Northeast Ohio Homeland Security Planning Region
Response Mission Capability: Isolation and Quarantine
NEO Region Containment Plan
Document Revision Page
Review and Maintenance of the Plan
This plan was approved on______by ______.
This document will be reviewed annually unless additional updates are required. The reviewer will add the review date and any changes in the table below and maintain a printed copy of the plan in a binder, replacing pages as needed. The binder will be located ______
Date / Revisionnumber / Description of Change / Pages
Affected / Reviewed or
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Table of Contents
Purpose
Assumptions
Plan Maintenance
Legal Authority
Concept of Operations
Command and Control
Key Considerations
Types of Containment Measure
Containment measures for individuals
Community-based containment measures
International Travel Restrictions
Coordination of Community Containment Measures
References
Appendices
Cuyahoga County Board of Health Public Health Emergency ICS/Unified Command System (UCS)
Ohio Department of Health’s Limitation of Movement and Infection Control Practices
CDC Interim Pre-pandemic Planning Guidance: Community Strategy for Pandemic Influenza Mitigation in the United States – Early, Targeted, Layered Use of Nonpharmaceutical Interventions
CDC Smallpox Response Plan and Guidelines (Version 3.0), Guide C, Part 1 – Infection Control Measures for Healthcare and Community Settings and Part 2 – Quarantine Guidelines
CDC Smallpox Response Plan and Guidelines (Version 3.0), Guide F – Environmental Control of Smallpox Virus
Interim Mask Guidance
Definitions
Acronyms
Annexes [to be developed]
2 / Standard Operating Guidelines for Monitoring Persons/Groups in Isolation and/or Quarantine
3 / Traveling Population SOG – Renee
4 / School Closure Standard Operating Guidelines
5 / Standard Operating Guidelines for Closing Businesses
6 / Standard Operating Guidelines for Implementing
Purpose
This document outlines the plan and procedures for the Northeast Ohio (NEO) Homeland Security Region to initiate non-pharmaceutical interventions (NPI) in response to an incident or outbreak of a communicable disease. The overall goal of community containment is to reduce transmission of disease by limiting contact among people. Community containment measures fall into two major categories: 1) individual level measures (e.g. isolation and quarantine) and 2) community level measure (e.g. suspension of public gatherings).
Scope
This plan will outline a range of approaches that may be used in relation to various levels of threat represented by different communicable diseases. This plan does not cover procedures used for mass prophylaxis. The distribution of mass prophylaxis is covered elsewhere.
Assumptions
1. A surveillance system is in place that provides the following epidemiological information on the disease in question: number of cases and contacts, characteristics of transmission, morbidity and mortality, and high risk groups.
2. In the absence of clear scientific data, community containment measures will be implemented based on public health judgment and historical information. Containment measures will be assessed on an ongoing basis for effectiveness and feasibility.
3. In the absence of pharmaceuticals (e.g. vaccine, antivirals, antibiotics), non-pharmaceutical intervention (NPI) community containment measures may be the principal means of disease control.
Plan Maintenance
This document should be reviewed at least annually and after every applicable exercise. Review dates and changes should be documented (see page 2). Updated pages will be replaced as needed. An electronic copy of this plan is located on the CCBH network at: N:disease/community containment. The file is titled NEO Regional Community Containment Plan. Printed copies of this document are in a binder titled NEO Regional Community Containment Plan in Epidemiology, Surveillance, & Informatics. This plan will be exercised to identify operating challenges and promote effective implementation.
Legal Authority1
The containment measures outlined below must be supported by legal authority. An official act may be authorized by law, but the act cannot violate an individual right without a compelling state interest. When considering containment measures, it is important for the government official to carefully weigh the situation to ensure there is sufficient data indicating a need. Containment measures need to utilize the least restrictive means of achieving the public good. Similarly, the government official needs to ensure the order is sustainable and logistically supportable. To this end, the government official should be familiar with the appropriate scope of authority and fully engage the appropriate legal counsel early in the process.
Federal Authority
Under the authority of Section 361 of the Public Health Service Act (42 USC 264), the Health and Human Services (HHS) Secretary may make and enforce regulations as necessary to prevent the introduction, transmission or spread of communicable diseases from foreign countries into the United States of from one state or possession into another. The CDC (under authority delegated by the HHS Secretary) Director may isolate and quarantine persons who have been exposed to or are infected with certain specified communicable diseases and are arriving in the United States from a foreign country or traveling from one state or possession into another.
· CFR Title 42, Chapter 1, Part 70 - Interstate Control of Communicable Disease. http://www.access.gpo.gov/nara/cfr/waisidx_03/42cfr70_03.html
· CFR Title 42, Chapter 1, Part 71 - Foreign Quarantine.
http://www.access.gpo.gov/nara/cfr/waisidx_03/42cfr71_03.html
State Authority
http://onlinedocs.andersonpublishing.com/oh/lpExt.dll?f=templates&fn=main-h.htm&cp=PORC
· ORC § 3701.13 - ODH has ultimate authority in matters of quarantine.
· ORC § 3701.56 - Provides for law enforcement and public health officials to enforce isolation and quarantine orders.
· ORC § 3701.14 - General powers of the Director.
· ORC § 3701.81- Requiring persons to limit spread and inform the health authorities of known contagions.
· ORC § 5923.21 - Governor may call-up Ohio National Guard (ONG) to enforce the laws of Ohio.
· ORC § 5923.27 - ONG called up by Governor is considered a law enforcement officer.
· ORC § 5923.27 - Arrest and detention by ONG is for purposes of escorting to civil authorities.
Local Authority
http://onlinedocs.andersonpublishing.com/oh/lpExt.dll?f=templates&fn=main-h.htm&cp=PORC
· ORC § 3707.04 - Authority to promulgate quarantine regulations.
· ORC § 3707.05 - Local health department (LHD) may not close highway without ODH permission and in compliance with regulations.
· ORC § 3707.08 - Isolation of persons exposed to communicable diseases; placarding of premises.
· ORC § 3707.09 - Establishment of quarantine guard.
· ORC § 3707.16 - Attendance at gatherings by quarantined persons prohibited.
· ORC § 3707.17 - Quarantine in place other than that of legal settlement.
· ORC § 3707.21 - Isolation of affected persons in institutions.
· ORC § 3707.23 - Examination of common carriers by board of health during quarantine.
· ORC § 3709.20 & 3709.21 LHD and Boards of Health may make such orders as necessary to protect public health.
· ORC § 3707.26 – Board shall inspect schools and may close them.
· Ohio Attorney General Opinion 926 (1949) - A LHD may impose a quarantine if reasonable.
On March 24, 2004, the CCBH signed a resolution granting the Health Commissioner authority to act on behalf of the board in enforcing provisions of Ohio Revised Code Section 3707.04 – 3707.32 (Appendix X). [Each Jurisdiction will insert own]
Concept of Operations
Command and Control
As per the NIMS guidance, the Incident Command System (ICS) will be the structure utilized for implementing this plan as the established response to an event. This provides a uniform system by which all involved organizations can respond at any level of management using common terminology, goals, and responsibilities. The NEO Homeland Security Planning Region Emergency ICS/Unified Command System (UCS) will be implemented for the duration of the event (Appendix X).
Add info about DOCs
Key Considerations
Table 1 presents data elements that will be analyzed when making decisions about when to use community containment measures. As information about specific disease transmission becomes known, the data listed below will be used to make decisions about appropriate disease control measures. NEO Homeland Security Planning Region will also utilize guidance from the CDC and ODH when determining thresholds.
Table 1. Threshold determinants for use in decisions about disease control measures2
Parameter / Data ElementCase and Contacts / · Number of cases (absolute or estimated)
· Age of cases
· Location of cases
· Estimated number of work, school, daycare, household or other social contacts per case
· Rate of incident cases
· Number of hospitalized cases
· Morbidity/Mortality
· Number and percentage of cases with no identified epidemiological link
· Number of cases occurring among contacts
· Number of cases under surveillance and/or quarantine
Public Health Resources / · Investigator to case and contact ratios
· Number of contacts under active surveillance
· Number of contact under quarantine
· Ability to rapidly trace contacts (# untraced/interviewed contacts)
· Ability to implement and monitor quarantine (staff member/volunteer to contact ratio)
· Ability to provide essential services
Community Cooperation, mobility and compliance / · Degree of compliance with voluntary individual isolation
· Degree of compliance with active surveillance and voluntary individual quarantine
· Degree of movement out of the community
· Degree of compliance with community-containment measures
Types of Containment Measures3
Containment measures for individuals
1. Isolation - A table ODH’s Limitation on Movement and Infection Control Practices (Appendix X) provides a list of type and duration of precautions recommended for selected diseases.
2. Quarantine - The contact remains separated from others for a specified period (incubation period), during which s/he is assessed on a regular basis (in person or by phone at least once daily) for signs and symptoms of the disease. Persons with disease specific symptoms will require immediate evaluation by a trained healthcare provider. Restrictions may be voluntary or legally mandated; confinement may be at home or in an appropriate facility. No specific precautions are required for those sharing the household with a person in quarantine as long as the person remains asymptomatic.
Application: Situations in which the risk of exposure and subsequent development of disease is high and the risk of delayed recognition of symptoms is moderate
Benefits: Reduces risk of spread from persons with sub acute or sub clinical presentations or from delayed recognition of symptoms
Challenges:
· May infringe on personal movement
· May lead to a feeling of isolation from family and friends
· May lead to loss of income or employment
· Requires plans/protocols for provision of essential services
· Requires plan for provision of mental health support
· Risk of noncompliance, particularly as duration increases
· May require enforcement for noncompliance
Resources Required:
· Staff for monitoring and evaluation
· Appropriate facility if home setting is unavailable or inadequate
· Staff, funding, and goods for provision of essential services
· Hotline for notification of symptoms or personal needs
· Mechanisms to communicate with family members outside the household or facility
· Mental health and social support services
· Delivery systems for food and other essential supplies
Partners:
· Professional and lay healthcare workers to perform assessments on behalf of the health department
· Community volunteers/workers to assist with provision of essential services
· Potential need for law enforcement to assist with noncompliant persons
Forms/Templates:
· Checklist for active monitoring
· Template for recording results of clinical evaluation
· Checklist and guidelines for evaluation of homes for quarantine
· Checklist and guidelines for evaluation of community-based sites for quarantine
· Guidelines for monitoring compliance with home quarantine
· Guidelines for monitoring compliance with quarantine in community-based facilities
· Forms for recording compliance with quarantine
3. Working Quarantine - Employees are permitted to work but must observe activity restrictions while off duty. Monitoring for illness before reporting for work is usually required. This may change based on the clinical presentation of disease. Use of appropriate infection control procedures while at work is required.
Application: Persons for whom activity restrictions (home or facility quarantine) are indicated but who provide essential services (e.g., healthcare workers, utilities, etc.)
Benefits: Reduces risk of community spread from high-risk contacts while minimizing adverse impact of activity restrictions on provision of essential services. Clinical monitoring at work reduces the staff required for active monitoring at the quarantine site.
Challenges:
· Need for close and consistent pre-shift monitoring at the work site to prevent inadvertent exposures
· May require means of transporting persons to and from work site to minimize interactions; persons in working quarantine should wear appropriate Personal Protective Equipment during transport.
· Must maintain close cooperation and communication between work site and local health authorities
· Need to provide mental health services to address concerns about isolation from family and friends
Resources Required:
· Appropriate facility for off-duty quarantine if home is unavailable or inadequate
· Staff, funding, and goods for provision of essential services
· Personal protective equipment
· Hotline for notification of symptoms and personal needs
· System to track results of work-site monitoring and location(s) of off-duty quarantine
· Mental health, psychological, and behavioral support services
Partners:
· Work-site administrators and infection control personnel
· Community volunteers/workers
· Staff/volunteers to assist with transportation to and from work
· Mental health professionals
· Potential need for law enforcement to assist with noncompliant persons
Forms/Templates:
· Guidelines and instructions for persons in working quarantine
· Instructions for supervisors of persons in working quarantine
· Checklist to evaluate homes for quarantine
· Guidelines for monitoring compliance
· Checklist for active monitoring at work site
· Template for recording results of clinical evaluation
· Forms for recording compliance
4. Passive Monitoring - The contact is asked to perform self-assessment periodically and to contact authorities immediately if symptoms occur.
Application: Situations in which 1) the risk of exposure and subsequent development of disease is low, and 2) the risk to others if recognition of disease is delayed is also low