicable disease in a qualifying stage and also believed:

      i. To be moving or about to move from a state to another state; or

      ii. To be a probable source of infection to individuals who, while infected, will be moving from a state to another state. 42 U.S.C. § 264(d)(1).

   2. Detention. Regulations may provide that an individual who is infected may be detained as reasonably necessary. Id.

   3. Qualifying stage. "Qualifying stage" means that a communicable disease is:

      i. In a communicable stage; or

      ii. In a precommunicable stage, if the disease would be likely to cause a public health emergency if transmitted to other individuals. 42 U.S.C. § 264(d)(2).

4. Federal-state cooperation.

   1. The Secretary of the U.S. Department of Health and Human Services is authorized to accept from state and local authorities any assistance in the enforcement of federal quarantine regulations that such authorities may be able and willing to provide. 42 U.S.C. § 243(a).

   2. The Secretary of the U.S. Department of Health and Human Services shall assist states and their political subdivisions in the prevention and suppression of communicable diseases and cooperate with and aid states and local authorities in the enforcement of their quarantine and other health regulations. Id.

5. No preemption unless in the event of a conflict. Nothing under 42 U.S.C. § 264 nor in regulations promulgated under this authority may be construed as superseding any provision under state law (including regulations and including provisions established by political subdivisions of states) except to the extent that such a provision conflicts with an exercise of federal authority under § 264. 42 U.S.C. § 264(e).

B. Disease Transmission from Foreign Countries.

1. Ship and aircraft notice of communicable disease. Ship captains and airline pilots are required to notify the federal quarantine station at or nearest the port or airport of any illness or death on board. 42 C.F.R. § 71.21.

2. Control measures at United States ports.

   1. Whenever the Director of the Centers for Disease Control has reason to believe that any arriving person is infected with or has been exposed to any of the communicable diseases listed in an Executive Order, he or she may:

      i. Isolate;

      ii. Quarantine; or

      iii. Place the person under surveillance. 42 C.F.R. § 71.32. See also 42 C.F.R. § 71.33.

   2. Diseases specified in Executive Orders of the President. Persons with the following diseases are subject to federal quarantine: Cholera; Diphtheria; infectious Tuberculosis; Plague; Smallpox; Yellow Fever; Viral Hemorrhagic Fevers (Lassa, Marburg, Ebola, Crimean-Congo, South American, and others not yet isolated or named); Severe Acute Respiratory Syndrome (SARS); and Influenza caused by novel or reemergent influenza viruses that are causing, or have the potential to cause, a pandemic. Exec. Order No. 13295, 68 Fed. Reg. 17255 (April 4, 2003), as amended by Exec. Order No. 13375, 70 Fed. Reg. 17299 (April 1, 2005).

3. Application to aliens. Aliens arriving at a port of the United States are subject to the applicable provisions of 42 C.F.R. pt. 71 with respect to examination and quarantine measures. 42 C.F.R. § 34.6.

   a. Additional requirements of Immigration and Nationality Act. Under the Immigration and Nationality Act, aliens may be inadmissible based on health-related grounds. See 8 U.S.C. 1182(a)(1); 42 C.F.R. pt. 34.

C. Interstate Disease Transmission.

1. Report of disease. The master of any vessel or person in charge of any conveyance engaged in interstate traffic, on which a case or suspected case of communicable disease develops, shall notify the local health authority at the next port of call and take such measures as the local health authority directs. 42 C.F.R. § 70.4.

   2. Measures in the event of inadequate local control. If the Director of the Centers for Disease Control determines that a state's measures are insufficient to prevent the spread of any communicable disease from a state or possession to another state or possession, he or she may take measures as he or she deems reasonably necessary, including inspection, fumigation, disinfection, sanitation, pest extermination, and destruction of animals or articles believed to be sources of infection. 42 C.F.R. § 70.2.

   1. The Commissioner of the Food and Drug Administration has similar authority. 21 C.F.R. § 1240.30.

2. Travel restrictions for certain diseases. Specific travel restrictions apply to persons in the communicable period or incubation period of cholera, plague, smallpox, typhus, or yellow fever. See 42 C.F.R. § 70.5.

3. Apprehension and detention for certain diseases. Individuals are subject to detention, isolation, quarantine, or conditional release for the purpose of preventing the introduction, transmission, and spread of the communicable diseases listed in an Executive Order setting out quarantinable diseases. 42 C.F.R. § 70.6; supra 5.34.B.2.

NOTE: The Centers for Disease Control has proposed new regulations to replace those currently governing foreign and interstate disease transmission. Control of Communicable Diseases; Proposed Rule, 70 Fed. Reg. 71892 (Nov. 30, 2005).

5.35 Summary of State and Federal Authority for Isolation and Quarantine

	State	Federal
Diseases to which isolation/quarantine applies	A communicable disease or chemical, biological, or radiological agent that would pose a "serious and imminent risk." WAC 246-100-040(1); supra § 5.31.B.1.a.	Diseases specified in Executive Order of the President. 42 U.S.C. § 264(b); supra § 5.34.A.2.
Persons who may be placed into isolation/quarantine	Persons within the county or district that is served by the local health department. See RCW 70.05.010(1), supra § 3.41.B.1.	1) Persons arriving at U.S. ports from foreign countries or possessions of the U.S. 42 C.F.R. pt. 71; supra § 5.34.B. (2) Persons in interstate travel. 42 C.F.R. pt. 70; supra § 5.34.C.
Person authorized to initiate isolation/quarantine	Local health officer. WAC 246-100-040(1); supra § 5.31.B.1.	Director, Centers for Disease Control. 42 C.F.R. § 71.32; supra § 5.34.B.2.
Length of detention	(1) Emergency detention by order of local health officer or ex parte court order: 10 days. WAC 246-100-040(3), (4); supra § 5.31.B.1. (2) Continued detention by court order: 30 days. WAC 246-100-040(5); supra § 5.31.B.2.	Not specified.