Public Health Preparedness: HHS Should Assess Jurisdictional Planning for Isolation and Quarantine
Fast Facts
States and territories can use isolation and quarantine to keep people from spreading infectious diseases—as they did in the COVID-19 pandemic.
It's easier to do this in the early stages of an emergency if a jurisdiction has a plan in place. The Department of Health and Human Services is supposed to help jurisdictions prepare for and respond to emergencies by providing guidance and funding.
But HHS doesn't know whether jurisdictions have isolation and quarantine plans—so it doesn't know where to focus its emergency assistance.
Our recommendations address this and more.
Public health emergency coordination is on our High Risk List.
Highlights
What GAO Found
When a new disease presents a public health emergency, isolation and quarantine are among the first measures available to limit disease spread. All seven selected jurisdictions (states and territories) GAO reviewed used isolation and quarantine for the COVID-19 pandemic. Officials from these jurisdictions identified considerations for implementing such measures for COVID-19, including difficulty with enforcement and isolation and quarantine facility logistics.
Examples of Selected Jurisdictions' COVID-19 Isolation and Quarantine Actions
The selected jurisdictions carried out some isolation and quarantine planning before the COVID-19 pandemic. Four had detailed plans based on past experiences with diseases such as H1N1 influenza, while the remaining three had high-level provisions within emergency plans. In response to COVID-19 experiences, the selected jurisdictions have taken steps to strengthen their isolation and quarantine planning, such as updating plans to identify potential facilities for isolation and quarantine.
Federal agencies—primarily the Department of Health and Human Services' (HHS) Centers for Disease Control and Prevention (CDC)—provided guidance and awarded funding to jurisdictions during the COVID-19 pandemic that could be used to support isolation and quarantine efforts. However, CDC did not provide advance notice of isolation and quarantine guidance to jurisdictions before publication, which slowed jurisdictions' implementation of these measures. CDC has a new process for developing and sharing guidance, and officials told GAO the agency intends to provide advance notice to jurisdictions when possible. However, CDC has not documented its intentions to provide advance notice. Doing so will help ensure CDC implements its approach as planned and thereby help jurisdictions prepare for and effectively implement isolation and quarantine when needed.
Additionally, CDC has not assessed jurisdictions' planning for isolation and quarantine. As a result, CDC is missing information to identify and address gaps in jurisdictions' planning, including the absence of such plans. The National Biodefense Strategy directs CDC to determine any gaps in disease mitigation preparedness, including for isolation and quarantine. By assessing jurisdictions' planning, CDC could better fulfill this responsibility and identify and help address any gaps in jurisdictional planning for future disease outbreaks.
Why GAO Did This Study
As of June 2024, over 1.1 million people in the United States have died from COVID-19, according to CDC. State and territorial (jurisdictional) governments have primary responsibility for leading the preparation for and response to public health emergencies, with federal support through guidance and funding awards. When jurisdictions' capabilities are insufficient, HHS is charged with leading the federal public health and medical response. GAO added HHS leadership of public health emergencies to its High-Risk List in 2022.
The Consolidated Appropriations Act, 2023 included a provision for GAO to review selected jurisdictions' isolation and quarantine planning. Regarding isolation and quarantine, this report examines (1) selected jurisdictions' COVID-19 actions, (2) their planning, (3) federal agencies' support to jurisdictions, and (4) CDC's efforts to assess jurisdictional planning. GAO reviewed documentation and interviewed officials from seven jurisdictions selected for geographic variation and representatives from five national public health associations. GAO also reviewed documentation and interviewed officials from HHS and the Federal Emergency Management Agency.
Recommendations
GAO is making two recommendations to CDC to (1) document its intentions to share finalized isolation and quarantine guidance with jurisdictions before publication; and (2) assess jurisdictional planning for isolation and quarantine. HHS agreed with the recommendations.
Recommendations for Executive Action
| Agency Affected | Recommendation | Status |
|---|---|---|
| Centers for Disease Control and Prevention | The Director of CDC should document the agency's intentions to share finalized isolation and quarantine guidance with jurisdictions in advance of publication to allow them to prepare to implement such guidance. (Recommendation 1) |
As of October 2024, we have not received an update from HHS on actions taken to address this recommendation. When we confirm what action the agency has taken in response to this recommendation, we will provide updated information.
|
| Centers for Disease Control and Prevention | The Director of CDC should assess jurisdictional planning for isolation and quarantine and determine whether federal actions are needed to help jurisdictions close any gaps. (Recommendation 2) |
As of October 2024, we have not received an update from HHS on actions taken to address this recommendation. When we confirm what action the agency has taken in response to this recommendation, we will provide updated information.
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