[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.

[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

  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.