Rights-Based Legal Considerations for Tuberculosis Isolation Practices in Community Settings in the Postpandemic Era.

Abstract

State and local governments are free to enact infectious disease control laws to protect the public health but must conform those laws to right-based limitations imposed by the United States Constitution. Tuberculosis (TB) control laws that empower public health agencies and their representatives to institute restrictions on movement and activities for persons with TB have remained largely unchanged for decades and warrant review to ensure consistency with modern legal principles. During the coronavirus disease 2019 pandemic, there was increased attention to the tension between nonpharmaceutical public health interventions (masking, isolation, lockdowns) intended to reduce transmission and improve community health and their potential negative consequences on learning, mental health, individual finances, and the economy at large. Increasing evidence suggests that much of TB transmission is likely to have occurred prior to diagnosis and treatment initiation, and there is limited scientific evidence for the efficacy of community-based isolation in reducing TB incidence or TB mortality; by contrast, there is evidence that treatment rapidly reduces infectiousness and that prolonged isolation may have deleterious health and financial effects for persons with TB. The postpandemic era presents an opportunity to reassess public health authorities' legal obligations in designing voluntary and involuntary isolation policies for persons with tuberculosis. In so doing, state and local governments can recalibrate the balance between respect for individual constitutional rights and achieving public health TB goals.