Preparing US Quarantine Stations for the Next Pandemic
Stanford Medicine's Jason Wang and Michele Barry sit on an expert committee of the National Academies examining ways the CDC's national quarantine network can better prepare for the next pandemic.
The COVID-19 pandemic uncovered serious problems in the CDC quarantine stations that screen travelers coming into the United States, a newly published report showed.
Researchers and other experts tasked with recommending ways to strengthen the program — developed decades ago by the Centers for Disease Control and Prevention to prevent the spread of dangerous diseases — found that stations at 20 U.S. ports of entry and land-border crossings weren't operating efficiently and that the technologies used at the stations were woefully out of date.
They found that the outdated technology impeded efforts to quarantine and trace people who tested positive for COVID-19, hindered information sharing among officials and limited the ability to alert other travelers to potential exposure. The stations were also inadequately staffed, according to the report conducted by the National Academies of Sciences, Engineering and Medicine at the request of the CDC.
The report was created by a panel of independent experts, including Jason Wang, MD, PhD, a Stanford Medicine professor of pediatrics and of health policy, who examined the technological aspects of the network; and Michele Barry, MD, a professor of medicine and tropical diseases and director of the Center for Innovation in Global Health, who reviewed disease control and response efforts.
In the first review since 2006 and the wake of the SARS outbreak, the panel examined the existing network of quarantine stations and recommended steps to better prepare the system for the next pandemic or public health emergency. The report was issued on June 10 by the National Academies, a private nonprofit organization of the world’s leading experts in these fields who volunteer on committees that address some of society’s most pressing challenges.
The CDC's Division of Migration and Quarantine (DGMQ) runs a network of quarantine stations located at 20 ports of entry and land-border crossing where most international travelers arrive. They are staffed by medical and public health officers who decide whether ill people can enter the country and measures should be taken to prevent the spread of contagious diseases.
The network came under some criticism during the pandemic, namely that the stations were slow to respond, unable to quickly increase the screening of passengers and that information gathering was inefficient and outdated data systems were unable to talk to one another.
“The U.S. needs a quarantine station system that can meet the infectious disease challenge we know are ahead of us,” said Georges C. Benjamin, executive director of the American Public Health Association and chair of the committee that wrote the report. “To do that, Congress needs to enhance the nation’s quarantine network system, to include updating the CDC’s legal authority by modernizing the Public Health Service Act (PHSC.) Such an update would ensure it can act appropriately during public health emergencies.”
Wang, a professor of pediatrics at the Stanford School of Medicine and professor of health policy at the Department of Health Policy, helped write the report chapter that focused on ways to improve the delivery of data during an emergency. The enhancement of medical technology and health data are among his areas of expertise.
“During the COVID-19 pandemic, we were faced with the challenge of a rapidly spreading virus,” Wang told a committee briefing during the release of the report on June 10. “It is clear that we will need more efficient ways to gather data, share data across data systems, and scale that data. New technologies offer opportunities for us to do that.”
Wang said the COVID-19 pandemic revealed striking inadequacies in the DGMQ’s technology infrastructure and that the division must improve its use of digital technologies to gather health data from travelers, trace transmissions and alert travelers to exposure. Wang has published research on how big data analytics, proactive testing and new technologies were successful in the fight against the coronavirus in his native Taiwan.
Wang noted that some of the new technologies that should now be taken into consideration include the use of CRISPR-based diagnostic tests; wastewater detection of pathogens and blue-tooth based technology for contact tracing.
Wang said the global program known as the IHE-Connectathon should be integrated with the DGMQ pandemic preparedness efforts. The Connectathons have been taking place annually for two decades in cities around the world to advance health IT and patient safety as vendors work together to test and debug their systems.
“The Connectathon is a way for data systems to practice talking to each other,” Wang said, adding that these exercises need to be enhanced with data standards for electronic medical records and software applications.
Rethinking Pandemic Preparedness
So how can we better fend off possible incoming infections?
Barry's team recommended Congress make additional emergency funding easily accessible during urgent times of crisis, and create a reservist corps of experienced professionals who would be available to head to quarantine stations and complement the staff during emergencies.
“The CDC’s quarantine division has to cover 300 ports of entry with only 20 quarantine stations and is in emergency crisis mode 24/7 with outbreaks like Ebola, Zika, SARS1 and now COVID-19 and monkeypox,” said Barry who is a Stanford Health Policy affiliate. “They are chronically underfunded with high burnout rates and have no capacity to access surge funding without going to Congress — an arduous process.”
The committee presented a string of recommendations to modernize the quarantine station network, which include:
- Developing better criteria for upgrading the stations and permanently housing maritime quarantine units within the stations to address the unique needs of the cruise industry.
- Enabling surge funding and exploring a user-fee program to ensure the division has a consistent source of revenue.
- Creating detailed operational playbooks based on the most concerning and likely scenario for transmissible disease threats such as coronaviruses and Ebola outbreaks.
- Improving its partnerships for better coordination during future emergencies and modernizing health communication efforts with travelers by collaborating with airlines to better inform passengers about prevention measures before departure.
Jason Wang, MD, PhD
