Telebriefing Transcript
CDC Modernizing Control of Communicable Diseases Regulations
THIS IS AN UNCORRECTED TRANSCRIPT AND MAY CONTAIN ERRORS
November 22, 2005
DR. GERBERDING: I thank everyone for joining us today. Sitting here with
me Dr. Marty Cetron, Director of our Division of Global Migration and
Quarantine, and Dr. Ram Koppaka, I'm going to spell that for you, R-a-m,
K-o-p-p-a-k-a. He is Associate Director for Policy and Preparedness in the
Division. Dr. Cetron is going to make some introductory comments and when
we'll open it up for Q-A. Marty?
DR. CETRON: Thanks very much for joining me on this call. We would like to
use this opportunity to formally put forward that CDC today proposed some
critical updates to existing regulations which will allow our agency and HHS
to move more swiftly to control potential outbreaks of infectious disease
that may result from international importation or interstate movement.
These proposed regulations are on display in the Federal Register for
public comment, and they will be posted in the Federal Register on Wednesday,
November 30, for a 60-day period. We look forward to the opportunity to
receive public comment on these Notices of Proposed Rule-making.
These regulations are an important step in one of many steps that CDC is
taking to enhance our preparedness to respond to global emerging infectious
disease threats and the globalization of infectious diseases and its
translocation across borders. We feel that along with other steps in
enhancing our nation's preparedness, these are some critical activities that
are in place and feel very pleased to see that this announcement is being
made today and look forward to moving this ahead in a high-priority manner.
Let me just end the opening comments by highlighting I think three of the
important areas where these regulations have been revised. One, we have
expanded the definition of ill passengers that is in the previous
regulations, and these are 42 C.F.R. Part 70 for interstate movement, and
Part 71 for international arrivals. And we've critically added the definition
of fever and influenza-like illness which is fever, cough and sore throat, to
the other definitions that were included in ill passengers which require
reporting from captains of conveyances. These will enable a more rapid
advance notification of ill passengers upon arrival and prior to arrival.
We've also clarified the requirements for maintaining passenger manifests
and holding that information of passenger name, seat location and emergency
contact information for a period of 60 days after the arrival of that
international conveyance for international airlines and cruise ship
passengers, and the requirement to submit that information electronically to
CDC upon request in a short duration of time.
We've also in the third major change to the regulations have been very
explicit about the due-process provisions in attempting to clarify the
aspects of due process which balance individual civil liberties against
public good in terms of these regulations which were largely silent on a lot
of the issues of due process in the past, so these are the three main areas
that are changed from the existing regulations.
I think that summarizes the general remarks, and I'm happy to open the
phone line to questions for either Dr. Koppaka or myself.
OPERATOR: Thank you. At this time, if you would like to ask a question,
please press star followed by 1 on your touch-tone phone. To withdraw your
request, you may press star followed by a 2. Once again, star-one if you
would like to ask a question.
Thank you. Our first question comes from Paul Shin with New York Daily
News.
MR. SHIN: Thanks for taking my call, Dr. Cetron. I was wondering, on the
domestic interstate flights which flights would be affected by the changes in
the regulations. And also in the past, how frequently were the quarantine and
isolation regulations invoked?
DR. CETRON: Let me clarify both parts of your question. With regard to
domestic interstate flights, it really applies to the large and medium hub
cities as defined by FAA, and there's a listing of those that are available
in the text. So it is not every single interstate flight or small charter or
small city airport, but really a listing of those that are predominantly
involved in large-scale movements.
I think the second question about how common is isolation and quarantine
probably needs a little bit of clarifying remarks. Let me just distinguish
what isolation and quarantine are as tools in the public health toolbox for
controlling emerging infectious disease.
Isolation refers to the limitation or restriction of movement and
separation of persons that are ill with a communicable disease, and this is a
practice that's been in use in public health and in medical circles for a
long time. It's typically something that's done at the state and local level
or in hospitals and used on a daily basis for separating folks who are
infectious with tuberculosis or other common contagious diseases.
Quarantine on the other hand refers to the separation and/or restricted
movement of those persons exposed to communicable diseases who are not yet
ill. They are typically in the incubation period of one of these illnesses
and that incubation period with time. It's also possible that during the
asymptomatic state of that incubation period, persons may or may not be
communicable with the disease to which they were exposed, but in that
asymptomatic incubating period, if one restricts the movement of such
individuals, that's referred to from a public health aspect as quarantine.
These tools have been long used as part of the public health toolbox for
centuries, and typically public health recommendations are made as
recommendations and are requested on a voluntary basis for compliance. In the
vast majority of cases, whether it is individuals or in population groups,
voluntary compliance with public health recommendations is all that is needed
to assure public safety.
In rare circumstances, public health authorities principally at the state
and local level have the legal power through state regulations to compel or
to order compulsory compliance with isolation or quarantine as a public
health tool.
In the setting of these regulations which apply to the federal
jurisdiction for compulsory use of isolation and quarantine, they apply in
Part 71 to international arrivals, and in Part 70 to interstate movement, and
these are areas where there is clear federal jurisdiction regarding isolation
and quarantine as public health tools, and they've been long-standing
regulations. This announcement today is really a modernization of those
regulations in order to be better prepared for 21st century threats.
DR. GERBERDING: Next question, please?
OPERATOR: Thank you. Our next question comes from Maryn McKenna with the
Atlanta Journal.
MS. McKENNA: Thanks for doing this. My main question is, in the past when
the issue of maintaining passenger manifests and delivering them when the CDC
requested has been raised, the main concern raised in response has been that
passengers will feel that it is a violation of their privacy rights. Could
you talk a little bit about how you managed that negotiation with the
airlines and transportation companies, if you did?
DR. CETRON: That's a great question, Maryn, and thank you for that. The
details of this regulation are just being made public today, so we are
incurring a period of public comment on this, and so this hasn't been
negotiated out there in the industry or in the public forum, and that's part
of the process that we're engaging in right now.
But I think really getting at the heart of your question is how does
public health assure privacy in meeting its responsibilities to carry about
its actions, and I think that there are some very rigorous standards of
privacy with which this information will be treated on a confidential basis.
The confidentiality and privacy concerns are spelled out very clearly in the
language of the proposed rule.
In addition, we have found that through surveys that have been done of the
public through Robert Blendon and his team at Harvard's School of Public
Health as well as other surveys that have been done, there is actually a
public expectation that CDC and public health officials have the ability to
contact them in the event that they sat next to or were exposed to a serious
communicable disease, and very much when asked those questions, while they
maintained some of their individual concerns about privacy, by and large they
were outweighed by their more significant concern that they be reachable so
that interventions and mitigations of the risks could be obtained. And well
over 90 percent I believe in surveys of both domestic and international
passengers have indicated this. While they reserved some concerns, they were
far more concerned about being inaccessible.
With respect to the airlines, I think that the airlines issues around
privacy have to do with having some clarity on the part of the federal
government about what is expected so that that clarity could be conveyed to
passengers in advance, and that for limited circumstances such as public
health use and with maintaining the confidentiality of records through the
security systems that are in place, the information would be released for
those purposes and not any others.
And by being able to spell that out up front and ask passengers either at
the time of purchase or potentially at the time of departure if they're
willing to share their contact information for public health response
purposes, I think it actually makes things easier than leaving it ambiguous
with the airline industries about whether to voluntarily turn over such
records when requested by CDC.
So I'm hoping and optimistic, but the public comment period will validate
this expectation that in fact there will be a fair amount of support for our
ability to do this as specified in the new regs.
DR. GERBERDING: Next question, please.
OPERATOR: Thank you. Our next question comes from Lisa Stark with ABC
News.
MR. STARK: A couple of quick questions. In trying to read through some of
this document, it also talks about the provisional quarantines for 3 days and
things like that. I'm trying to understand if that's something new or if
that's something that always existed and you're just reiterating it.
The second question is, could you be a little more specific on what would
be some of the due-process provisions that you're putting in place?
DR. CETRON: Sure. Let me take the second part first. By and large, as
states review, and have reviewed it in the last several years as part of
emergency public health preparedness, reviewing their own state legal
authority, there is concern and consideration taken for standard components
of due process. Some of these include written notification, providing a
rationale and justification for an effort, that an effort be scientifically
and medically justified as a need to control, that these approaches be used
with the least restrictive means necessary to accomplish the goals, that
there be an opportunity for filing a dispute and hearing a dispute by an
independent arbiter. These are some standard components of due process which
assure some of that delicate balance that we think needs to be in place.
The previous regulations had largely been silent about the specifics on
how we would actually operationalize and conduct these processes, and these
regulations make much more explicit the components of due process that are to
be in place.
So while you rightly pointed out in your first question there was this
3-day or 72-hour kind of temporary holding period which is needed to conduct
an emergency response at a point of entry, once that time is fast, a
definitive decision needs to be made and issued by the director regarding a
quarantine order or not, and that just is a part of the step-wise pieces that
would go into place, and that the temporary holding or detention for
assessment would take no longer than that period of 72 hours before a formal
written order would be issued.
While we may have actually acted along these lines in the past under the
older regulations, this makes it quite a bit more explicit and I think puts
forward those pieces of due process that I spoke of earlier.
DR. GERBERDING: Next question?
OPERATOR: Thank you. Betsy McKay with The Wall Street Journal, your line
is open.
MS. McKAY: Dr. Cetron, thank you. I'd like to follow-up if I could on some
of Maryn's questions a few minutes ago about passenger manifests. One is I'm
wondering if you could describe in a little bit more detail what is changing
here in terms of what you're asking from the airlines and what information
the passengers are being asked to provide. In other words, were airline
previously required to turn over manifests or was it a voluntary thing?
The other question is, as far as I understand, while airlines would be
required to turn over this information if this regulation goes through,
passengers necessarily would not be required to give that information to
airlines. So how would that be managed, or would they be required?
DR. CETRON: Those are great questions, Betsy, and thank you for giving me
the opportunity to clarify. Let me be real clear about the way things used to
be done and what the challenges are, and then highlight the specific fixes
that are taken in this rule.
Often, more often than not, the vast majority of times in the era of rapid
jet travel, notifications of significant public health events might occur
after passengers have disembarked from planes and public health would be left
to reconstruct an itinerary, a manifest, a seating chart and any contact
information based on what existed at the time depending on how long after the
event that disease notification occurred which could be days, sometimes even
longer than days, waiting for a positive laboratory report from a state lab
or something like that.
What would happen is, because of the volume of international travel, some
of the early electronic records of those manifests are purged very quickly,
often within 24 or 48 hours or shortly thereafter, depending on the airline
maintaining that database. So these records would then need to be
reconstructed by hand, and that often would only have a name and maybe a seat
location at best. It wouldn't include sufficient contact information for
public health authorities to actually find that person and intervene within
the incubation period.
We would then be going to customs declaration forms on international
arrivals and try to pick those handwritten papers out of a warehouse
somewhere and reconstruct them and identify the contact information from
there and try it enter it into a database and then go back and try to find
those people through state and local health officials. This was an extremely
time-consuming process even for a single flight and almost hopelessly
unsuccessful when we had to deal with large multiple fights and large volume
contact tracing as occurred during SARS.
So the specific changes are requirements that passenger manifests be
maintained by airlines in electronic format for 60 days after the final
destination of that journey; that at the request of public health that
information needs to be turned over in less than a day, by and large in 12
hours of that request; and that the information be turned over to public
health authorities electronically and that specific fields be included to
allow for effective contact tracing.
These are now requirements that are proposed in this Notice of Proposed
Rule-making to facilitate public health's ability to intervene swiftly in a
21 century approach when often there are only hours or days to implement
countermeasures, to offer postexposure vaccination or antibiotics, antivirals
or to separate people who have been exposed from others who were unexposed.
In addition, you raised the question about whether individuals themselves
would be required to provide this information or whether it would be
voluntary, and this was discussed a lot as we put together this proposed
rule. Largely this is a voluntary requirement but made as an active request
either at the time of purchase of the ticket or at the time of check-in. What
we're asking for us a plan for the airlines to come up with a proposal and a
plan for how they would accomplish this.
We do think that when given the rationale, that is to respond to an
emergent public health event like a SARS event or exposure to meningococcal
meningitis or other serious significant public health conditions, that most
people would in fact voluntarily comply with assurances that the information
would be kept confidential and their privacy maintained and not used for
other than emergent public health purposes.
So we're hopeful and optimistic that we'll have a fairly high degree of
compliance with a voluntary request that's made from the airlines to the
individuals for this information.
DR. GERBERDING: Next question, please.
OPERATOR: Thank you. Rick Weiss with The Washington Post, your line is now
open.
MR. WEISS: Thank you. I'm wondering who is actually making the diagnosis
or making the decision that someone or some group of people are suspected of
being contagious or communicable? It sounds like it's the director, but I
don't the director is walking down the aisle of the plane to look in
everyone's eyes.
DR. CETRON: No, no. As I indicated earlier in the opening, updating
regulatory authorities and jurisdiction is only a part of an enhanced
preparedness plan to deal with communicable diseases that travel around the
globe.
Another key part is expanding the capacity of our quarantine stations at
ports of entry, and many of you may know that over the last 18 months we've
added from a baseline of eight quarantine stations, 10 additional stations,
and are currently are at 18 at major international points of arrival, and
have phased in proposals for expanding further contingent on budget and
resource allocation.
In addition to expanding the locations of these stations at ports of
entry, we've also changed the skill sets significantly and have added
quarantine medical officers to the ports of entry in addition to senior
public health advisers. It would be their responsibility if requested by
anybody, whether it's a captain of a conveyance who reports in advance,
whether it's a CBP inspector who notices something at the point of
disembarkation or arrival through customs, or whether it is a public health
official who raises a flag either in advance or after the fact, the
quarantine medical officers together with the state and local public health
departments will be making these assessments and determinations.
Therein lies the component that's in the reg for this 72-hour temporizing
capacity for these medical officers before a decision is made by the CDC
Director.
DR. GERBERDING: Next question, please.
OPERATOR: Thank you. Larry Altman with The New York Times, your line is
now open.
MR. ALTMAN: Yes. First of all, where are all these regs written out?
Because I'm amiss and I don't have them and where can I look at them.
Secondly, what are the listings now? You say you're adding fever influenza.
What are they now and how is this expanded? I realize possibly with the
written document I can find that, but I don't have it.
DR. CETRON: Firstly, we can get you a copy of the written document, but
they will be posted for display in the Federal Register in the morning.
MR. ALTMAN: That does no good. We're writing a story today.
DR. CETRON: We can get you to them if we send you after this to our
Website, we have them posted by section and you can look at that immediately.
As well, they'll be posted in writing in the Federal Register. We've broken
them down by section on our Website for your ease in making reference to
them.
The other question was what is currently in the definition of an ill
passenger. If you go to the Website, this will be in Section 8, actually, in
the specific comments on the reg text. Line number 3199 or 3200 which may or
may not be outlined that way, but page 142 has the definition of an ill
person in it. And this is someone with a temperature of 38 centigrade of 104
degrees or greater, accompanied by one or more of the following, rash,
swelling of the lymph nodes or glands, headache with neck stiffness, and
changes in level of consciousness or cognitive function.
And then diarrhea, fever that has persisted for more than 48 hours, fever
associated with severe bleeding, jaundice or severe persistent cough
accompanied by bloody sputum, respiratory distress. So these are some of the
changes or nuances in the definition of ill passengers.
Then the last caveat is signs and symptoms that are suggestive of
communicable diseases which the director may describe in an order as the
director determines necessary, and this is to deal with a constellation of
emerging threats that currently are unknown, for example, in the situation of
SARS.
But largely, the definition was modified to really take into account the
respiratory components and the neurologic components that are compatible with
the list of nine diseases that are currently specified by Presidential
Executive Order as quarantinable diseases.
DR. GERBERDING: For everyone's reference, we apologize that they're not
available at the Federal Register. The regulations are posted at
www.cdc.gov/ncidod/dq. They're
available there now.
Next question, please.
OPERATOR: Thank you. Mike Stobbe with the Associated Press, your line is
now open.
MR. STOBBE: Just two clarifying questions. Following Dr. Altman's
question, for those symptoms, what's the significance of the addition to that
definition that these are symptoms that if they're detected by a ship captain
or something? How are those definitions put into use or effect?
DR. CETRON: These are requirements for a ship's captain or the captain of
a conveyance, whether it's a ship or airplane. If these compatible symptoms
are noticed in a passenger on a flight or on a ship, there is a requirement
for that captain of the conveyance to report this information to the
quarantine station of jurisdiction. The most efficient and effective
responses are those that come with advanced notification prior to landing
which allow for prepositioning of public health medical personnel to assess
and evaluate individuals in advance at the time that the ship or plane is
about to disembark so that contact information could be obtained in real
time, assessments could be made in real time, and separation of ill persons
from well persons could be made prior to the disembarkation and scattering
and onward connecting flights of the many individuals.
So these are requirements of captains of conveyances to notify public
health authorities, specifically quarantine stations, that have jurisdiction
over the port of entry.
DR. GERBERDING: Next question, please.
OPERATOR: Thank you. John Rashad [ph] with Congressional Quarterly, your
line is open. We'll go on to the next question, Christine Gorman from Time
magazine.
MS. GORMAN: Yes, thank you. I was wondering how many reports were sent to
the CDC of ill passengers in a given year, let's say, prior to this new
proposed rule, and how do you think this new proposed rule will affect that
number?
DR. CETRON: That's a great question, and I can't give you a specific
answer to it right at the time, but we can look into it and try to get back
to you.
Your point is a good one, and let me just back up by saying in general
what happens is the majority of ill passenger reports really come after the
fact. So what we have now is a very passive system that we occasionally can
enhance with awareness and education through various networks to get greater
reporting, and during SARS and during large-scale public health emergencies,
the degree of reporting in advance in comparison to after-the-fact reporting
was increased dramatically through what we call enhanced passive
surveillance.
There are also opportunities to do active surveillance and to physically
have quarantine and medical officers reviewing and assessing people at the
point of arrival along with their surrogates.
In reality, the volume of these reports varies by station. It varies by
the volume of arrival, it varies by the nature of the conveyance, the age
distribution of the conveyance. There are some cruise ships which cater to
elderly or particularly infirm or persons with chronic disabilities for which
the nature of some of those reports are much higher.
I really wish to emphasize, most reporting of ill events and persons who
were traveling ill and ill while they were on an international conveyance or
on an interstate conveyance actually happened after the fact through
traditional public health system surveillance, and the quarantine station
staff and the federal public health response needs to retrospectively
reconstruct the itinerary, the exposures, those at risk, the nature of the
communicability at the time of travel, in all of those things so that the
vast majority of our incoming reports are really after the fact and not
meeting with the requirements for notification by the captain of conveyances,
and we hope to stimulate a more enhanced system of passive reporting in the
absence of an emergency in order to better respond and respond more swiftly.
DR. GERBERDING: We probably have time for two more questions. Next
question, please.
OPERATOR: Thank you. Anita Manning with USA Today, your line is open.
MS. MANNING: Thank you very much for taking this question. I just wonder
if you could walk us through an example of a person on an airplane who has a
fever or is coughing. I don't understand how the pilot is going to know that.
So the first line of defense would be flight attendants? Is that correct?
DR. CETRON: Yes. In reality what happens is, and this why again most of
the reporting of a totally passive nature occurs much after the fact, that a
lot of people against advice of public health recommendations while travel
while ill, and a smaller number will develop their acute illness in the
course of their journey. But a lot of folks, really motivated to get home or
get where they're going will do the best to plug on and may travel while
they're ill.
For an illness to really reach the awareness and notification of flight
attendants and other people who are clearly more appropriately focused on
other job responsibilities, it has to be quite evident and quite apparent,
someone whose illness often requires medical assistance or intervention in
flight or some degree of response on the part of a flight attendant, and it
may be that that individual actually asks for assistance with regard to their
illness while they're traveling. That may or may not result in a request that
people hear occasionally while they are flying whether there's a physician on
board a flight that can help in an assessment of somebody who's quite ill.
What we're looking for is in the subset of occasions where that type of
illness not only brings the attention of a flight attendant, but is also
likely to be of a communicable nature and meet these definitions of an ill
passenger, where the illness is likely to be an infectious disease and one
that may be contagious, to get that notification into the public health
officials.
We have tried to enhance the ability to notify and detect by developing
short cards, some type of cockpit briefing cards with a list of the major
signs and symptoms to be on alert for. Also enhancing the ability through
airlines and other conveyances through their medical departments to educate
broadly across the staff of what kinds of things to look for.
Then of course, the concerns are much greater in times of significant
global public health emergencies or threats like SARS where we ramped up into
a different state of awareness, and really it's in these settings in
particular that we need to be much more complete in our surveillance and
assessments in catching such cases.
DR. GERBERDING: We'll take two more questions. Next question, please.
OPERATOR: Thank you. Our next question comes from Sabin Russell with The
San Francisco Chronicle.
MR. RUSSELL: One other point on the Website. If you could repeat those
last numbers very slowly before we hang up that would be very helpful.
The question I have, I don't know if it goes under the jurisdiction of the
CDC, but I'm wondering about the legal liability questions for a false alarm
where somebody either misses a flight or misses a convention or has a
vacation and that these are real practical things that can happen when people
are quarantined for cough that's just a cough. I'm just wondering if these
regulations in any way address that kind of practical issue of what happens
when someone is quarantined for no good reason.
DR. CETRON: I would hope that that never occurred, that people aren't
quarantined for no good reason. As I mentioned earlier in my remarks, there
are only nine specific diseases specified by Presidential Executive Order for
which the legal federal authority can be used to quarantine individuals, to
quarantine people. I'm happy to recite them, but I can also point you to our
Website where you can find them.
There were seven until recently in 2003 when SARS was added to that list,
and in April 2005 when pandemic strains of influenza were added to that list.
So the threshold for diseases for which a quarantine order would be issued is
really quite high, cholera, yellow fever, plague, smallpox, infectious
tuberculosis, diphtheria, and then SARS and viral hemorrhagic fevers and
influenza. So we're talking about things like Ebola virus and people who are
really quite ill and are spontaneously hemorrhaging from multiple body sites,
these are not always subtle conditions that would really raise people's
awareness and attention. We're not talking about quarantining anybody for a
sniffle or a cough alone. That's really not going to be the case and it has
not occurred.
I do think that there are lots of things specified in these regulations
which do allow for due process and balance of civil liberties against public
good, and for these things not to be applied in a capricious or whimsical
manner and not to be applied in a discriminatory way, but to be applied
even-handedly across all persons.
I'm hoping that the safeguards as well as the requirements for the disease
thresholds to be quite significant that would get us away from the kinds of
situations that you are in. And I would also point out that outside of the
CDC arena a whole other set of ways of handling passengers who are
inadvertently for whatever reason detained from their ability to make their
connections as is reasonable that have been worked out through the industry
at times whether that be weather or all sorts of other things. So it's not
like there isn't precedent for those kinds of adjustments to be made by
reasonable people.
DR. GERBERDING: Our final question, please.
OPERATOR: Thank you. Bob Roth [ph] with--News, your line is now open.
MR. ROTH: Hello. Thank you. I was wondering if you could talk a little bit
about the challenges that CDC encountered during the SARS episode, how much
you had to use isolation and quarantine and what kinds of problems occurred
then.
DR. CETRON: That's a great question and I think it's very germane because
as many know, it really was the global SARS epidemic in 2003 that highlighted
our global gaps as well as our global strengths and abilities to respond to
these threats.
From the specific focus of these regulations, one of the things we
realized is the absence of rapid electronic passenger manifests with detailed
contact information to find individuals, completely paralyzed our ability to
notify people who were on board together with suspect SARS cases during this
epidemic in a timely way, that is, within the incubation period of 2 weeks of
that illness, and that was really, really quite shocking.
On an individual basis, it is challenging enough for a single ill person
with a significant public health disease and a planeload of folks around them
for that information to be achieved and notification to occur in a timely way
to get somebody postexposure prevention for meningococcal meningitis, for
example, or even for measles situations and other things.
So filling the gap in inadequacies in contact tracing is a very important
one to plug, and it was a leading recommendation of the after-action GAO
report to the Secretary of Health, as well as the Secretaries of State and
Transportation in addressing.
There were other issues around SARS which was that globally where there
was a tremendous amount of community transmission and intense burden of the
epidemic in several Asian countries and in Toronto, voluntary isolation and
quarantine orders and in many cases compulsory orders for isolation and
quarantine were used and were an important component of effectively stamping
out that epidemic and sort of putting the genie back in the bottle.
In the United States where the impact of this disease was minimized, we
had a policy of rapid isolation of suspect cases that met a compatible case
definition for SARS as defined by the World Health Organization which was the
illness profile in conjunction with an epidemiologic link with a transmission
area, and we very much used rapid detection and rapid isolation along with
heightened surveillance through passenger notifications.
During this period, CDC staff were present at 25 points of entry, meeting
every flight arriving from an impact area directly or one stop indirectly and
handing out yellow notification cards in what symptoms to look for and how to
rapidly respond to the emergence of those symptoms over the incubation period
of SARS. So the general policy was early detection, rapid isolation and
containment, and we did not have a federal policy of using quarantine of
contacts as part of our containment strategy at the federal level during the
SARS epidemic in 2003.
I will say that many states, however, when faced with high-risk
situations, health care workers exposed to unsuspecting laboratory confirmed
SARS cases in emergency rooms where aerosol producing procedures were going
on and there were lots of people at risk, did recommend that those
immediately exposed health care workers not come to work and stay home
voluntarily during the period of incubation and monitor themselves for
symptoms and an onset of SARS symptoms and self-exclude.
So during SARS in 2003 worldwide, largely voluntary isolation and
quarantine, home quarantine, was a principal strategy used to contain this
epidemic, and in some areas compulsory quarantines as well as fever
monitoring and other approaches were used. These are important tools that we
need to keep in our toolbox and not forget that really our history of having
direct medical countermeasures is quite short, in the last five decades or so
in contrast with centuries of public health practice in which
nonpharmaceutical countermeasures were used to contain communicable diseases.
With that I'd like to wrap up that these proposed changes are just one
component of CDC and HHS's strategy to better prepare us for the
globalization of communicable disease threats. They're necessary to expedite
and improve our operations, they facilitate contact tracing, they provide
immediate medical follow-up of infected passengers and contacts, and the
streamlining of this procedure will enhance and benefit the American public
by reducing deaths and illnesses and avoiding unnecessary quarantines and
unnecessary delays by detecting outbreaks and responding to them early.
I think that there are many other things going on to enhance our country's
preparedness to combat these threats both in the isolation and quarantine
arena, in the community controls, in the international controls, as well as
in the preparation of stockpiles and direct medical countermeasures that are
available for the significant threats that are on our horizon.
In addition, the international health regulations were just passed by the
World Health Assembly in May 2005 and in many ways provide an analogous
global framework for containment of these types of threats as well.
This notice that is released today is a Notice of Proposed Rule-making to
combat and to plug the gaps that we're identified in this arena. We very much
look forward to public comment and comment of stakeholders and constituents
that may be impacted by this proposal in a way to enhance and improve upon it
before issuance of a final rule which will take place following the receipt
and incorporation of public comment.
So with that, I'd like to close and thank everybody very much for getting
together on short notice to communicate this message.
DR. GERBERDING: Thanks, Marty. Let me repeat the Website where the regs
are posted and apologize again. We initially thought they would be available
immediately at the Federal Register, and they'll pop up I believe later this
week, Wednesday, tomorrow, but today they're available at
www.cdc.gov/ncidod/dq, Division of
Quarantine. If anyone has any questions, please don't hesitate to call the
clerk's office and we'll get back in touch. Thanks everybody.
OPERATOR: Thank you. This concludes today's conference call. We thank you
for your participation.
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