Quarantines Not the Answer to a Flu Pandemic

Commentator Lawrence Gostin, an expert on public health at Georgetown University, says the government should be very careful about making plans to institute quarantines in case of an influenza pandemic. He says that, besides infringing on individual liberties, quarantines aren't the best tool to use against influenza.

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STEVE INSKEEP, host:

Those traditional public health measures include travel and border restrictions, simple hygienic practices like disinfecting contaminated surfaces, wearing masks, and one of the most effective measures is simple thorough hand washing. Now, there are other measures up to and including quarantines, but public health attorney Lawrence Gostin says it's hard to use them while safeguarding individual rights.

Attorney LAWRENCE GOSTIN (Head, Center for Law and the Public's Health, Georgetown University Law Center): It is assumed but not proven that decreased social mixing would slow the spread of pandemic influenza. This could include closing public places, such as schools, work places and mass transit, or canceling public sports or conferences. As fear increases, people may voluntarily shun public gatherings.

But social separation for long periods of time can cause loneliness and emotional detachment. It can disrupt social and economic life and infringe individual rights. People whose family and friends have died might not be allowed to attend funerals or church services. A modern quarantine probably wouldn't involve forced confinement. More likely, it would simply mean asking people to stay at home or shelter in place.

Quarantines could entail confinement in hospitals, schools or work places, or institutional settings, such as military bases or stadiums. Or public health officials might quarantine an entire geographic area. Isolation and quarantine were widely used in Asia and Canada during the SARS outbreaks. But influenza is very different from SARS. With influenza, individuals become highly infectious early in the illness, which would allow little time for isolation or quarantine.

As a result, I believe isolation and quarantine would be of limited use in an influenza pandemic. And the logistical problems of large scale quarantines would be formidable. We would need to ensure safe and hygienic locations, provide food, water, clothing and medical care; and maintain effective communication with the outside world. Care for the poor disabled and elderly is extremely important, as we learned from the tragedy of hurricane Katrina. Monitoring and enforcement are equally problematic. Would the federal government use the military to keep order as President Bush has suggested.

People have a constitutional right to due process of law when they are deprived of liberty. Pandemics are deeply divisive. To be successful, the government must gain the public's trust by acting transparently and in accordance with the principles of social justice.

The way we respond to a health crisis, whether we choose to exercise authoritarian powers, whether or not we protect the vulnerable is a measure of our society.

INSKEEP: Commentary from Lawrence Gostin. He heads the Center for Law and the Public's Health at Georgetown University Law Center.

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