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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.
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. Implementation of quarantine, however,
is not simple, will very likely be unsuccessful, and has significant
unintended consequences.
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.
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.
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.
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.
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.
JAMA
December 5, 2001;286:2711-2717
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