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Quarantine trample civil liberties { April 26 2003 } Original Source Link: (May no longer be active)
http://www.washingtonpost.com/wp-dyn/articles/A39436-2003Apr25.htmlhttp://www.washingtonpost.com/wp-dyn/articles/A39436-2003Apr25.html
Laws Not Up to SARS Epidemic
Quarantining the Infected and the Exposed May Trample Civil Liberties
By Ceci Connolly
Washington Post Staff Writer
Saturday, April 26, 2003; Page A01
With the spread of the highly contagious SARS virus from Asia to Toronto, federal officials here say this nation's patchwork of public health laws, many 100 years old and possibly unconstitutional, has left the United States ill-prepared to handle a major epidemic.
Though there are just 41 probable cases of severe acute respiratory syndrome (SARS) in the United States, experiences in Beijing and Toronto illustrate the urgent need for clear laws that protect public health and personal liberties, advocates of comprehensive legal change say.
Because there is no treatment or vaccine for SARS, and because the virus that causes it is so virulent and contagious, medical experts said, the most effective way to limit transmission is to isolate those who have been infected and quarantine those who have been exposed.
Only recently -- weeks, if not months, after SARS hit -- have officials in China and Canada begun cordoning off entire buildings containing infected patients. Physicians such as Abraham Verghese say that slow response permitted the deadly virus to infect many others in their own countries and beyond. "The lesson of Hong Kong, China and, to some degree, Singapore is if you don't aggressively isolate, this thing can get out of hand," said Verghese, director of the Center for Medical Humanities and Ethics at the University of Texas Health Sciences Center at San Antonio.
In Virginia, which has reported three probable and five suspected cases of SARS, health officials have been enlisted in a massive, Centers for Disease Control and Prevention-organized effort to track down passengers who flew on planes with those suspected of having the disease. But one CDC official has acknowledged that passenger information being sent to the states could be wrong.
If the United States saw a surge in SARS cases, it is unlikely most states would have a clear plan for protecting public health and personal liberties, said Michael T. Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota.
"How do we deal with mass isolation or quarantine? How do we close large venues? How do we take control of an entire airplane?" he said. "Quarantine is not a panacea, but it can be a useful tool. We don't even have it well-defined as a tool."
The underlying principle behind isolating infectious patients and quarantining those exposed to the virus is that "the needs of the many outweigh the needs of the individual," said Howard Markel, a physician and author of the upcoming "When Germs Travel."
The problem, said legal scholar James G. Hodge Jr., is a patchwork of 50 different state laws, many antiquated, contradictory or too disease-specific to work today. Some might not withstand a constitutional challenge because they do not provide for due process.
Other legal analysts said that the government has enough statutory authority to act in an emergency.
"The idea that a judge is going to step in and tell a health director he can't do something, when that health director says we need it to save thousands of lives, is absurd," said Edward Richards, director of the Program in Law, Science and Public Health at Louisiana State University.
Public health experts are in wide agreement that U.S. officials would always attempt voluntary isolation and quarantine at the first hint of a potential epidemic.
"It only takes one individual not complying to cause a real problem," said Georges Benjamin, executive director of the American Public Health Association. "If that one person exposes 20 people, then we have to track those 20 new people, and it really drains resources."
At the request of the Bush administration, Hodge and his colleagues at the Center for Law and the Public's Health at Georgetown and Johns Hopkins universities drafted a model law early last year intended to help states respond rapidly to bioterrorism. The bill would provide broad powers for health officials in the event of a large-scale medical emergency, such as a smallpox attack, as well as allow individuals to appeal a quarantine order.
Twenty-two states and the District passed parts of the bill, but others, such as California, Connecticut, Oklahoma, Minnesota and Nevada, have yet to act. The result, said legal scholars, is a fragmented approach to potentially global problems. "Not having a universal system is a chink in the armor," Markel said. "It's a small world that's getting smaller every day."
In Toronto, an "obnoxious, threatening, belligerent" health care worker showing SARS symptoms refused to quarantine himself at home for 10 days, putting many others at risk, a regional medical officer there said. After denying the existence of the disease, Beijing officials are racing to contain the outbreak. The People's Hospital has been wrapped in yellow police tape with 2,000 patients and workers inside. Singapore announced that it intends to open a camp for any of the 2,500 people under home quarantine who disobey.
"Restricting the movements of healthy people who might have been exposed to disease is not something one does lightly," Verghese said. "On the other hand, if we had a kind of outbreak like they've had in Singapore, there would be a hue and cry about why didn't we quarantine."
Large-scale quarantine was a common prevention technique at the turn of the 20th century, when isolating infected patients was the most effective way to slow contagious diseases such as cholera and tuberculosis. Today, state health officials routinely quarantine individual TB patients.
But an epidemic would quickly make that approach unrealistic, said several state health officers. "To take everyone in an apartment building or in a hospital or set geographic area, and attempt to limit their movements for a period of time would be hard," said James Hadler, Connecticut's state epidemiologist.
Legislators in Connecticut and Nevada are debating public health authority statutes, but the version crafted by Hodge and colleagues may not be sufficient in situations such as SARS, where there is no single, cataclysmic event. "The government would need to declare the emergency before any powers were triggered," said co-author Lawrence O. Gostin.
Passing laws may make politicians feel good, but it does not necessarily mean the public is any better protected, Richards of LSU said. "With state budgets in terrible shape, they are looking for easy fixes, so they pass these laws instead of providing resources. That could give people a false sense of security," he said.
At the same time, the CDC effort to track down airline passengers is running into problems posed by the antiquated system for collecting traveler data. When the CDC enlisted state health officials, a deputy director acknowledged that "the burden of these notifications is significant."
Martin S. Cetron, deputy director of the CDC's Division of Global Migration and Quarantine, in a letter to state epidemiologists dated April 25, offered a "triage" list to help local officials prioritize their efforts. Passengers sitting within two rows of a traveler who has tested positive for the SARS virus top the list.
Cetron also noted that information on the airline passenger lists being sent to the states could be wrong. "It is gathered by manually merging handwritten airline manifest lists and handwritten customs declarations with locating information of each passenger," he wrote.
Virginia officials have contacted more than half those on the passenger list sent by the CDC about a week and half ago, according to Denise Sockwell, regional epidemiologist for Northern Virginia. Officials have had to visit or write those individuals they could not contact by phone, she said. They check if the passengers have been ill, and instruct them to monitor their health for 10 days.
"Sometimes people wonder, 'How'd you get to us?' " she said. "We tell them, 'We got it from the CDC.' " Officials also don't make a point of telling people how close they were to the suspected patient. Otherwise, "people start thinking through who was sitting around them. It's better to just say, 'We have been told you were near someone,' " she said.
Staff writer Michael Laris contributed to this report.
© 2003 The Washington Post Company
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