Yes We Love Quarantine. Please Don't Do It.

Health Affairs published today a report by Blendon et al. of the opinions of those around the world toward quarnantines for public health emergency.

Most Americans favor the use of quarantine as a weapon against contagious diseases like SARS and avian flu, but that support dries up quickly when the talk turns to strictly enforcing and monitoring the quarantines. This message is contained in a new study, “Attitudes toward the Use of Quarantine in a Public Health Emergency in Four Countries,” that will be published 24 January on the Health Affairs Web site. While 76 percent of Americans surveyed said they favor quarantining those potentially exposed to serious contagious diseases, only 42 percent supported a compulsory quarantine under which those who refused to comply could be arrested.

Among residents of Hong Kong, Singapore, and Taiwan, the threat of arrest also reduced support for quarantine, according to Robert Blendon of the Harvard School of Public Health and his coauthors, John Benson and Catherine DesRoches of Harvard and Martin Cetron, Theodore Meinhardt, and William Pollard of the U.S. Centers for Disease Control and Prevention (CDC). However, in these Asian nations, which recently experienced quarantines and other public health measures in connection with the SARS epidemic, the use of quarantine retained majority support even when the arrest sanction was included.

In the U.S., the threat of arrest reduced support for quarantine especially among African Americans. In phone interviews conducted between 18 November and 16 December 2004, 90 percent of blacks said that they supported the use of quarantine, compared with 76 percent of whites. But when told that quarantine violators could be arrested, only 33 percent of blacks stood by the use of quarantine, versus 46 percent of whites.

This is at the conceptual level vacuous; proof of the obvious. I have a hard time imagining the execution of this study ... zzz ... yup ... same as you guessed before you funded us. But at another level it is important - even fascinating - because it suggests the actual dimension that the police will face, and the specific pressures on politicians that will arise particularly in the U.S.. How will the U.S. government in particular, given the abject failure with Katrina, deal with the clear threat of insurgency when a quarantine becomes necessary, given what the study reveals to be a very large group likely to rebel. Print this one off and send it to your public health commissioner.
[thanks Jim Fossett]

posted Jan 24, 2006 | link | jump to the comments (12)

comments

Why is this vacuous? Understanding attitudes toward quarantime would seem to be a worthwhile effort, especially as public health officials express increasing concern about pandemic outbreaks in the not too distant future.
So some people--more of whom are black than are white--say in a survey that they would oppose mandatory quarantine policies that would allow the arrest of quarantine violators. You conclude from this that there would be race riots? (If that is in fact what you mean by "insurgency," which is an interesting word choice . . .)

- by Lurker on Jan 24, 2006 at 3:19 PM | link

Three things:
* Just because a person opposes a regulation does not necessarily mean she will rebel against it. Many (most?) people obey at least a few laws they disagree with. Some will use legal means to advocate for a change in the the law or policy. A small number will use non-violent (though perhaps illegal) means to protest the law or use of the law that they see as unjust. Very few will choose be involved in an "insurgency".
* It is interesting that neither this blog post nor the original article focus on the result that 90% of 'African-Americans', 88% of 'Hispanics' and 76% of 'whites' "initially favor" quarantine. This suggests that the focus should be on developing quarantine policies and procedures that will not (or only rarely) require arrest. At least according to this study, the vast majority African, Latino, and European Americans would support a well designed quarantine plan that does not depend on arrest. We will have to 'think outside the box' to develop such a plan.
* I hope that one day study results like these will not be 'vacuous', that is, one day our health care, legal, and police systems will be just and no person or group will have reason or desire to distrust, protest or rebel against them. I admit that that is idealistic, but we can certainly do better than our current systems.

- by Karama Neal on Jan 24, 2006 at 6:01 PM | link

"Vacuous" is not the word you want, merely "unsurprising." The survey results are expected the same way we expect most people to say they want good schools and infrastructure, but don't want to pay any taxes for them, or the way people are all gung ho about war until there are casualties.
But, you know, most survey results are unsurprising. As Kuhn said, scientists do not go looking for novelty, and when science works, they don't find any.

- by rob helpy-Chalk on Jan 24, 2006 at 6:20 PM | link

Isolating members of the population so they do not spread disease is a relatively good idea. The problem is that some people may not like the idea of being removed from their family and support to be put on their own. While that makes good sense, you're going to find that a lot of people would oppose that just on face value.

- by Joseph O'Donnell on Jan 25, 2006 at 4:00 AM | link

As was briefly mentioned, quarantine is not just an opinion - but a legal process. Persons having the flu or pertussis refuse to stay home and quarantine themselves. We have little hope of having an effective quarantine policy unless it becomes a front-line issue in the political realm. Has anyone ever researched "Typhoid Mary"? If not, you should. It gives a very interesting and true perspective on this issue.

- by Amy Winger on Jan 29, 2006 at 11:59 AM | link

I think that in the case of SARS or other potentially epidemic diseases quarantine is essential. I dont understand why people would want to take the risk of giving something potentially deadly to others. Especially their family. I know if I got it I would be deeply saddened to be apart from my family and others but I would have to say that in protecting them from something as harmful as this I could find comfort. Also if I gave something like this to one of my children and they died, how could I deal with this if it was something that was preventable.

- by Eamigh on Jan 29, 2006 at 1:22 PM | link

The thought of being arrested and placed in quarantine may have made some say Hmmmm. . .maybe this isn't a good idea. However the statistics do point out that initially the majority favored the concept. Also I'm sure many people of all nationalities would agree that those with infectious diseases that may kill you should be quarantined-also was quarantine explained? An uneducated person may think by being "quarantined" you have no contact with anyone-which isn't true-we need to contain these diseases for treatment and future spread of the infectious entity--however it is 2006--so we will not be locking anyone up or sending them to an isolated island to die, they will be given medical treatment in a controlled atmosphere. Policies need to be written on this issue since it is such a current threat to our nation, and education of citizens in regards to the issues and actions that will be taken is imperative.

- by Kasey O'Neil on Jan 29, 2006 at 4:17 PM | link

There's an interesting thought-experiment in Tom Clancy's Executive Orders. Terrorists acquire a strain of Ebola that's transmitted much more easily than the usual kind, and they try to set off an epidemic in the US. Several people do get sick and die, but fortunately the virus is not robust enough to bring about the devastation that the terrorists hope for. But the President, not knowing that, has to make snap decisions about public health and there is the inevitable political nitpicking about everything he does and doesn't do.
I remember from reading And the Band Played On that as the AIDS epidemic was exploding in San Francisco and New York, it was understood that shutting down the gay bathhouses would have gone a long way toward containing the outbreak, but no one had the political will to even try. Or possibly the political power to bring that about if they did try.
And everyone remembers the swine flu fiasco, when the flu turned out not to be the threat the government made it out to be, but several people came down with Guillain-Barré syndrome after they were vaccinated.
I don't have any great hopes for our public health system to do anything about avian flu if it ever does become a problem here. I don't think anybody will take responsibility for doing anything unpopular. Let's all hope we dodge this bullet.

- by Laura(southernxyl) on Jan 29, 2006 at 11:39 PM | link

http://www.pbs.org/wgbh/nova/typhoid/ is the link for information on Typhoid Mary.
Laura, thanks for the vote of confidence for the public health system! Maybe a look at the number of deaths which still occur from flu would "color your vision" a little. A flu shot goes a long way towards prevention, and no war was ever won without casualties.

- by Amy Winger on Jan 31, 2006 at 7:35 PM | link

Amy, do we have a flu shot that would work against the avian flu we keep being warned about?

- by Laura(southernxyl) on Jan 31, 2006 at 9:39 PM | link

If we quarantine people, just maybe the people that do not want to catch these virulent diseases may want to stay in. Maybe if the world shut down around the contagious, they would be forced to stay in and recover from these diseases. I am a nurse and expose myself to these threats everyday that I go to work, that is who I am, but if stores and schools and etc. close down due to epidemics, where will these sick people have to go. I am not sure that forced quarantine will be a major issue.

- by Karen Nellis on Feb 7, 2006 at 4:22 PM | link

In theory, a quarantine in the event of a pandemic sounds good. In actual practice, it would be nearly impossible. People are not self sufficient beings. There are not months and months worth of canned goods in our basements, nor is there a cow to milk in the backyard or a chicken for eggs or chicken soup. The reality is that people need the infrastructure that has been built around them and they have become dependent upon. If they are forced into quarantine, even for a short time, many would have great difficulty surviving. The cost in dollars and cents with lost revenue to businesses will not be able to operate under a quarantine would be unimaginable. If a pandemic strikes, I believe we are in big trouble with or without a quarantine.

- by Judy Northrop on Feb 13, 2006 at 10:31 PM | link