Tuesday December 4 4:02 PM ET
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.
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