LOS ANGELES _ Los Angeles County health officials told more than 900 college students and staff members who may have been exposed to measles to stay home this week, in one of the largest quarantine orders in state history.
The declaration has raised questions about how exactly the orders will be implemented at the University of California, Los Angeles and California State, Los Angeles, where students have been diagnosed with the disease, and how effective the mandate will be. But there is one thing public health experts agree on: They don't envy L.A.
Measles is one of the most contagious diseases in the world and a single case can lead to hundreds more. Banishing people to their homes becomes a necessary last resort in a measles outbreak, experts say, especially on college campuses where cases can rapidly spread.
"What else can you do?" said Columbia University public health professor Dr. Stephen Morse. "It's disruptive, it's resource-intensive and it doesn't make people feel very pleased _ this is basically the measure you're left with."
The five people diagnosed with measles so far in L.A. County this year include a UCLA student and a Cal State L.A. student. In total, health officials have told more than 900 people without proof of vaccination to stay home this week, though that number had dropped to around 700 by Friday afternoon as more people confirmed their immunization status, according to officials.
The orders are a major undertaking for health officials. If more people do get measles on either of the campuses, even more students may have to be quarantined, possibly through the end of school year, officials say.
"Thank God we're not confronted with this on my campus," said one East Coast university medical professor.
Health officials in other parts of the country have also been turning to extreme measures to try to stop measles outbreaks from mushrooming, including barring unvaccinated children from public spaces and mandating vaccines under penalty of fines.
The efforts are the result of public health officials' desperation as 2019 shapes up to be the worst measles year in decades in the United States. So far this year, 625 people have been diagnosed with measles nationwide, the highest case count since the disease was considered eliminated in 2000.
On Thursday evening, UCLA senior Johnny Schmidt was riding a city bus when he received an unusually long text message. It was from the UCLA dean of students.
"You may have been exposed to measles, which is very contagious," the text read. "You are mandated to isolate yourself until you can provide proof of immunization."
Schmidt panicked, unsure whether he needed to immediately get off the bus. But then he remembered he had been vaccinated against measles as a child. He asked his mother to scan his records and send them to him.
A few hours later, officials freed him from quarantine.
UCLA sent similar messages to more than 100 students who went to class in April in the same two buildings as a student sick with measles. Schmidt attended class in both buildings.
Measles spreads through coughing and sneezing, but the virus can linger in the air for up to two hours after the sick person leaves the room. If a measles patient touched a desk or a doorknob, people can pick up measles that way, too.
The order Schmidt received said he could not attend class or go anywhere else in the coming days. If he had roommates, he could not quarantine himself in his apartment, the order said.
That part was confusing, he said. Schmidt said he likely would have quarantined himself in his apartment anyway and just informed his roommates and health officials.
"I don't know where else I would go," he said.
As of Friday afternoon, the number of people quarantined at UCLA had dropped to 45, with only one student who lives on campus still under the quarantine orders, according to a county officials . Officials said they had made accommodations for that student to not stay in dorm buildings, but did not provide further details.
In 2015, the University of California system approved a regulation requiring that students be fully vaccinated before enrolling at any campus. At California universities in the last decade, there have been outbreaks of mumps, meningitis and norovirus.
But amid pushback, UC officials did not begin enforcing the regulation until fall 2018, the beginning of the current school year. Therefore, most students at UCLA enrolled before the requirement took effect.
At Cal State L.A., an infected student earlier this month visited a campus library that typically has about 2,000 people in and out per day, according to county officials.
The health department's investigation identified 660 students and 127 staff who were in the library on the same day and may have been exposed to measles and had not yet shown health officials proof of immunization, according to a statement from the university. As of Friday afternoon, the quarantine orders were in place for 550 students and 106 staff members.
None of the roughly 1,000 students who live on-campus are under quarantine orders, according to campus spokesman Robert Lopez.
Health officials said they would lift the quarantine orders as soon as people showed documentation that they had been immunized or had a lab test to verify their immunity. Without that proof, people exposed at UCLA could be quarantined until April 30 and those at Cal State L.A. until May 2.
"Really quarantine and isolation is the only thing at that stage," said Dr. Cameron Wolfe, an infectious disease specialist at Duke University.
For each patient with measles, health workers have to track everywhere that person went while contagious and figure out who they may have come into contact with during an eight-day period when they are most infectious, Wolfe said.
One sick patient could have come into contact with hundreds, if not thousands, of people, especially in a college campus, he said. Once health workers have identified those people, they need to figure out which ones of them were vaccinated.
The ones who haven't been immunized will likely need to be quarantined. People who develop measles can spread the disease to others four days before their symptoms show up, so officials can't wait to see if they develop symptoms, he said.
"Suddenly, that's a lot of people," he said. "So you can see how the concentric circles of potential contacts get pretty large, pretty quickly, especially if you're in an environment like a college campus _ getting your arms wrapped around that many people so quickly would be incredibly challenging."
Wolfe said that the vaccine can be administered in the first 72 hours after exposure, but it is difficult to catch people in that window. The exposures at UCLA and Cal State L.A. were on April 9 and 11, so the 72-hour window has passed.
Such a large quarantine order is rare, in part because it is difficult to identify everyone a measles patient may have come into contact with on the subway or at a Starbucks. School rosters make that task easier.
The California health department said in a statement that it "is not aware of a recent instance of a quarantine of this size for measles in California."
This year, officials in other parts of the country have also resorted to drastic measures to try to stop the spread of measles.
In New York City, where nearly 400 people have come down with measles this year, officials earlier this month began requiring some unvaccinated individuals in Brooklyn to pay a $1,000 fine if they did not get their shots. The measure was challenged in court, but was upheld.
In Rockland County, northwest of New York City and also the site of a major measles outbreak, officials issued an order last month banning unvaccinated children from public. That measure was overturned in court.
"There's a big difference between what New York did and what they're doing here," because the people in L.A. have been exposed to measles, said UC Hastings law professor Dorit Reiss.
L.A. did not issue a blanket order affecting anyone in the city who is unvaccinated. States have the legal power to issue quarantines for people who have been exposed to contagious diseases such as measles, she said.
Still, sometimes there are legal challenges against such quarantine orders, but those lawsuits typically fail, she said.
"Most of the time, people are asked to stay at home," she said. "So it's pretty run of the mill to do that for some people exposed."
