Quarantine and Isolation Orders in Puerto Rico’s Executive Orders from March 2020 to April 2021

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[co-authors: José L. Maymí-González, Irene Viera]

Since the beginning of the COVID-19 pandemic and as new information has become available, the Centers for Disease Control and Prevention (CDC) and local governments have continuously revised their isolation and quarantine requirements and recommendations. The constantly changing guidelines and executive orders makes it difficult to keep track of the changes and their applicability to different circumstances. Accordingly, below we summarize the progression and current status of CDC recommendations and Puerto Rico mandates and provide a brief timeline on the modification of isolation and quarantine requirements since the start of Puerto Rico’s COVID-19 state of emergency. Finally, we summarize the recently amended quarantine and isolation provisions for air passengers arriving in Puerto Rico.

CDC Definitions and Guidelines for Quarantine and Isolation

The terms “quarantine” and “isolation” have become ubiquitous during the COVID-19 pandemic and while they are sometimes used interchangeably, they are indeed different. The CDC distinguishes them as follows: quarantine, on the one hand, keeps someone who might have been exposed to the virus away from others; isolation, on the other, also keeps someone who is infected with the virus away from others, but even within their own home. Thus, a person will need to quarantine when there is suspected exposure to a transmittable disease, but once infection is confirmed, isolation is recommended.1 More specifically, the CDC recommends quarantine for individuals who have been in close contact with someone who has COVID-19, unless the exposed individual has had COVID-19 within the past three months or is fully vaccinated.2 The CDC considers there to have been “close contact” if any of the following has occurred: (a) the person was within six feet of someone who has COVID-19 for a total of 15 minutes or more; (b) the person provided care at home to someone who is sick with COVID-19; (c) the person had direct physical contact with the person; (d) the person shared eating or drinking utensils with someone who has COVID-19; (e) or the infected individual sneezed, coughed, or somehow got respiratory droplets on the person. Isolation is required when there is a confirmed infection, regardless of whether COVID-19 symptoms are present.

In terms of their duration, there are also some differences. For quarantine, the CDC recommends a 14 day period (since the last contact with the person with COVID-19), but allows shorter periods in some cases, such as: (i) 10 days without testing when no symptoms have been reported during daily monitoring; or (ii) 7 days assuming that the person obtains a negative COVID-19 test result on the 5th day following exposure or later. For isolation, the CDC has streamlined its guidelines to reduce prolonged isolation periods and unnecessary use of testing resources. To this effect, isolation can be discontinued 10 days after the onset of symptoms and after 24 hours with no fever without the use of fever-reducing medication, and improvement of other symptoms. If no symptoms have developed, then isolation can be discontinued after 10 days. Ultimately, these are suggested guidelines and CDC recognizes that local public health authorities can determine and establish the quarantine and isolation options for their jurisdictions. In Puerto Rico, the quarantine length requirements follow the 14-day CDC guidelines, while isolation periods have changed throughout the COVID-19 pandemic.

Quarantine and Isolation in Puerto Rico

The CDC issues recommendations that state and local governments are free, but not required, to adopt. The concepts of quarantine and isolation that the Puerto Rico Department of Health (“Department of Health”) has implemented throughout the COVID-19 pandemic were established by regulation dating back to 2007. Regulation 125 on isolation and quarantine provides definitions for each term, establishes the general provisions for its procedures, and states the penalty for failing to comply with the same.

Regulation 125 defines quarantine as “an action directed at persons reasonably suspected of exposure to a transmittable disease […] that do not show signs or symptoms of a transmittable disease […] whose movement is restricted or are physically separated.”3 The same regulation defines isolation as the “physical separation, confinement, or movement restriction of a person or persons infected with or reasonably suspected of infection of a transmittable disease.”4 Regulation 125 dictates that general procedures for quarantine and isolation must be carried out using the least restrictive means within reason, must respect, to the extent possible, cultural and religious beliefs, and facilities used for such purposes must be secure, maintained, and provide for the needs of quarantined and isolated individuals. Furthermore, Regulation 125 requires that isolated individuals must be separated from the quarantined population.

The penalty for any violation to Regulation 125 is an administrative fine of $500 to $5,000, in addition to other penalties that may be imposed under the Puerto Rico Penal Code.5 Notably, however, Regulation 125 does not specify a particular length of time for quarantine or isolation periods. As applied to the COVID-19 pandemic, the Department of Health has issued preliminary guidelines which specify the duration of quarantine and isolation periods required because of COVID-19 infection, exposure or suspected exposure, which, in turn, also depend on specified circumstances. For example, in the context of correctional facilities, prisoners must quarantine for 14 days after physically appearing in court for a hearing.6 In the employment context, the Department of Health states that an employee who tested positive for COVID-19 may end isolation if the following three conditions are met: (1) 10 days after onset of symptoms; (2) at least 24 hours have passed without onset of fever without using fever medication; and (3) other symptoms, such as coughing, have subsided. Alternatively, if the person tested positive for COVID-19 but never developed symptoms, then isolation may end after 10 days from the positive test result. Theses directives are in line with the previously mentioned CDC recommendations regarding the duration of isolation.

The absence of quarantine and isolation periods left by Regulation 125 has also been filled by the executive orders (“EO”) issued during the COVID-19 pandemic. The following table provides a summary on how Puerto Rico’s quarantine and isolation mandates established in EOs have changed throughout the COVID-19 pandemic:

Quarantine and Isolation Provisions in Executive Orders from March 2020 – April 2021

Date

Order No.

Description

March 12, 2020

EO 2020-20

Former Governor of Puerto Rico Wanda Vázquez-Garced declares a state of emergency due to the COVID-19 pandemic and grants a “special leave” of 14 days to public employees suspected of or diagnosed with COVID-19. The “special leave” could also be used if a family member living under the same roof as the employee was suspected of or diagnosed with COVID-19.

March 15, 2020

EO 2020-23

Establishes the first lockdown and the first Quarantine Order mandating that persons reasonably suspected of or diagnosed with COVID-19 should be confined to their homes for 14 days to prevent transmission.

March 30, 2020

EO 2020-29

Extends the same Quarantine Order to asymptomatic individuals.

April 12, 2020

EO 2020-33

Explicitly states the first isolation order with a period of isolation of 14 days for persons diagnosed with or reasonably suspected of having COVID-19. Thereafter, the former governor would issue a new executive order around every two weeks with no remarkable change to the quarantine and isolation orders.

July 16, 2020

EO 2020-54

Maintains the conditions of previous quarantine and isolation orders, however, forewarns of criminal liability as established in Act 20-2017 for not complying with the isolation order.

August 20, 2020

EO 2020-62

Requires persons exposed to COVID-19 undergo testing at least five days after being in contact with the exposed individual.

October 16, 2020

EO 2020-77

Changes the isolation period to require 10 to 20 days of physical isolation for persons that have tested positive for COVID-19.

April 8, 2021

EO 2021-026

Governor Pedro R. Pierluisi maintains the previously mentioned quarantine provisions but reduces the minimum isolation period to 10 days starting from the onset of COVID-19 symptoms. After that minimum term, the person may cease isolation if they do not experience symptoms for 24 hours without the aid of fever-reducing medication. Other isolation provisions, such as criminal liability for non-compliance, remained in force from previous EOs.

Other EOs have provided quarantine and isolation orders specific to one of the main focal points of transmittable diseases: airports. These EOs have at times caused problems for both the traveler arriving in Puerto Rico and for the government attempting to enforce measures to prevent and contain the spread of COVID-19 infections within the Island.

Quarantine and Isolation Provisions for Air Passengers Arriving in Puerto Rico

As of January 26, 2021, the federal government requires all international air passengers (regardless of citizenship or vaccination status) arriving to the United States to present a negative COVID-19 test taken within three calendar days of departure or proof of recovery from the virus within the last 90 days. Air passengers on domestic flights (including to and from U.S. territories like Puerto Rico) are not required to present a negative COVID-19 test. Nevertheless, “State and local governments may have additional testing requirements for air passengers arriving in their jurisdictions.” The CDC’s recommendation for international air travel includes not only getting tested 1-3 days before the U.S.-bound flight as is required by the new federal mandate, but also getting tested again 3-5 days after arriving and self-quarantining for 7 days. Therefore, while a negative COVID-19 test is only required by the federal government for international U.S.-bound flights, state and local governments may implement such a requirement, or even additional ones, for both foreign and domestic flights. In Puerto Rico, at the start of the COVID-19 pandemic, the government required an automatic quarantine period for all passengers, subject to other additional requirements and certain exemptions.

On March 30, 2020, after the Federal Air Administration (FAA) authorized all commercial flights coming to Puerto Rico to land at Luis Muñoz Marín airport (LMM) only,7 EO 2020-30 recognized the CDC’s recommendation for a quarantine period of 14 days and established that any passenger “in a flight from the United States of America or any international destination shall be considered a person” suspected of COVID-19 exposure and “shall remain under quarantine for a period of fourteen (14) days or for the duration of his or her stay in Puerto Rico, whichever is shorter.” For purposes of this 14-day period, day one was considered the day when the person arrived at the airport. That EO did not exempt from the quarantine period individuals who presented a negative COVID-19 test. Furthermore, EO 2020-30 mandated that passengers were required to fill out a form from the Department of Health upon arrival which included “personal information, travel history, medical background and place of residence or lodging.” If the person was a resident of Puerto Rico, then they could remain under quarantine at their residence. If the person were not a resident of Puerto Rico, regardless of their reason for travelling to Puerto Rico, they would remain under quarantine at their lodging (i.e., a hotel room) but could not use common areas, such as pools or hotel restaurants. Notwithstanding residency status, a person under quarantine could only leave quarantine to obtain medical services. Persons exempted from the above quarantine period and provisions included: emergency and essential services workers, health professionals, and others. Lastly, EO 2020-30 warned that, pursuant to Art. 6.14 of Act No. 20-2017, any violations to an executive order during a state of emergency constitutes a misdemeanor offense.

On June 22, 2020, the former governor signed EO 2020-45, which amended the previously discussed EO 2020-30 and expanded the list of persons exempted from the mandatory quarantine period. In EO 2020-45, the government acknowledged the CDC’s warnings that airports are places of infection risk, and the CDC’s recommendation, as well as those from the World Health Organization (WHO), regarding preventative measures for such places. The amendments introduced by this EO exempted passengers who arrived in Puerto Rico to work in any industry exempted from the total closure of operations as established in the various other EOs (e.g., a car mechanic). To benefit from this amendment, the exempted passenger could not show any symptoms of COVID-19, needed to provide a negative COVID-19 molecular test performed 24 hours prior to boarding their flight, and had to comply with the company’s risk control measures for COVID-19. Thus, following the amendments of EO 2020-45, only passengers arriving to Puerto Rico for non-work-related reasons were required to comply with the full quarantine provisions of EO 2020-30. Although it seems like the exemption was larger than the rule, tourists and other recreational visitors benefiting from cheap air fare still made up most of air passengers arriving to the Island.

On July 3, 2020, citing a new plan “to reactivate tourism in accordance with the parameters established by the CDC, the WHO, and the Department of Health,” former Governor Wanda Vázquez-Garced signed EO 2020-52, which repealed EO 2020-30 and established new rules for domestic and international passenger entry to Puerto Rico. Pursuant to EO 2020-52, all passengers, from domestic or international flights, did not need to quarantine if they provided “a negative COVID-19 result from a qualified molecular SARS-CoV2 test performed within the last 72 hours prior to their arrival.” Failure to do so would activate “a reasonable suspicion that [they were] exposed to COVID-19 and [the traveler would be required to] remain under quarantine for a period of fourteen (14) days or for the duration of [their] stay in Puerto Rico, whichever [was] shorter.” The same quarantine conditions of the repealed OE 2020-30 were reinstated with an additional, new provision imposing responsibility on the homeowner or host of the lodging receiving the passenger to ensure the passenger’s compliance with the directives of EO 2020-52. Flight crew members staying for less than 72 hours and certain public employees (i.e., federal agents) were exempted from the above requirements and quarantine conditions.

EO 2020-52 was recently amended by EO 2021-28, which was signed by Governor Pedro R. Pierluisi on April 16, 2021. Under the new amendments, a passenger that tests positive for COVID-19 is responsible for all the medical and extended stay costs incurred while remaining in isolation. Furthermore, EO 2021-28 restates that the Department of Health has the authority to impose administrative fines on any person in breach of the EO’s provisions.8 Shortly thereafter, on April 19, 2021, the Department of Health issued Administrative Order 499 (AO 499), which became effective April 28, 2021, announcing that passengers that arrive to Puerto Rico without a negative molecular COVID-19 test would be fined $300.9 Under AO 499, travelers fined by the Department of Health can have those fines deleted if they provide a negative COVID-19 test within 48 hours of arrival. AO 499 expressly states that the negative test requirement applies to fully vaccinated individuals.

As a result, under the mandates of EO 2021-28 and AO 499, quarantine is no longer an option for domestic passengers arriving in Puerto Rico since all passengers are required to provide a negative molecular COVID-19 test. Quarantine, however, is still required in certain cases. Although it uses the terms quarantine and isolation interchangeably,10 AO 499 is clear in requiring quarantine, the correct term, for persons arriving in any airport from any domestic or international flight without a negative COVID-19 test performed 72 hours prior to their arrival. This quarantine period will last until the results of the molecular COVID-19 test performed in Puerto Rico arrive—generally, less than 14 days. Similar to previous EOs, the quarantine period in AO 499 must be completed in the hotel or residence where the passenger will be staying. Under both AO 499 and EO 2021-28, isolation is still required for passengers who test positive for COVID-19, in which case they must isolate and are responsible for any medical or extended stay costs. Epidemiologist Miriam Ramos, responsible for the Department of Health’s air passenger monitoring, stated that previous quarantine orders relied on the good faith of the passengers for its compliance and that it was difficult to enforce. She acknowledged, however, that it remains unclear how the Department will enforce payment for the fines in cases where the 48 hours to comply with the test requirement post-arrival have transpired. During the first 18 days of April 2021, almost 233,000 passengers arrived at Puerto Rico, 48% of whom did not show a negative COVID-19 test upon arrival.

In conclusion, Puerto Rico has followed, yet sometimes expanded, the CDC guidelines for quarantine and isolation. The definitions for quarantine and isolation in the Department of Health’s Regulation 125 closely resemble those of the CDC. The Department of Health’s guidelines, however, are silent as to the required duration of quarantine and isolation. The governors’ EOs during the COVID-19 pandemic have filled this void with mixed results. While the EOs have consistently required the CDC-recommended quarantine period of 14 days, as to isolation, the EOs have required at times more extended periods than those recommended by the CDC.

At the beginning of the pandemic, the EOs required 14 days of isolation upon a positive COVID-19 test, then they ordered 10 to 20 days, and, most recently, the isolation orders have kept with the CDC-recommended 10-day minimum. In light of the recent federal requirements and CDC recommendations, Puerto Rico’s provisions for air passengers are broader since they apply to passengers in all flights and are not limited to international U.S.-bound flights. There have also been recent changes within the EOs themselves regarding air travel. EO 2021-28 eliminated the quarantine alternative for air passengers who arrived in Puerto Rico without a negative molecular COVID-19 test. Instead, EO 2021-28 requires that air passengers who fail to provide a negative COVID-19 test upon arrival need to take one within the next 48 hours. AO 499 expands upon this requirement and mandates that such persons must quarantine until the results of the test arrive. AO 499 further adds that failure to provide a negative COVID-19 test upon arrival exposes the air passenger to a fine of $300. This fine, however, may be left without effect if, within 48 hours of their arrival, the passenger submits a negative molecular COVID-19 test result. Ultimately, the EOs and their quarantine and isolation mandates have reacted to the spikes and dips of reported COVID-19 cases in Puerto Rico and will likely continue to change as the situation develops.

 

Footnotes

1 This video from the Mayo Clinic summarizes the differences between the terms. While it may be evident when a person should isolate, that is when they test positive for COVID-19 or experience its symptoms, when they should quarantine is hazier.

2 The CDC considers that a person has been “fully vaccinated” two weeks after their second dose in a two-dose series, such as the Pfizer or Moderna vaccines, or 2 weeks after a single-dose vaccine, such as Johnson & Johnson’s Janssen vaccine.

3 P.R. Dep’t of Health, Reglamento de Aislamiento y Cuarentena 3 (July 5, 2007) (translation ours).

4 Id. (translation ours)

5 Id. at 10-11.

6 P.R. Dep’t of Health, Admin. Order 454 (July 3, 2020).

7 All three of Puerto Rico’s international airports (LMM Airport in San Juan, Mercedita Airport in Ponce, and Rafael Hernández Airport in Aguadilla) have since reopened under the provisions of applicable EOs. See Discover Puerto Rico, Travel Guidelines, (April 23, 2021) https://www.discoverpuertorico.com/info/travel-guidelines.

8 Under Article 33 of Act 81 of March 14, 1912, as amended, also known as the “Organic Law of the Department of Health,” the Department of Health may impose administrative fines as high as $5,000 for the first offense.

9 P.R. Dep’t of Health, Admin. Order 499 (April 19, 2021). This is not the first time the Department of Health imposed fines for noncompliance with COVID-19 measures. On August 21, 2020, the Department of Health published Regulation 9210, which imposes an administrative fine of $100 for failing to comply with COVID-19 preventive measures like, for example, wearing a facemask when outside the home.

10 AO 499 states in paragraph FIRST that isolation is required for passengers arriving without the required negative COVID-19 test. Paragraph FOURTH of the same AO has the same language but uses the term quarantine instead. The correct term for purposes of AO 499 is quarantine because it applies such period to persons that it considers reasonably suspected of being infected with COVID-19—i.e., persons arriving to Puerto Rico from domestic and international flights without a negative COVID-19 test. If AO 499 applied such period to persons with confirmed cases of COVID-19, then the correct term would be isolation.

DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

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