Quarantine-Who Has the Right?

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About This Module  

Topics: Human health, epidemiology, pathogens (bacteria), quarantine, isolation, public health, infectious disease, Ebola, disease transmission

Grade levels: 9-12

Overview  

When a deadly disease may enter the community, everyone has an opinion about what to do about it. Can you sort through the issues to help your community deal with the potential deadly outbreak? 

Learning Objectives  

To better understand the policies of quarantine and isolation as they apply to controlling an infectious disease, students should be able to:

  • Explain the difference between quarantine and isolation.
  • Describe the epidemiology of Ebola, including incubation period, transmission, pathogen, symptoms, and treatment.
  • Recognize the importance of social, political, and cultural factors in dealing with a communicable disease at a community level.
  • Draft a plan to prevent the possible spread of an infectious disease through a community.
  • Make recommendations for public safety that conform to state laws regarding quarantine and isolation. 
Standards  

Next Generation Science Standards

Standards Aligned to PBL Modules

Scenario (with possible answers)  
Large group of people in an auditorium for a town meeting
The town hall meeting. Image: http://www.public-domain-image.com/free-images/people/crowd/general-meeting

What a mess!  Members of city council, the mayor, the city manager, city attorneys, local doctors, and many people from the community are having a town hall meeting to discuss the possibility of quarantine for people returning from a missionary trip helping victims in Ebola-infected countries in Africa. As the county health officer, you have a critical role in providing the latest information on the infectious disease and the possible consequences of the epidemic occurring in multiple countries. The matter is even more complicated now that the disease has spread outside the countries originally affected and is in several locations far from Africa.

The situation is further confounded by the disease itself. Ebola is not a mild disease from which you easily recover. It is a devastating illness that is highly infectious and highly virulent. Victims infected with Ebola hemorrhagic disease bleed out all major body openings—including the eyes and mouth— and bleed internally as well.  Death rates are high; case fatality rates can be as high as 90%. Public fears are naturally heightened due to the gruesome disease effects.

So far, the meeting has been three hours of heated arguments. As soon as someone tries to make a point, a squabble breaks out.  No one can seem to agree on anything, but you’re hearing a lot of conflicting information flying around.

A sign reading Danger:Quarantine AreaYour job is to protect your community from threats to their health and to inform them of healthy life choices, but this matter is complicated. City attorneys are worried about the city being sued, local doctors are worried about having the resources to handle a potential outbreak, and the public is worried that a devastating infectious and fatal disease could be in their community. While some people want the strictest measures to prevent exposure to a deadly disease, others say that government officials do not have the right to quarantine people just because they may be contagious.

The mayor finally proposes that more information is needed.  He suggests that you, as county health officer, present the relevant facts at the next meeting and have a plan that will address all the concerns that were discussed. He schedules another meeting in two days!

You decide to form a committee at your county health office to help consider all the pertinent facts.  This will be a great help in answering all the questions from the various interest groups and the general public at the town hall meeting. You and your co-workers on the committee will assemble the information and will also be able to make recommendations concerning quarantine or isolation.

Your Tasks:

  • Find out about the health risks associated with Ebola hemorrhagic disease.

Research the epidemiology of the disease, including the pathogen, incubation period, symptoms, treatment, and disease transmission.

  • What policies from governmental agencies handle isolation and quarantine issues?

What policies do you have to follow, if any?  How much is in your control at the state or local level?

  • Your committee must propose a policy and protocol that will guide your community health services regarding people coming into your community who have been exposed to the Ebola virus. Members on the committee may have different positions or opinions about the policy, but you must come to a consensus that you can present at the next meeting.
  • Be prepared to present your findings and recommendations at the town hall meeting and support them with scientific information.
  • Be prepared to make amendments to your plan if possible when suggestions are made. You need to have a plan in place for your community. The assembled townspeople will vote on the plans presented.

 Guiding Questions:

  1. What do the interested parties at the town hall meeting need to know about Ebola?

What are the symptoms? incubation period? type of pathogen? treatment? containment procedures? fatality rates? transmission?

Symptoms: Fever, headache, joint and muscle aches, sore throat, weakness, diarrhea, vomiting, stomach pain, rash, red eyes, internal and external bleeding, chills, backache, fatigue.

Initial symptoms lead to: bleeding from the eyes, ears, and nose and bleeding from the mouth and rectum (gastrointestinal bleeding), and eye swelling.

Incubation period: 2-21 days. Average is 8-10 days.

Type of pathogen: RNA virus of the Filoviridae (filovirus) family. There are 5 types of Ebola viruses: Bundibugyo ebolavirus BDBV), Zaire ebolavirus (EBOV), Reston ebolavirus (RESTV), Sudan ebolavirus (SUDV), and the Tai Forest ebolavirus (TAFV).

Treatment: There is no standard treatment; antivirals do not work well. Supportive therapies to maintain the patient’s fluid balance, electrolytes, oxygen, and blood pressure are prescribed. Additional infections are treated with antibiotics. Several new vaccines are being tested.

Containment: Containment requires several interventions, including case management, contact tracing, laboratory confirmations, safe burials, and public education on transmission risks.

Also, steps should be taken to reduce the wildlife-to-human transmission; reduce contact with infected fruit bats or monkeys and do not recommend eating the raw meat of these animals) Gloves, masks and personal protective equipment should be worn around ill patients.

Transmission: The virus is transmitted through:

  • direct contact with blood or body fluids of an infected person
  • contact with contaminated objects
  • contact with infected animals

Fatality rates: Onset of illness is often sudden and mortality rates can be 90% or higher. Lower mortality rates can occur in countries with better health systems in place.

  1. What options are available to prevent the possible spread of disease through the community if one of the health volunteers returning to your community is infected with Ebola?

Answers will vary. Students should discuss having strict guidelines for personal protection gear and equipment, frequent public health reports, incubation period protocols, and quarantine and isolation.

  1. What are the pros and cons of voluntary or mandatory quarantine or isolation?

Answers will vary. Students may say that it isn’t necessary to quarantine someone who has been exposed to Ebola until they test positive. Other students may say that with such a potentially deadly disease as Ebola, it is better to be safe about possible transmission than to have an outbreak begin.

No student is likely to argue against voluntary quarantine or isolation. Mandatory regulations may cause more debate.

  1. What is your recommendation for this community situation?

Answers will vary.

Be prepared to defend your committee’s position and answer questions from each interest group at the town meeting. 

Students should recognize that different interest groups within the community may have different opinions on what the community should do. Business owners may not want an alert issued that warns people of a possible outbreak if they think more people will stay home unnecessarily. Hospitals and medical personnel may want community activities such as sport events, festivals, or parades canceled in order to lessen exposure to a possible very infectious virulent pathogen; few hospitals are equipped to deal with an Ebola outbreak on short notice. Political leaders may want to avoid a policy decision that may either be too strong if the outbreak does not occur or too weak if it does. 

Teacher Notes  

The scenario:

Make sure the students know that they have to come up with a policy. They may have differing positions on the committee, but as a committee, they have to come up with a policy. As students find out more about the issues and about the laws in their states, they should see that it is sometimes a difficult issue to address. Even if they do not completely agree, they need to be aware that some issues may require compromise to move forward.

Refer the students to the internet resources for this module. They will find links to information about federal and state regulations concerning quarantine and isolation and can link to their state’s specific regulations.

If students come up with different plans or responses to the isolation-quarantine issue, that is fine. But, make sure they know they need to defend their views from an informed perspective and be able to back up their opinions.

After all student “committees” propose their policies, have the students as a class vote on the policy for their community.

Ask them what they would do if the situation actually occurred in their city or town and they didn’t agree with the decision. Remind them of the nurse who refused quarantine requests in Maine after coming back from volunteering in an Ebola clinic in west Africa during the Ebola outbreak. She went bike-riding through the community during the possible 21-day incubation phase. She was within her rights under the law, but the community did not appreciate her actions. She later had to move from the community because people did not respect her seemingly lack of concern for their safety.

After the students present their “decision”, tell them that the local hospital just delivered the news that a patient has tested positive for Ebola. It is no longer a “what if”, but a “what is.” Does that change their decision on the policy or their vote?

Sample Rubric  

Information about constructing and implementing rubrics for problem-based learning strategies can be found in Developing Rubrics in the Teacher Professional Development section.

Extensions  

Invite your county or district public health officer to talk to your classes about how public health is monitored in your area. Ask the public health officer to discuss how a decision like the one presented in this module would be made in the students’ community. Allow enough time for student questions about the decision-making process, the federal and state laws regarding communicable and reportable diseases, and the process that led to a career in public health.

► Debrief with your students on what they thought was the hardest part of the assignment. Was the process of arriving at a policy easy? Were all students satisfied with the compromises that were made (assuming they had to compromise)?  Did they think the final decision was the best one to protect the public? Do they think there is a problem with public perception of science issues? Do they think the same decision would be made in other communities?

Students should realize that social, political, economic, and cultural factors often underlie the science issues.

► Watch the Frontline PBS documentary “Outbreak” which details the 2014-2015 Ebola epidemic in West Africa. The video describes how it may have started, what caused it to spread through several West African countries, and how mishandling of key epidemiological practices resulted in thousands of deaths. It also details the epidemiologic investigative process used in the outbreak.

NOTE: Be sure to watch this video before showing it to your class.  At times, this video is difficult to watch. It shows people who have contracted Ebola and present s desperate conditions in medical camps built to deal with Ebola cases. It is an excellent video that highlights the different factors, including social, cultural, political, and economic issues that influence the efforts of dedicated medical professional in trying to stop the epidemic, but it may not be suitable for all classes.

Access the Frontline Outbreak! video at http://www.pbs.org/wgbh/frontline/film/outbreak. You can also access the teacher and student Study Guide from this site.

Additional Resources   

Additional resources about quarantine and isolation issues can be found at:

in the Quarantine! Who Has the Right? background materials at:
http://www.pandemsim.com/pdc/quarantine-who-has-the-right/

in the Key Resources section in the Pandem Disease Center at:
http://www.pandemsim.com/pdc/resources-videos/

in the Quarantine module background materials at Internet Resources-Quarantine  http://www.pandemsim.com/pdc/1818-2/