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>> The first official concept in the use of quarantine started
in Venice in the late 1300s during a big plague epidemic.
This is before the germ theory,
before we knew what pathogens caused diseases.
It was quite clear that human mobility, particularly by sea,
was moving the bubonic and pneumonic plague
around the world through ports.
And the port of Venice set up this system,
a formal system of quarantine.
Quarantine comes from the Italian
and then Latin quarantina meaning 40 days.
They would stay out of port, flying a yellow quarantine flag
for 40 days until the epidemic of plague
or whatever it would be would burn itself out.
The concept of quarantine was used to protect healthy cities
from the importation of these threats
through commercial travel.
>> As the colonies developed,
epidemic spread into North America.
American quarantine law dates back
to the Massachusetts Bay colony in 1647.
And the quarantine has served as a cornerstone
of America's public health ever since.
In 1793, a yellow fever epidemic struck Philadelphia killing 5000
people in three months.
Because of the severity of the yellow fever epidemic,
Philadelphia built the first U.S. quarantine station
and hospital on the Delaware River called the Lazaretto.
>> In 1798, President John Adams
and Congress created the U.S. Marine Hospital Service.
This service established a network of hospitals
and quarantine staff along the coast
to protect our young country against the spread of disease.
Sailors and immigrants arriving
from foreign ports were screened for signs of disease.
Sick people were isolated and treated
and exposed people were quarantined.
Eventually, this network became the U.S. Public Health Service.
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In 1918, the worst influenza pandemic in recorded history,
also known as the Spanish flu,
occurred at the end of World War I.
Influenza killed nearly 700,000 people in the United States
and about 50 to 100 million worldwide.
As World War I was ending,
cities in the United States held liberty loan parades
to help pay for the war effort.
With the flu pandemic at its peak, St. Louis decided
to cancel its parade while Philadelphia chose to continue.
The next month, Philadelphia had a death toll of more
than 10,000 people from the pandemic flu
versus 625 flu deaths in St. Louis.
This deadly example provided a great case
for canceling mass gatherings during pandemic outbreaks,
an important outbreak control tool.
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>> The Foreign Quarantine Service began to come into being
through regulation and law changes
in the Public Health Service Act around 1948.
The concept of quarantine first and foremost originated
in a commercial context.
It was about protecting international commerce
and the receiving communities.
From the benefits of that commerce, it wasn't until 1967
that it came to CDC during a great period
of mergers and acquisitions.
>> In 1969, quarantine practice went from ships to space ships.
President Richard Nixon cheers the Apollo 11 astronauts
who just returned from the moon.
To prevent potential cross-contamination from space,
the astronauts spent 21 days quarantine inside a hermetically
sealed trailer as CDC recommended.
In January 2017, CDC updated U.S. federal quarantine
regulations and published a final rule for control
of communicable diseases, interstate and foreign.
These rules clarify CDC's authorities
in controlling the importation and spread
of communicable diseases into the United States
and territories and ensures CDC will seek
to use the least restrictive means necessary
to prevent the spread of communicable diseases.
>> One of the challenges, it's both a challenge
and a great opportunity, is to align and deal with the balance
of protecting public health, protecting American communities
with balancing the civil rights of individuals.
That balancing act is very, very challenging.
When I told you earlier about the ethics of quarantines
in the 14th century through, I would say,
the early 20th century, it really focused on the protection
of the community at the expense of the victims.
The victims were seen as vectors and nothing else,
not victims of disease.
We had the emergence in the last 50 years
of the civil rights movement in the United States
where the rights of individuals and human rights
and individual rights and rights
of vulnerable populations has come, you know, right up front
and center as it should.
But when you think
about applying the regulatory responsibility of quarantine,
and our division has the largest regulatory responsibility
at CDC, you've got to do that in a way that's commensurate
with protecting individual rights and civil rights.
And it's a challenge which we welcome.
>> Today, CDC's Quarantine and Border
Health Services branch maintains 20 quarantine stations
to protect America's health at U.S. ports of entry
where most international travelers arrive
by sea, land, and air.
Disease is just a flight away.
It's our job to make sure one sick traveler doesn't become 100
sick people in our communities.
Quarantine and Border Health Services staff respond
to sick travelers who may have contagious diseases.
We connect newly arrived immigrants
who have certain public health conditions
with state public health authorities.
We restrict the importation of animals and products
that may carry disease.
We alert travelers and the travel industry
of disease outbreaks.
We send emergency life-saving drugs to hospitals and clinics
to treat patients with malaria, botulism, or diphtheria.
We collaborate with federal agencies,
local health officials, airlines, and cruise lines
to identify sick travelers and alert other passengers
of potential exposure.
With a passion and expertise for safeguarding America's health
from borders to our communities, we are a diverse workforce
from many cultures speaking many languages.
We are scientists, doctors, nurses, veterinarians,
technology and data experts, educators, communicators,
and emergency responders.
We responded to outbreaks of Zika, Ebola, MERS,
the 2009 H1N1 flu pandemic, SARS, and Cholera.
We sent border health response teams
to help control the Ebola epidemic in Guinea, Liberia,
and Sierra Leone because the most efficient way
to protect America and other countries is
by stopping the outbreak at its source.
>> Part of the near-term future is figuring out how
to build a staff that has the concurrent capacity for response
and our core peace time work.
To do that, I think, is a challenge that will go on.
>> Learning from our Ebola response,
our international border team helps foreign governments
develop their capacity to prevent the spread of disease
across borders and into our own country
or other parts of the world.
We are CDC's Quarantine and Border Health Services branch
with a legacy of serving as a cornerstone to public health.
Now reinvented to serve a world
where disease is just a flight away.
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