THE WALL STREET JOURNAL. **** Saturday/Sunday, March 14 - 15, 2020 |A
The new coronavirus pan-
demic threatens to pose an
unfamiliar challenge to health
officials nationwide: how best
to get possibly contagious in-
dividuals to follow quarantine
orders, and what to do with
them if they don’t.
The issue arose last week-
end in St. Louis County, Mo.,
where a family broke self-
quarantine recommendations.
County health officials said
the father and sister of a
woman who tested positive for
the virus ignored those recom-
mendations on Saturday in or-
der to attend a father-and-
daughter dance at a Ritz-
Carlton hotel.
And earlier this month, the
first coronavirus patient in
New Hampshire defied self-
quarantine instructions and
attended an “invitation-only
private event,” the New Hamp-
shire Department of Health
and Human Services said in a
press release.
State and local health de-
partments haven’t often issued
legally binding orders to stay
inside, instead relying on co-
operation from the people
they are quarantining. Typi-
cally, health authorities don’t
issue a legal order unless a
person breaks that initial re-
quest.
“It really is pretty much the
honor system,” said Polly
Price, a professor of law and
global health at Emory Univer-
sity. “Public-health people
themselves can’t arrest some-
one or force them to stay
somewhere, and they try to
use that as an absolute last re-
sort.”
Thepowertoexercise
stronger measures exists.
The federal government has
the authority to legally quar-
antine people through a World
War II-era law, though the
government has invoked that
law rarely.
States and localities also
have enforcement powers.
Many carry penalties for vio-
lating a quarantine. So far, of-
ficials haven’t arrested anyone
accused of violating a corona-
virus quarantine.
But health authorities out-
side St. Louis threatened to is-
sue a formal quarantine after
learning that the sister and fa-
ther of an infected patient at-
tended last weekend’s dance at
the hotel.
The infected patient was
announced as the state’s first
case by Missouri Gov. Mike
Parson last weekend. De-
scribed as a female in her 20s
who recently traveled to Italy,
authorities believe she re-en-
tered the country through Chi-
cago’s O’Hare International
Airport and then rode on an
Amtrak train to St. Louis.
At a press conference, St.
Louis County Executive Sam
Page said health authorities
learned of the quarantine
break on Sunday, and immedi-
ately informed the father that
he must remain in his home or
be “issued a formal quarantine
that will require him and the
rest of his family to stay in
their home by the force of
law.”
Dr. Page and county offi-
cials didn’t elaborate on what
the “force of law” would en-
tail, but under Missouri state
law, the local health authority
can issue and require a quar-
antine of residents. Anyone
found breaking the quarantine
order could be charged with a
class A misdemeanor.
A formal quarantine order
wasn’t issued to the family.
Neil Bruntrager, a lawyer
representing the family, says
neither the daughter nor the
family was ever told to self-
quarantine last Thursday,
when they first reached out to
state and county officials
about their concerns about
their daughter’s health.
“The idea that they would
blithely ignore a quarantine
order is just preposterous,”
Mr. Bruntrager said.
BYTALALANSARI
ANDBRIANNAABBOTT
Officials
Weigh How
To E n f o r c e
Quarantine
So far, officials
haven’t arrested
anyone for violating
a quarantine order.
ing cruises for 30 days at his
request. The suspension will go
into effect at midnight, he said.
Across the nation, lines
snaked out the door for stores
that sell groceries and other
home supplies, as Americans
panicked they might soon run
out of necessities and cleared
shelves of everything from
pasta to toilet paper. Firearms
dealers also reported a rush
on guns and ammunition.
At a San Francisco Target
on Friday, bleach-based disin-
fectant wipes had been gone
from the cleaning-supply aisle
for more than a week. Signs
indicated that sales of disin-
fectant wipes, hand sanitizers,
toilet paper and bottled water
were being limited to keep
people from stockpiling.
Arthur Nguyen, 36 years
old, was walking through the
store with his 7-year-old son,who he said had a respiratory
illness and was wearing a face
mask. He had no luck buying
disinfectant wipes and was
buying food because his son
was home with him for the
next three weeks given the
cancellation of San Francisco’s
public schools.
“If it’s something like a dis-
infectant, or something that
cleans, it’s gone like instantly,”
he said.
At least 25 states and
Washington, D.C., have made
emergency orders over the
past two weeks, as governors
have taken increasingly far-
reaching measures to combat
the virus’s spread.
Mr. Trump, flanked by se-
nior members of the adminis-
tration’s coronavirus task
force and business executives,
on Friday said the administra-
tion would join with the pri-Shoppers awaited the opening of a Costco store Friday in Palm
Beach Gardens, Fla., as the virus threat encouraged stocking up.With nearly 30 years of ex-
perience in public health, Mr.
Morrow said, “If I am filled
with uncertainty, I can only
imagine how the general pub-
lic must be feeling.”
New guidance issued by Mr.
Newsom in California Wednes-
day urged canceling or postpon-
ing large events such as con-certs, conferences and sporting
events of 250 people, and even
smaller ones if social distance
couldn’t be maintained.
“These are tricky deci-
sions,” said Jon Mitchell,
mayor of New Bedford, Mass.,
60 miles south of Boston.
Mr. Mitchell earlier this
week called off the New Bed-THE CORONAVIRUS PANDEMIC
ford Half Marathon, which was
set for Sunday. Thousands of
runners penned in at the start,
sweating and coughing and
spitting, “makes for a 3,000-
person petri dish,” he said in
an interview Thursday. “I woke
up in the morning and said,
‘Nowaycanwedothisrace.’”
Local officials face a funda-
mental problem, he said: A
lack of information because so
few people have been tested
relative to populations. That
means cities can’t easily iso-
late infected people, leaving
two main steps of recourse:
good hygiene and keeping
people away from one another.
Diverse responses aren’t
problematic in themselves,
said Yaneer Bar-Yam, a scien-
tist at the New England Com-
plex Systems Institute, a re-
search institution that has
studied community response
to pandemics.
The ability to be nimble and
implement different responses
“frees up the system to
change,” he said.
A greater risk is “people re-
ally don’t understand that
there are these superspreader
events,” he said. A number of
coronavirus outbreaks around
the world had superspreader
events, from a food market in
China to a religious service in
South Korea, he said.
At a mass gathering in the
U.S. right now, the “chance
that no one is sick is almost
zero,” he said.
Houston Mayor Sylvester
Turner this week halted the
remainder of the city’s biggest
annual event, the Houston
Livestock Show and Rodeo, af-
ter the first area coronavirus
case not tied to international
travel. “That changed things,”
he said at a news conference.
But 85 miles away, in Beau-
mont, organizers of the big
annual South Texas State Fair,
set to start March 26, are pro-
ceeding. They will cancel if
mandated to do so, but hope
that doesn’t happen, said Marc
Richardson, a lead volunteer.
The fair raises money for chil-
dren’s causes.
Mr. Richardson, who thinks
there may be excessive panic
about the coronavirus, hadn’t
been surprised to see Austin
shut down the South by
Southwest festival over coro-
navirus concerns, but was
stunned to hear about Hous-
ton.
“Austin is much more of a
liberal area, but Houston?” he
said. “That’s the closest thing
we have to the Wild West.”
Seattle Mayor Jenny Dur-
kan said she welcomed Mr. In-
slee’s approach, which was
made in consultation with city
officials and based on model-
ing that estimated a 50% re-
duction of contact through so-
cial distancing could result in
a 75% to 80% reduction in the
number of potential infections
and deaths in the region
through April 7. “This disease
is not going to respect a city
line, a county line or state
lines,” she said.The Newport City Council
narrowly voted Tuesday to al-
low its 64th annual St. Pat-
rick’s Day parade to march on
Saturday, siding with commu-
nity members who warned that
canceling would signal that the
coastal Rhode Island tourist
town is closed for business.
“Don’t choke,” Jack Mil-
burn, a retired firefighter,
urged Newport council mem-
bers from the podium.
Some 24 hours later, the
same City Council voted unan-
imously to nix the parade after
Gov. Gina Raimondo asked
people not to attend events
for more than 250 people for
the next two weeks.
With limited information
and facing extreme time pres-
sure, county-level officials,
mayors and governors from
New Jersey to Washington state
issued a patchwork of edicts
and directions this week. They
moved to try to halt the spread
of the novel coronavirus, in
some cases making hard deci-
sions to overturn beloved tradi-
tions and disappoint constitu-
ents. With the gravity of the
situation setting in, most public
officials have chosen to cancel
events or limit crowds, but U.S.
states and municipalities thus
far are taking divergent ap-
proaches to the new virus.
“We understand that people
have to live their lives, and
business has to continue, how-
ever we have only one chance
to contain this,” Ms. Raimondo
said, warning there would
need to be “radical change” in
behaviors for a period of time.
The government’s message
helped Mr. Milburn come
around to the idea that New-
port’s parade should be can-
celed, he said.
Confirmed cases of the new
coronavirus in the U.S. have
topped 1,700, including 40
deaths, according to Johns
Hopkins University. Roughly
80% of cases tend to be mild or
moderate. But those who are
older or have underlying health
conditions are at a higher risk.
In California’s Santa Clara
County, which has been partic-
ularly hard-hit, county health
officials initially banned
events with 1,000 people or
more before revising that
number to 100 on Friday,
while Riverside County, which
has reported fewer than 10 lo-
cal cases, ordered the
Coachella music festival and
all events with 250 people or
more canceled or postponed.
New York Gov. Andrew
Cuomo banned most gather-
ings of more than 500 people,
a move that darkened Broad-
way shows. Washington Gov.
Jay Inslee halted events of 250
people or more in three coun-
ties. Ohio Gov. Mike DeWine
squashed many get-togethers
topping 100 people.
The disparate responses
stem from the fact that most
public-health powers rest with
states, said Lawrence Gostin, aBYJENNIFERLEVITZ
ANDCHRISTINEMAI-DUCStates Vary on Virus Approach
could hamper the response to
the outbreak, Mr. Trump said,
including limits on how hospi-
tals can treat and accommodate
patients with the virus. Centers
for Medicare and Medicaid Ser-
vices Administrator Seema
Verma said she was taking ac-
tion to temporarily restrict all
visitors and nonessential per-
sonnel from nursing homes,
with some limited exceptions.
Similar moves are also be-
ing made in Europe, which
World Health Organization di-
rector-general Tedros Adha-
nom Ghebreyesus on Friday
called the epicenter of the new
coronavirus outbreak, as the
number of cases topped
136,800 in 123 countries and
regions around the globe.
“More cases are now being
reported every day than were
reported in China at the height
of its epidemic,” he said.
Spain said it would declare
a state of emergency after the
number of cases in the coun-
try shot up to more than
4,000, making it the second-
biggest epicenter of the pan-
demic in Europe after Italy.
“Difficult weeks lie ahead of
us,” Spanish Prime Minister
Pedro Sánchez said.
Italy, which is under an un-
precedented nationwide quar-
antine, reported over 2,
new cases on Friday for a total
of 17,660. The death toll rose
by 250 to 1,266.
Poland said it was suspend-
ing all international air and
rail connections and would
close restaurants and shop-
ping centers.vate sector to speed up test-
ing, adding that the U.S. is in
talks with pharmacies and re-
tailers to make drive-through
tests available.
A new, high-speed coronavi-
rus test was earlier granted
emergency clearance by the
Food and Drug Administration.
Developed by Roche Holding
AG, the test is designed to run
on the company’s automated
machines, which are already
installed in more than 100 lab-
oratories across the U.S. It will
be available immediately.
By early next week, Mr.
Trump said, there would be a
half-million additional tests
available, with five million
tests available within a month.
He said he doesn’t recommend
that every member of the pub-
lic get tested.
“We don’t want everybody
taking this test. It’s totally un-
necessary,” Mr. Trump said.
The CDC says physicians
should use their judgment to
determine if a patient has
signs and symptoms of
Covid-19, the disease caused
by the virus, and whether the
patient should be tested.
The president later told re-
porters that he would likely be
tested for the coronavirus
“fairly soon.” The president
was potentially exposed to the
virus after posing for a picture
at his Florida resort with an
aide to Brazilian President Jair
Bolsonaro who later tested
positive for the virus.
The emergency declaration
will also allow key federal
agencies to waive rules thatGREG LOVETT/THE PALM BEACH POST/ZUMA PRESSsupported the legislation and
urged lawmakers to vote in fa-
vor of it. A vote was expected
Friday evening.
The U.S. has more than
1,600 confirmed cases and at
least 46 deaths, according to
the Centers for Disease Control
and Prevention, a number that
is expected to grow rapidly as
testing capabilities improve.
The crisis continued to
force cancellations or delays.
Boston pushed its iconic mara-
thon back until September. The
Masters golf tournament was
postponed. Berkshire Hatha-
way Inc. said its annual meet-
ing will take place virtually.
Louisiana moved its primary
until June, and the Los Angeles
Unified School District said it
would close all of its schools—
joining at least 11 states and
dozens of cities.
The Transportation Security
Administration said it would
allow airline passengers to
bring larger bottles of hand
sanitizer on board, subject to
additional screening.
Mr. Trump wrote on Twitter
Friday night that major cruise
lines—Carnival, Royal Carib-
bean, Norwegian and MSC—
had agreed to suspend outgo-Continued from Page OnePresident
Declares
Emergency
professor of global health law
at Georgetown University.
“Unlike Italy or China, the
United States Constitution is a
federalist constitution, and it
gives virtually all public health
powers to the states,” he said.
That philosophy has long
prevailed in states like Califor-
nia, which has 58 counties and
more than five dozen local
health departments.
“What we are doing is a
bottom-up process not a top-
down process. I think the local
health officials should make
those determinations,” Gov.
Gavin Newsom said this week.
That may be easier said
than done.
In a statement the same
day, San Mateo County public
health officer Scott Morrow
said he had been asked to
make “significant policy deci-
sions” with very little infor-
mation. Mr. Morrow had rec-
ommended canceling all
nonessential gatherings but
acknowledged he could offer
no standard definition of that
term. “Use your best judg-
ment,” he said.The remainder of the Houston Livestock Show and Rodeo, top, was halted this week. Below, workers
cleared space at a Cleveland college after presidential candidate Joe Biden’s rally was canceled Tuesday.FROM TOP: XINHUA/ZUMA PRESS; SCOTT OLSON/GETTY IMAGESCaliforniaWashingtonMassachusettsIllinoisCumulativeCoronavirusCasesintheU.S.
Note: Data through March 12 Source: Johns Hopkins Center for Systems Science and Engineering5000100200300400casesDAY1020304050 1
DAYSSINCEEACHSTATE’SFIRSTCONFIRMEDCASENew YorkColoradoBY WEEK 2 WEEK 4 WEEK 6