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Summary of State Health Rules on Communicable Disease Quarantine and COVID-19 Positive Isolation

January 4, 2022

Effective Dec. 22, 2021, emergency rules were promulgated by the Tennessee Department of Health addressing procedures to be followed by the Commissioner of Health, health officers, and their designees, in carrying out disease control enforcement activities involving persons or premises that pose a health threat to others. The rules also address enforceable guidelines regarding the quarantine of COVID-19 positive individuals. There are aspects of the rules of which physicians needs to be aware.

Duty to Report a Person Who Is or May Be a Health Threat to Others
The rules impose a duty to report on physicians and other licensed health professionals who have reasonable cause to believe that a person is, or may be, a health threat to others because the person is unable, is unwilling, or is failing to act in such a manner as to not place others at significant risk of exposure to infection that causes serious illness, disability, or death. The report must be filed with the Commissioner of Health or other health officer.

The rules define “health threat to others” as:

“The direct threat of endangerment to others due to the presence of a cause or source of a disease on premises, or due to the inability, unwillingness, or failure of a carrier to act in such a manner as to not place others, without their consent, at significant risk of exposure to, based on the reasonable medical judgment and clinical or epidemiological understanding of public health authorities, a disease that may cause serious illness, disability, or death. A determination of whether or not premises or a person poses a health threat to others may include, but is not necessarily limited to, assessing the cause, source, and/or nature of a disease, the likelihood of infection, the modes of transmission, the risk of transmission, and the severity of harm that might result due to transmission of a disease. With respect to carriers, such a determination is not based solely on a person’s past behavior but also involves an assessment of a person’s current situation, including the effects of educational efforts and statements of intent. A person having a disease, such as active tuberculosis, even though rendered temporarily not capable of transmission because of receiving therapy, who discontinues treatment prior to reaching a curative result, may continue to be a health threat to others.”

“Health Officer” is defined as:

“The Chief Medical Officer for the State of Tennessee; a licensed physician who is authorized by the Department to function as a county, district, or regional health officer in Tennessee, a licensed physician who serves as the health director or health officer of any metropolitan public health department in Tennessee; a licensed physician in the central office of the Department’s Health Services Administration.”

TMA notes that there is already a requirement to report in statute (Notification of Health Authorities of Patient with Communicable Disease -T.C.A. § 68-5-102) whenever any physician knows or suspects that any person whom the physician has been called to visit, or who has been brought to the physician for examination (or whenever a physician has received any suspicious information relative thereto), is infected with—or even suspected to be infected with—a communicable disease, except venereal disease, the physician shall immediately notify the health authorities of the town or counties in which the diseased person is found. Click here to access the state’s website on reportable diseases and instructions on how to report.

The rules do not specify a penalty for a physician who fails to report a person who he/she believes is a health threat to others based on the defined circumstances. Much of the rules specify the legal process as to what health officials can do with reported information in terms of issuing health directives, petitioning a court to place a person in temporary hold, petitioning a court for a public health measure, or commitment of an individual to the custody of the Commissioner.

Quarantine for COVID-19
This part of the rule applies to persons who test positive for COVID-19. COVID positive persons must immediately isolate. For persons who do not experience COVID-19 symptoms, isolation must be at least ten (10) days from the date of the specimen collection that resulted in the positive test result. For persons who do experience COVID-19 symptoms, isolation must be for at least ten (10) days from the date of initial onset of symptoms, and isolation must continue until the person has shown improvement in symptoms and has been fever free without fever-reducing medication for at least twenty-four (24) hours. One may end isolation at any time upon receipt of a negative antigen, PCR, or other FDA approved or authorized test for acute COVID-19 infection test result following the initial positive test result.

Note that since the rules were effective, CDC has issued shorter isolation requirements for asymptomatic persons (5 days). The Tennessee rules, however, must be followed and physicians should advise accordingly.

The rest of the rules address when the Commissioner may quarantine a private business when there is a serious public health or safety threat.