Mandatory Quarantine: Administrative Order by the Georgia Department of Public Health for Public Health Control Measures: Isolation Protocol

JurisdictionGeorgia,United States
Publication year2020
CitationVol. 37 No. 1

MANDATORY QUARANTINE: Administrative Order by the Georgia Department of Public Health for Public Health Control Measures: Isolation Protocol

Matthew C. Daigle
Georgia State University College of Law, mdaigle1@student.gsu.edu

Carissa L. Lavin
Georgia State University College of Law, clavin1@student.gsu.edu

MANDATORY QUARANTINE


Administrative Order by the Georgia Department of Public Health for Public Health Control Measures: Isolation Protocol

Code Sections: O.C.G.A. §§ 31-2A-4; 31-5-8; 31-12-2.1, -4; 38-3-2, -3, -51

Administrative Orders: Ga. Dep't of Pub. Health, Administrative Order for Public Health Control Measures; Amended Administrative Order for Public Health Control Measures; Second Amended Administrative Order for Public Health Control Measures; Third Amended Administrative Order for Public Health Control Measures; Fourth Amended Administrative Order for Public Health Control Measures; Fifth Amended Administrative Order for Public Health Control Measures; Sixth Amended Administrative Order for Public Health Control Measures; Seventh Amended Administrative Order for Public Health Control Measures

Effective Dates: March 21, 2020; March 23, 2020; April 3, 2020; April 15, 2020; May 6, 2020; May 12, 2020; June 1, 2020; June 16, 2020

Summary: The Administrative Order for Public Health Control Measures and its subsequent amendments outlined the isolation and Quarantine Protocols for individuals who either tested positive for COVID-19 or were suspected of

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COVID-19 infection based on symptoms or prolonged exposure to the virus.

Introduction

Coronavirus Disease 2019 (COVID-19), a severe respiratory disease, was first identified in Wuhan, China.1 On March 11, 2020, the World Health Organization (WHO) declared a COVID-19 pandemic.2 As of October 10, 2020, in the United States alone, there had been more than 7.6 million confirmed cases and 213,000 deaths attributed to COVID-19.3 The virus spreads through the air by coughing or sneezing, through close personal contact such as touching and shaking hands, and through touching of the mouth, nose, and eyes.4 Those infected with COVID-19 may display a wide array of symptoms, including fever, chills, cough, difficulty breathing, fatigue, body aches, headache, loss of taste or smell, sore throat, congestion, nausea, and diarrhea.5 Infected individuals may display symptoms anytime between two-to-fourteen days after being exposed to COVID-19.6 Symptoms range from mild to severe, and some people remain asymptomatic the entire time they are infected and contagious.7 Older adults and people with underlying medical conditions are at heightened risk for developing severe illness or death.8 According to the Centers for Disease Control and Prevention

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(CDC), adults ages sixty-five and older account for eight out of ten COVID-19 related deaths reported in the United States.9

Background

Public Health State of Emergency

In Georgia, the Governor may declare a state of emergency in response to a public health emergency after calling a special session of the Georgia General Assembly.10 On March 14, 2020, Governor Brian Kemp (R) declared a Public Health State of Emergency in Georgia.11 At the time Georgia had reported over sixty laboratory-confirmed cases of COVID-19, and the CDC had declared the disease to be "'community spread,' meaning people have contracted the virus . . . as a result of direct or indirect contact with infected persons, including some who are not sure how or where they became infected."12 Governor Kemp subsequently extended the Public Health State of Emergency through a series of additional Executive Orders.13

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Effect of Public Health State of Emergency Declaration

Declaring a Public Health State of Emergency empowers the Governor to take appropriate actions that may be considered necessary to promote and secure citizens' safety.14 This power includes suspending regulatory statutes governing State conduct and state agencies if complying with those procedures imposes an obstacle to responding to the emergency.15 The Governor may utilize all available state resources reasonably necessary to manage the emergency.16

Governor Kemp's Order declaring a Public Health State of Emergency directed the Georgia Department of Public Health (DPH) to work with the Georgia Emergency Management and Homeland Security Agency "to take any action necessary to promote the public's health . . . without limitation," including "planning and executing public health emergency assessments, mitigation, preparedness response, and recovery for the state" and "implementing a program of active monitoring [of persons with or suspected to have COVID-19], which may include a risk assessment . . . and twice daily temperature checks for a period of at least fourteen (14) days or until the [person] tests negative for COVID-19."17 The DPH was also charged with "implementing quarantine, isolation, and other necessary public health interventions" consistent with Georgia law that authorizes the DPH to segregate, isolate, and quarantine individuals with communicable diseases where failing to do so would likely endanger the public health.18

The Administrative Order for Public Health Control Measures

Pursuant to this directive, the DPH issued an Administrative Order requiring persons with known or suspected COVID-19 cases to isolate themselves until they had been fever-free for a minimum of

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seventy-two hours (without the use of fever-reducing medicine), until their other symptoms had improved, and until at least seven days had passed since they began displaying symptoms.19 Asymptomatic persons had to isolate themselves for a minimum of ten days after receiving a positive laboratory test.20 The Order also outlined a protocol for persons who had been exposed to the illness, requiring that those persons quarantine in an approved location (often their home) for fourteen days after receiving notice of exposure from a healthcare provider, public health official, or isolated or infected individual.21 The Order required the quarantined individual to take their temperature twice a day and monitor any symptoms of illness.22 If the person developed any COVID-19 symptoms during his or her quarantine, then he or she was considered a person with a suspected case and was required to follow the isolation protocol.23 Failure to abide by the Order was considered a misdemeanor, and the DPH was allowed to provide information to law enforcement to ensure compliance with the Order and facilitation of criminal prosecution.24

Iterations of the Administrative Order for Public Health Control Measures

The Administrative Order for Public Health Control Measures was effectively a living document, changing as the Governor's Office and the DPH learned more about COVID-19 and its transmission.25 As of

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October 10, 2020, the DPH had issued eight amendments to the Administrative Order.26 The vast majority of amendments were either clerical edits, adjustments of effective dates or references to then-current Executive orders, or changes to define symptoms as described by information promulgated by the CDC.27

Amended Administrative Order

The Amended Order implemented three changes.28 First, the "NOW, THEREFORE" paragraph directly cited sections from the Georgia Code from which the Order derived its authority.29 Second, the new Order added a fourth condition to Section 4, requiring isolation for those who tested positive but showed no symptoms.30 Finally, Section 8 carved out an exception to the quarantine requirement for healthcare providers, emergency medical service workers, and other first responders who otherwise would have met the exposure requirement.31

Second Amended Administrative Order

The Second Amended Order removed language specifically quantifying confirmed COVID-19 cases in the state.32 Additional amendments included changing symptom descriptions and quantifying the term "prolonged exposure" as "ten (10) minutes or

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more" based on updated guidance from the CDC.33 This iteration also removed enforcement language referencing involuntary detention for violation of the Order.34 Finally, the Second Amended Order added a section stipulating that the Order would terminate "thirty (30) days following the end of the Public Health State of Emergency."35

Third Amended Administrative Order

The Third Amended Order added a third "WHEREAS" section addressing Governor Brian Kemp's extension of the Public Health State of Emergency.36 Further, the amendments updated references of COVID-19 symptoms to reflect then-current guidance from the CDC.37 Finally, the Order added "critical infrastructure workers" to the list of exceptions to the quarantine Order.38

Fourth Amended Administrative Order

Clerical edits to the Fourth Amended Order adjusted dates and titles to reflect the then-current Executive Order.39 Additionally, the Fourth Amended Order increased the minimum isolation time period from seven days to ten days, increased exposure time from ten minutes to fifteen minutes, and edited symptom descriptions based on updated guidance from the CDC.40

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Fifth Amended Administrative Order

The Fifth Amended Order updated references of COVID-19 symptoms to reflect then-current guidance from the CDC.41

Sixth Amended Administrative Order

The Sixth Amended Order updated several references to COVID-19 symptoms to reflect then-current guidance from the CDC.42

Seventh Amended Administrative Order

The Seventh Amended Order contained only one change, though it may have been the most significant change at the time.43 Unlike the prior amendments, which provided general clarifications or updates based on developing understanding of COVID-19, the Seventh Amended Order altered the cooperation requirements of an isolated person and shifted the burden of notification to state and local public health officials.44 Where prior Orders instructed the isolated individual to notify...

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