Approaches to isolation and other social distancing measures for control of tuberculosis

State and local public health officials’ use of social distancing tools in infection control varies widely. Instituting social distancing requires legal authorities and financial resources, and can also be impacted by evidentiary standards, risk assessments, political will, and community and individual support. Awareness of these factors, as well as knowledge of state and local uses of social distancing measures, is essential to understanding what actions are most likely to be instituted during a public health emergency and to target interventions to better prepare health departments to utilize the best available tools necessary to control the spread of disease.

We conducted a series of in-depth interviews with public health officials at the local, state and federal levels, to better understand how health departments around the country utilize isolation measures to control tuberculosis.  We selected 16 jurisdictions, representing a wide geographic region, urban, suburban, and rural communities, and with experiences with tuberculosis in a wide range of populations, including prisoners, the homeless, foreign-born, school age children, and clinical care settings.  Through our case studies we were able to document variation in how states and localities respond to tuberculosis and the implications for other public health emergencies. 

We have found that the resources available for handling non-compliant patients vary greatly between jurisdictions, and this variation directly impacts the experience of the patient.  At the extreme, some health departments must use jail cells for isolation of non-compliant patients Even in cases where the patients are compliant, health departments often struggle with homeless patients in need of housing for isolation, and the need for incentives including rent payments and grocery delivery to enable patients to maintain their isolation; many departments either do not have adequate resources or funding mechanisms to allow them to pay for these services.

We also found variation in states’ and localities’ legal support to address various types of TB cases, and the flexibility and cooperation of other sectors, such as law enforcement, to work with health departments to maintain social distancing orders.

Based on the findings from these case studies, we were able to compile a series of policy recommendations to enable public health professionals to have the necessary flexibility and resources to adequately respond to and mitigate the consequences of a communicable disease outbreak.