Thomas Eric Duncan, the first person to be diagnosed with Ebola in the United States, died from the virus on Wednesday. Compounding the sadness was the fact that he spent his final days isolated from the people he had traveled from Liberia to visit. While the 42-year-old Duncan was being treated at the Texas Health Presbyterian Hospital, his partner, Louise Troh, her 13-year-old son, and two other people who lived with them were quarantined in Dallas. “I am now dealing with the sorrow and anger that his son was not able to see him before he died,” Troh said in a statement shortly after Duncan’s death, a reference to the 19-year-old son the couple had together, who was away at college when the hospital put his father in isolation. “This will take some time, but in the end, I believe in a merciful God.”
This forced quarantine raises an obvious question: Can the government confine people to what is basically house arrest without due process? The short answer: yes. Both states and the federal government have the legal authority to isolate people in their homes or at other locations if they pose a substantial danger to public health.
As difficult as that separation undoubtedly was, doctors in Texas viewed it as a necessity. Troh, her son, and the two others had been in proximity to Duncan when he began to display symptoms—usually the exact moment that an Ebola victim becomes contagious. While none of the four has so far shown any symptoms, it’s exceedingly risky to allow them to interact with the general public until doctors can rule out the possibility that they were infected. (The state of Texas will keep them quarantined for at least 10 more days to ensure that Ebola’s 21-day incubation period has expired.) The family was originally confined to its own apartment but has since been moved to a larger home in a more remote area. During their time there, they will be barred from leaving or having visitors, while state officials provide them with food and other necessities as doctors monitor their health for the first signs of symptoms.
The job of quarantining people who are already in the country typically falls to the states. Laws vary, but most state health departments can quarantine first and ask questions later. In this particular case, the decision came from the Texas Department of State Health Services, which sent two county officials and a local deputy to serve the order at Troh’s apartment on Sept. 30, the day a blood test confirmed Duncan’s infection. (In Texas, violating such an order is a third-degree felony; in most other states it’s a criminal misdemeanor.) Health officials are also keeping close tabs on several dozen people who came into contact with Duncan before his symptoms began, but have so far found no reason to extend the quarantine order to include anyone else.
The federal government’s chief responsibility, meanwhile, is preventing infectious diseases from reaching the American public in the first place. The first line of defense are the quarantine stations that the U.S. Centers for Disease Control and Prevention operate at 20 of the most heavily trafficked U.S. ports of call and border crossings. When someone arrives in America who authorities suspect may be infected, they can quarantine the individual until health officials sign off on his or her release.
Such screenings aren’t foolproof. Authorities, for example, didn’t flag Duncan because he denied having contact with anyone infected with Ebola. The federal government announced new screening procedures on Wednesday that will require temperature checks for passengers arriving from the three West African nations that have been hit hardest by the Ebola virus. But that is largely just security theater, since it will do little to stop the spread of the virus. Duncan, for one, would have likely breezed through such a checkpoint because his symptoms did not begin until four days after he arrived in Dallas.
The basic logic of quarantine is simple—keep sick or potentially sick people isolated to prevent a disease from spreading—and the tactic has been around since at least the Middle Ages. The word itself is derived from the Italian words quaranta giorni, which translate literally as 40 days—in the 14th century, this was the amount of time ships arriving in Venice from infected ports were required to wait at anchor before docking.
According to the CDC, the first quarantine station in the United States was built in 1799 at the port of Philadelphia, six years after a yellow fever outbreak began there. It would take nearly a century before Congress passed the National Quarantine Act in 1878, officially giving the power of quarantine to the federal government. The federal system was then incrementally beefed up over the next several decades, and in 1944 the Public Health Service Act codified the government’s responsibility for preventing the spread of communicable diseases from foreign countries to the United States.
Though quarantines have long proved effective, the history of forced isolations in America isn’t a spotless one. In 1900, health officials in San Francisco attempted to fight an outbreak of the plague by imposing what was basically a complete quarantine of Chinatown. That decision effectively isolated Chinatown’s sick and healthy together—and, not incidentally, immigrants from China from the rest of the city. As Wendy Mariner, a professor of health law at the Boston University School of Public Health, recently explained to NPR, the quarantine’s borders “kind of wound around the Caucasian places, so it was pretty obviously discriminatory.”
Such miscarriages of justice aside, the states’ power to quarantine in the name of public safety has largely been backed up by the courts. Even when an individual challenges his or her isolation or quarantine by petitioning for a writ of habeas corpus, judges usually “give deference to the determinations of state boards of health and generally uphold such detentions as valid exercises of a state’s duty to preserve the public health,” according to the Congressional Research Center. Perhaps the best example of that was in 1922, when the Illinois Supreme Court upheld the forced quarantine of a woman who ran a boarding house where someone infected with typhoid fever had lived, but who herself had not contracted the disease.
The need for isolation and quarantine is all the more evident when you consider how Duncan likely became infected in the first place. According to the New York Times, he had been living alone in a small room he rented in the Liberian capital of Monrovia. When his landlords’ daughter fell ill with Ebola last month, Duncan helped take her to and from the hospital. It was that decision that exposed him to the virus that has already killed more than 3,000 people in West Africa—and one that ultimately claimed his own life on Wednesday.