In the Balance | BioAttack & City Under Siege | Quarantine | Your Turn

The Counterargument:

You have decided to quarantine the city. Although you are rightly concerned that the disease will spread if citizens are allowed to move freely, there are serious drawbacks to implementing quarantine that are worth considering.

Infringing on Civil Liberties
Despite the mandate to protect the public's health, it is vital to be wary of infringing upon civil liberties, both because of the potential misuses of quarantine and because of the practice's effects on quarantined individuals and communities. Quarantine can be implemented in a discriminatory way, as historical examples in the United States demonstrate.

Howard Markel, M.D., Ph.D., a medical historian, professor, and director of the Center for the History of Medicine at the University of Michigan, asserts, "No matter how well contained an epidemic, those quarantined always undergo some type of stigmatization." Additionally, quarantined populations may be placed at heightened risk of exposure to the disease.

Challenges to Containment
Would you still choose to quarantine if there was a chance the disease had already spread? Thanks to the ease and speed of movement allowed by modern transportation and globalization, a quarantine cannot be counted upon to fully contain the spread of a contagious disease.

The SARS outbreak of 2003 demonstrated how quickly an epidemic can spread across the globe. According to the World Health Organization, between November 1, 2002, and July 31, 2003, there were 8,096 probable cases of SARS and 774 deaths from SARS in 29 countries.

Resistance to Quarantine
Public resistance to quarantine may arise, especially when the public mistrusts the government. During the SARS outbreak, the Washington Post reported on April 29, 2003, that in China:

Government officials, who initially covered up the severity of the epidemic, are now struggling to gain the trust needed to effectively implement measures to fight the disease. . . . Hundreds of thousands have fled Beijing, despite orders and pleas for them to stay in the city, because they don't believe the government can control the illness in the capital.

Such resistance to treatment can accelerate the spread of disease and undermine public-health efforts. As Georges Benjamin, executive director of the American Public Health Association, points out, "It only takes one individual not complying to cause a real problem. . . . If that one person exposes 20 people, then we have to track those 20 new people, and it really drains resources."

As these counterarguments demonstrate, quarantine is a powerful tool for controlling disease. It can save lives but can also cause harm when used inappropriately. The bottom line is that careful consideration is necessary before making any decision regarding quarantine.

Read on for concluding remarks on quarantine>>

References

Historical Examples: Bias in Quarantine

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Typhus
A typhus outbreak in New York City in 1892 primarily affected newly arrived members of the Eastern European Jewish community on the Lower East Side. Public-health officials reacted by quarantining many residents of the neighborhood on North Brother Island, where the healthy were placed at risk and where cultural needs (such as the observance of kosher traditions and burial practices) were, at least at first, ignored. Additionally, authorities often dismissed typhus diagnoses in individuals outside the afflicted communities, allowing cultural bias to outweigh medical evidence.

Cholera
During an 1892 cholera outbreak in Europe, ships entering New York City were quarantined. Wealthy and poor passengers were subjected to such different sanitary conditions that "cholera spread disproportionately among the poor on board the vessels and resulted in at least 58 deaths on one ship alone."

Plague
In 1900, San Francisco's Chinatown was quarantined after plague cases were identified there. Political pressure forced officials to lift the quarantine, but fear of the disease's spread coupled with a severe lack of medical understanding ultimately prompted President McKinley to order a quarantine of all Chinese and Japanese individuals in the city. A federal court overturned the quarantine based on its violation of the equal protection guarantees of the Fourteenth Amendment to the Constitution.