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3PUBLIC TRANSIT EMERGENCY PREPAREDNESS AGAINST EBOLA AND OTHER INFECTIOUS DISEASES: LEGAL ISSUES By Trudy C. Henson, JD and Megan Timmons, University of Maryland Center for Health and Homeland Security I. INTRODUCTION This digest examines responses to infectious disease outbreaks (IDOs) or public health emergencies (PHEs), and identifies legal issues that may confront transit agencies during such incidents. Although numerous guides address transit agency emergency planning and preparedness,1 PHE response mecha- nisms may differâfrom who will be responding to what powers those responding possess. Given the ability of transportation to aid in the spread of disease, transit agencies will likely be heavily involved in an IDO response. Thus, knowing the roles and responsi- bilities of key responders can help transit agencies better prepare for and respond to an IDO. This digest provides a legal background of public health laws and how they may affect transit agen- ciesâ response so that agencies can develop protocols and procedures that address issues that may be raised in a PHE. A. Understanding the Legal Issues Surrounding Emergency Preparedness for Infectious Disease Outbreaks Public transportation is a $61 billion industry that employs roughly 400,000 people across 7,200 agencies in the United States.2 In 2014, Americans used public transit to take approximately 10.8 billion trips.3 In fact, when the 2014 Ebola outbreak occurred, New York City subway ridership was at record high levels, averaging more than 5 million weekday rides.4 Nonetheless, as transit officials discovered during that same Ebola outbreak, there is a dearth of guidance for addressing IDOs on transitâfrom effective disinfection of carriers, to worker protection, to handling infected or poten- tially infected passengers. Although all transporta- tion agencies have protocols for infection control and the handling of bodily fluids, most of these protocols do not contemplate a widespread event, where multiple cases of infection control or disinfection may be needed at a time. At the same time, the 2014 Ebola outbreak and various state responses, such as statesâ implementa- tion of quarantine and isolation policies, revealed the complexities of an effective public health response that respects individual civil liberties of both passengers and employees. Kaci Hickox, a healthcare worker who was involuntarily quaran- tined after returning from West Africa, became the most famous face of these issues. Indeed, although the Ebola outbreak focused attention on healthcare workers, a number of workersâ unions, including transportation and janitorial unions, protested the lack of clear guidance for worker protection and voiced concerns about adequate worker safety during an IDO. Some threatened to strike. The 2014 Ebola outbreak also highlighted the difficulty of containing an infectious disease when transportation is involved, as well as the various agencies and actors such a response requires. Amber Benson, a healthcare worker who had been exposed to Ebola, fell ill after taking a domestic flight from Texas to Ohio. Craig Spencer, a doctor who had been exposed to Ebola, fell ill after riding the New York City subway. As transit officials worked with public health officials to identify which potentially contaminated carriers to remove from service and to contact potentially exposed passengers and employees, the need for clear poli- cies, procedures, communication, and collaboration became apparent. Local, state, and federal authori- ties were critical to the implementation of an effi- cient and effective response. Finally, as this digestâs case studies illustrate, the power of communication and working relationships across agenciesâparticularly transit and public health agenciesâcannot be underestimated. The response structure for a PHE, such as an IDO, is not fixed: there may be times when local or state health 1 See, e.g., Nicholas Thomizawa, LegaL Issues In PubLIc TransIT emergency PLannIng and OPeraTIOn, Legal Research Digest No. 44, Transit Cooperative Research Program, Transportation Research Board of the National Academies of Sciences, Engineering and Medicine, Washington, D.C., 2013. 2 American Public Transportation Association, Facts, http://www.apta.com/mediacenter/ptbenefits/Pages/ FactSheet.aspx (last visited Sept. 15, 2016). 3 Id. (Indicating that this is the highest ridership has been in 58 years.). 4 Metro Transit Authority, Introduction to Subway Ridership, Subway Ridership at a Glance, http://web.mta. info/nyct/facts/ridership/ (last visited Sept. 15, 2016).