Report examines how to improve CDC’s network of quarantine stations, using lessons learned from COVID-19

Among the many parts of the U.S. public health system strained by the COVID-19 pandemic were the Centers for Disease Control and Prevention’s Division of Global Migration and Quarantine and its network of quarantine stations. DGMQ’s quarantine stations located at 20 U.S. international airports and other ports of entry — including in Miami, Chicago, Los Angeles, and New York City — work to reduce the spread of infectious diseases as travelers pass into and out of the country.

For example, stations are notified about potentially ill incoming travelers by airlines or by U.S. Customs and Border Protection, which does initial screening of all travelers for visible signs of illness. The quarantine station then coordinates medical evaluation for these individuals.

In addition, DGMQ maintains the federal Do Not Board list — which is used to prevent passengers known or suspected to have a contagious disease from boarding airplanes — and the Public Health Lookout list, which helps identify ill passengers who try to enter the U.S. DGMQ and its quarantine stations also work with state and local public health agencies to do contact tracing, notifying travelers who may have been exposed to an infectious disease.

The COVID-19 pandemic drove a drastic increase in the number of illnesses detected in airports that warranted responses. The level of public health needs was unprecedented, as were other steps the U.S. public health system took to try to slow the spread of COVID-19.

“The quarantine system of the United States has been tested like never before,” said Georges Benjamin, executive director of the American Public Health Association. “The use of isolation and quarantine authority during the COVID-19 pandemic in the United States has included international border closures, limits to transportation, and even suspension of the cruise industry.”

Benjamin chaired a National Academies committee that studied how DGMQ could improve its effectiveness and that of its network of quarantine stations, based on lessons learned during the response to the COVID-19 pandemic.

Funding and staffing for a new normal

Although COVID-19 posed the greatest challenge in recent years, it’s also just the latest in a long line of microbial threats that DGMQ’s quarantine stations have had to handle, members of the study committee noted at a webinar held to release their report earlier this summer.

“This division has basically been in response mode continuously for over the last decade,” said Edward Ryan, director of global infectious diseases at Massachusetts General Hospital. Before COVID-19, quarantine stations responded to Zika, dengue, Ebola, H1N1, Middle Eastern Respiratory Syndrome (MERS), and other infectious pathogens — and often to multiple disease threats at once.

“Not only has this now become the normal operating state and not the exception, but the responses themselves have become longer, and they’ve become far more complex,” said Stephen Ostroff, former acting director of FDA and adjunct professor at the University of Pittsburgh’s Graduate School of Public Health.

Despite the growing number and complexity of public health emergencies, the DGMQ’s core funding has remained remarkably flat, added Ostroff. For each crisis, the division can seek supplemental funding, but it often arrives late in the course of the response — an ineffective way to respond to the emergencies that the stations confront.

“Most of these responses that they’ve had to deal with have been looked at as one-offs, and they’ve been funded as if they’re one-offs, rather than being the norm for the quarantine division,” said Ostroff. The fluctuations in funding have led to fluctuations in the number of personnel working in the division, and the vast majority of employees are temporary — which makes it difficult to have consistency in staff and to sustain programs, he said.

To ensure that the division has a steady, dependable source of funding, CDC should explore, in collaboration with the administration and Congress, the development of a user-fee program funded by the aviation and maritime industries, the report says. The report also urges DGMQ to implement a comprehensive personnel plan to address multiple staffing challenges, including recruitment, retention, increasing vacancy rates, burnout, and excessive reliance on contract and temporary employees.

As part of this plan, DGMQ should develop and implement a “Ready Reserve Corps” — a well-trained, experienced, and agile group of personnel with essential competencies to help during public health emergencies. These individuals would be preapproved and cleared and placed on standby status, and they could be immediately available to rapidly meet personnel needs of the organization during emergencies.

Developing playbooks and building partnerships

Quarantine stations need to confront a wide range of potential pathogens, each of which is unique in terms of length of incubation period, route of transmission, and other characteristics. DGMQ should continue to develop detailed operational plans and playbooks for a variety of transmissible disease threats, especially for the most concerning and likely scenarios, the report says.

The report also urges the division to improve its use of technologies to detect outbreaks, gather health data from travelers, and alert travelers to exposures — while also putting a governance structure in place to ensure that these efforts consider ethical issues and follow regulations for protection of personal data.

In addition, DGMQ and other stakeholders should foster strong and stable partnerships, given how much the agency relies on federal, state, tribal, and local partners in doing its work, said the report committee.

“A lot of the engagement that happens with [DGMQ] occurs on an episodic basis, and we think that by partnering more regularly — so people aren’t exchanging business cards as soon as a disaster happens — would benefit everything,” said Benjamin.

These cooperative efforts should extend internationally, explained Ietza Bojoquez, professor in the department of population studies at El Colegio de la Frontera Norte, Mexico. For example, DGMQ should get involved in the upcoming revisions of the International Health Regulations, which guide detection of and response to public health events of international concern. “The division has a major part to play within the discussion, given its relationships with many international partners,” said Bojoquez.

Watch the webinar.

• Read the report: Improving the CDC Quarantine Station Network’s Response to Emerging Threats

• See an interactive overview of report’s findings and recommendations