October 24, 2005

A Kinder, Gentler Quarantine.

With epidemiologists and virologists counting the months until a pandemic of avian flu strikes, it has become all-too-obvious that one of the most effective measures will be isolating infected and likely-to-be-infected populations. But 'quarantine' scares people to death, unless (perhaps) it can be rebranded - as 'community shielding'.
People could stay in their homes. It might not have to be compulsory and, in contrast with the cruel, centuries-old tradition, the individuals under quarantine would be well cared for. Formal quarantine was pioneered by the city-state of Venice in the mid-14th century, according to Cetron, when the Black Death stalked Europe. The city fathers decreed that international ships would have to wait offshore for 40 days ("quarantina" in Latin) before unloading passengers and cargo. "People either died of the contagion or survived and it was felt that the threat was over," said [Martin] Cetron, who called the practice "the sacrifice of the few for the benefit of the many."

In a flu pandemic, the effectiveness of quarantine - used to separate and restrict the movement of people or groups thought to have been exposed to a disease-causing agent - and of isolation - used for people who are already sick - will depend on the timing, said Cetron, who is director of the division of Global Migration and Quarantine of the CDC's National Center for Infectious Disease.

If a pandemic advances slowly, quarantine and isolation could buy some time to employ other measures - vaccination and the use of antiviral drugs, for example. The key is to detect the pandemic flu strain as quickly as possible.

Though a quarantine might seem like a tough sell, the world's experience with SARS suggests that citizens will come on board if they see it as in the interest of their families and communities. In Singapore, where both quarantined individuals and health care workers were stigmatized, according to Cetron, government leaders transformed the public image of the shunned groups by declaring that they were like soldiers fighting for Singapore.

Cetron said state and local health officials across the country would be in charge of community quarantine, and that state laws incorporate due process to ensure a balance between personal freedom and societal needs. The federal government is empowered to act in cases of state-to-state movement and to monitor and intercept, if necessary, those who arrive from abroad.

Quarantine-at-home is a daunting and costly undertaking, according to Dr. Ross Upshur, associate professor in the departments of Family and Community Medicine and Public Health Sciences at the University of Toronto and a member of the university's Joint Centre for Bioethics. He said more than 45,000 people in and around Toronto during the SARS outbreak were asked to remain in home quarantine for 10 days.

"That's a lot of people to contact twice a day and make sure that they're taking their temperature," he said. "That's a lot of people whose banking needs need to be serviced; who need to get food." He said that if people are going to be asked to give up their personal liberties for the good of society, the community needs to step in and help.

Dan Rutz, a special assistant for communications at the CDC's National Center for Infectious Disease, said that 85 percent of those polled for the CDC said they were "willing" or "very willing" to care for themselves or sick family members at home in the event of a serious flu outbreak. More than half - 62 percent - said they and their families would be ready to limit contact with others for a month or more. About half said they'd be willing to wait months for a vaccine so that doctors, nurses and other high-priority individuals could get vaccinated first.

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