Bringing some dried goat skin back from your trip to Haiti? Not on Jennifer Torres’ watch.
Torres is the assistant officer in charge of the CDC Quarantine Station at Philadelphia International Airport. And Haitian goat skin, she explained, could contain anthrax (yes, anthrax develops naturally, not just in the labs of terrorists).
We spoke to Torres to find out what the quarantine station does, and what measures are in place to keep dangerous communicable diseases from entering the Philadelphia area.
First, a little background: Isolation and quarantine are some of the oldest and most essential practices of public health. Isolation is the practice of sequestering sick individuals so that they don’t spread their disease to others. Quarantine, on the other hand, is the practice of sequestering and monitoring the health of individuals who may have been exposed to a communicable disease but have yet to develop symptoms.
These practices of separating the sick, or potentially sick, from the healthy to prevent the spread of disease date back to Biblical times and have been common on ships in ports since the Black Death took the planet by storm in the mid-14th century.
In the U.S., isolation and quarantine are compulsory for certain diseases and enforced byfederal authorities through powers derived from the Constitution’s Commerce Clause. What are the quarantinable diseases? Torres describes these as the “Big 9.”
- Cholera: an infection of the small intestine spread primarily through contaminated water;
- Diphtheria: an upper respiratory tract illness transmitted through the air;
- Infectious Tuberculosis: different from “latent tuberculosis,” which is much more common and less contagious;
- Plague: a deadly bacterial infection spread through the fleas of rodents — it still infects an estimated 10-15 people in the U.S. annually!;
- Smallpox: a viral and highly contagious disease spread through saliva;
- Yellow fever: a viral infection transmitted by mosquitoes;
- Viral hemorrhagic fevers: a group of multisystem illnesses, like Ebola, which generally originate in wild animals ;
- SARS - severe acute respiratory syndrome: a highly contagious and serious form of pneumonia; and
- Flu that can cause a pandemic: a novel strain of flu for which little natural immunity exists, like the 2009 version of H1N1 (which happened to cause illness no worse than seasonal influenza for most people but could have been disastrous if it had been more severe).
So what happens if authorities suspect that someone on your plane has yellow fever or another one of the Big 9?
First, the Quarantine Station would be notified via the airline or U.S. Customs and Border Protection. Then, Torres and an EMS worker or medical officer would arrive on the scene and make an assessment. Unless the quarantine officials are virtually certain that an individual has one of the Big 9, they are limited in their legal authorityto force isolation or quarantine. What they can do, however, is notify the airline of their connecting flight. And airlines have the right to prohibit people from boarding their plane if there is reason to believe that they pose a threat to other passengers.
Quarantine officials would also make arrangements for the people in question to undergo tests and receive treatment at a local hospital. Unlike some quarantine stations, Philly’s does not provide medical services on-site or have a negative air pressure room to prevent the spread of pathogens.
Luckily, the Big 9 is very rare in Philadelphia. As Torres explained, the vast majority of cases the Philadelphia Quarantine Station deals with are for infectious tuberculosis (TB).When local health officials determine that someone has infectious TB, and has recently flown through PHL, they will contact the Quarantine Station. Torres will then pull the flight manifest and help with an investigation to determine whether anyone sitting near them (2 rows in front and 2 rows behind) is showing symptoms of TB.
Quarantine Stations are operated by the U.S. Centers for Disease Control and Prevention (CDC). In the 1970s, thinking that infectious disease was no longer a major public health problem, the CDC reduced the number of Quarantine Stations from 55 to 8. The events of 9/11 and the SARS outbreak of 2003, however, reawakened concerns around public health preparedness — prompting the CDC to increase the number of Quarantine Stations to 20.
The Philadelphia Airport’s Quarantine Station opened in 2007 and is the newest in the country. It so happens that one of the oldest quarantine hospitals in the nation is here as well. The Lazaretto was built in 1799 and still stands in Tinicum Township today. Professor Yudell will explore its history and quarantine practices in an upcoming post.
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