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Info, Not Quarantine, Key to Bioterror Response
Reuters ^ | December 4, 2001 | Charnicia E. Huggins

Posted on 12/04/2001 8:35:45 PM PST by Timesink

Tuesday December 4 5:21 PM ET

Info, Not Quarantine, Key to Bioterror Response

By Charnicia E. Huggins

NEW YORK (Reuters Health) - The primary defense against the spread of smallpox or any other germ used in a bioterrorist attack should not involve a large-scale quarantine of potentially exposed individuals, as some emergency management personnel have proposed, researchers assert.

Instead, isolating exposed people, restricting mass transportation and informing the public about the nature of the outbreak and how they can minimize their risk of illness may more effectively prevent the spread of disease, according to a team of public health and biodefense experts.

``Credible, authoritative public information is the key to managing both the disease effects of the outbreak and the terror effects on America,'' lead study author Dr. Joseph A. Barbera of George Washington University in Washington, DC, told Reuters Health.

``Implementation of quarantine, however, is not simple, will very likely be unsuccessful, and has significant unintended consequences,'' he added.

Historical evidence suggests that quarantine can be harmful in some cases, leading to both the spread of disease from infected to noninfected persons sequestered together and to violence, if quarantined individuals resist the public health sanctions placed on them, Barbera's team reports in the December 5th issue of The Journal of the American Medical Association.

A further concern is bias, the authors note, which was seen during the quarantine instituted in 1900 after several Chinese residents of San Francisco were diagnosed with the plague. This quarantine, which included only Chinese households and businesses, was later judged unconstitutional because it unfairly promoted ethnic bias.

In addition, a large-scale quarantine would necessarily involve not only a prolonged separation of family members and possible stigmatization of the quarantined area, but also ''potentially severe injury to the psyche of America, since for the first time we will be secondarily victimizing the victims of terrorism, rather than providing the usual outpouring of response and assistance that has inspired America and the world,'' Barbera said.

Thus, before calling for quarantine, officials should determine whether or not the action is warranted and feasible, and if its potential benefits will outweigh any adverse consequences, Barbera and colleagues advise.

In doing so, officials should consider whether the quarantine will effectively and significantly diminish the spread of disease, and whether there are enough resources to enforce and maintain the quarantine, including keeping areas of confinement safe and clean, and providing confined individuals with adequate food and medical care.

Lastly, decision-makers should determine the potential health risks to noninfected persons under quarantine, the consequences of noncompliance, and the economic effects of restricting commerce and transportation to and from the areas of confinement.

Viable alternatives to quarantine include isolation, whereby individuals known or suspected to be infected with a contagious disease are kept apart from others, as well as rapid vaccination or treatment programs, the report indicates.

Other ``more practically achievable'' methods of disease containment, depending on the specific circumstances involved, may include restricting large gatherings, instituting short-term voluntary home curfews, promoting widespread use of disposable masks, and closing buses, trains and other systems of mass transportation.

``With modern, in-depth understanding of specific diseases, more specific and medically valid response is appropriate than that used in the era of poor scientific understanding that established the practice of quarantine,'' the researchers conclude.

``(We) hope that our article will focus the political and public health dialogue so that realistic, effective capabilities are in place to limit the natural or deliberate outbreak of contagious disease,'' Barbera added.

SOURCE: The Journal of the American Medical Association 2001;286:2711-


TOPICS: Front Page News; Government; News/Current Events
KEYWORDS: smallpoxlist
I'm posting this because it's quite a challenge to Conventional Wisdom on the matter of smallpox quarantines, a CW I admit to sharing myself. But this article is making me think twice.
1 posted on 12/04/2001 8:35:45 PM PST by Timesink
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To: Timesink
Here's the AP story on the same article:

Tuesday December 4 4:02 PM ET

Essay Sees Problems in Quarantine

By LINDSEY TANNER, AP Medical Writer

CHICAGO (AP) - Picture entire neighborhoods of people suddenly forbidden to leave their homes, with streets patrolled by armed guards, violators carted off to jail and businesses ultimately ruined.

That is what happened in real-life U.S. examples of quarantine - a drastic measure that should be used only as a last resort against bioterrorism, ethicists and public health experts say in a medical journal essay.

While mass quarantines have not been imposed within U.S. borders for eight decades, they suddenly seem plausible given the new threat of large-scale bioterrorism prompted by Sept. 11 and the anthrax attacks.

Health and Human Services Secretary Tommy Thompson has said that quarantine would be among the measures considered if there were a smallpox outbreak.

But while local, state and federal authorities can all legally impose a quarantine, it is one of the most restrictive, most problematic and least effective options for curbing the spread of disease, the authors said in Wednesday's Journal of the American Medical Association.

Quarantine ``should not be the knee-jerk response. We should quarantine only as a last resort, and then only if it's preplanned in a very careful, planned, strategic way,'' said Lawrence Gostin, professor of law and public health at Georgetown University.

For one thing, a quarantine probably would be ineffective in curbing a terrorist smallpox outbreak because patients are contagious before symptoms appear, and would thus most likely have spread the disease before being diagnosed, said Dr. Joseph Barbera of George Washington University's Institute for Crisis and Disease Management, lead author of the report.

Isolating infected patients, closing down mass transportation or barring large public gatherings all might make more sense, he said.

The authors cite three examples to show the potential consequences of quarantines:

- In 1892, during a cholera outbreak in Europe, New York imposed a quarantine on ships traveling from Europe. Poor passengers were confined below deck without sanitary provisions, and cholera spread disproportionately among them, with at least 58 deaths on one ship alone.

- An outbreak of smallpox in Muncie, Ind., in 1893 resulted in many neighborhoods being quarantined, with infected residents confined to their homes and armed guards patrolling the streets. Some residents resisted and several public health officials were shot.

- When plague broke out in San Francisco in 1900, a quarantine was imposed in a Chinese neighborhood, hurting thriving businesses.

2 posted on 12/04/2001 8:37:35 PM PST by Timesink
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To: All
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3 posted on 12/04/2001 8:38:57 PM PST by 2ndMostConservativeBrdMember
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To: Timesink
Here's the abstract of the JAMA article (you have to have paid access to view the full thing):

Large-Scale Quarantine Following Biological Terrorism in the United States

Scientific Examination, Logistic and Legal Limits, and Possible Consequences

Author Information  Joseph Barbera, MD; Anthony Macintyre, MD; Larry Gostin, JD, PhD; Tom Inglesby, MD; Tara O'Toole, MD; Craig DeAtley, PA-C; Kevin Tonat, DrPH, MPH; Marci Layton, MD

Concern for potential bioterrorist attacks causing mass casualties has increased recently. Particular attention has been paid to scenarios in which a biological agent capable of person-to-person transmission, such as smallpox, is intentionally released among civilians. Multiple public health interventions are possible to effect disease containment in this context. One disease control measure that has been regularly proposed in various settings is the imposition of large-scale or geographic quarantine on the potentially exposed population. Although large-scale quarantine has not been implemented in recent US history, it has been used on a small scale in biological hoaxes, and it has been invoked in federally sponsored bioterrorism exercises. This article reviews the scientific principles that are relevant to the likely effectiveness of quarantine, the logistic barriers to its implementation, legal issues that a large-scale quarantine raises, and possible adverse consequences that might result from quarantine action. Imposition of large-scale quarantinecompulsory sequestration of groups of possibly exposed persons or human confinement within certain geographic areas to prevent spread of contagious diseaseshould not be considered a primary public health strategy in most imaginable circumstances. In the majority of contexts, other less extreme public health actions are likely to be more effective and create fewer unintended adverse consequences than quarantine. Actions and areas for future research, policy development, and response planning efforts are provided.

JAMA. 2001;286:2711-2717

Author/Article Information



Author Affiliations: Institute for Crisis and Disaster Management, George Washington University (Dr Barbera), and Department of Emergency Medicine, George Washington University Medical Center (Dr Macintyre and Mr DeAtley), Washington, DC; Center for Law & the Public's Health, Georgetown University and Johns Hopkins University (Dr Gostin), and Center for Civilian Biodefense, Johns Hopkins University (Drs Inglesby and O'Toole), Baltimore, Md; Office of Emergency Preparedness, Department of Health and Human Services, Rockville, Md (Dr Tonat); and Department of Public Health, New York, NY (Dr Layton).

Corresponding Author and Reprints: Joseph Barbera, MD, 13814 Oxmoor Pl, Germantown, MD 20874 (e-mail: jbarbera@seas.gwu.edu; emdjab@gwumc.edu).

Disclaimer: The opinions and findings in this article are those of the authors and should not be construed as official policies or positions of the US Public Health Service or the New York City Department of Health.

4 posted on 12/04/2001 8:43:50 PM PST by Timesink
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To: *Smallpox List; Alamo-Girl
Indexing
5 posted on 12/04/2001 8:48:25 PM PST by meridia
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To: meridia
Thanks for the heads up!
6 posted on 12/04/2001 8:59:13 PM PST by Alamo-Girl
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To: Timesink
Had we quarantined the early AIDS patients, we wouldn't have the epidemic we have now. Instead we turned loose the breeders.
7 posted on 12/04/2001 9:47:42 PM PST by holyscroller
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To: Timesink
bumpity bump
8 posted on 12/04/2001 11:53:56 PM PST by Timesink
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To: Timesink
afternoon bump
9 posted on 12/05/2001 11:44:49 AM PST by Timesink
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To: Timesink
late night bump
10 posted on 12/05/2001 8:08:12 PM PST by Timesink
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