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Last Updated

18 Dec 2002

Source: Associate Press, January 28, 2002.

States Revisit Old - Style Quarantines


ATLANTA (AP) -- Sobered by the recent alarm over anthrax and bioterrorism, state officials have begun using the Q-word: quarantine.

The public health tactic has been revisited as officials consider roping off homes, blocks, or even entire cities to keep a potentially dangerous agent from spreading.

Health leaders stress it would take an emergency, like a wide release of smallpox in a sprawling airport, to trigger a quarantine, which would restrict potentially exposed people to a tightly controlled area.

But at least 20 states and the federal Centers for Disease Control and Prevention are reviewing their quarantine laws, trying to determine exactly who has the authority to call one -- and who would enforce it.

"We realize the Q-word is pretty loaded with emotion,'' said Dr. Marty Cetron, deputy director of the CDC's quarantine division. "The struggle to balance individual liberty with the public good is not something we take lightly.''

The anthrax attacks in the fall killed five people, but anthrax isn't contagious. If terrorists released deadly smallpox, plague or Ebola virus, quarantines could be critical to prevent thousands of deaths, experts said.

In the shadow of the new threat, some states are revisiting their quarantine laws for the first time in decades -- and finding they are vague and woefully outdated, if not unconstitutional.

Under some existing laws, "You'd probably end up with large amounts of confusion and indecision,'' said Lawrence Gostin, a Georgetown University public health professor. "And you're losing critical time. You're causing confusion and panic in the population.''

Rushing to help states that wanted to be more prepared after Sept. 11, the CDC asked Georgetown and Johns Hopkins universities to write a sample law that legislatures could use as a pattern.

The latest version includes detailed instructions for handling a quarantine, declared by a state's top health officer. It directs the government to use the "least restrictive means necessary'' to keep a killer germ from spreading.

And it takes pains to make sure the quarantined people -- whether it's an office building or an entire neighborhood -- get enough food, decent clothing and good medical care.

Health officials say it represents a huge shift in the purpose of the quarantine itself -- focusing on caring for the people who may have been exposed instead of just shutting them off from the population.

Still, health officials admit they're fighting fears produced at the mere mention of quarantine -- images of armed guards swarming around hospitals, with infected patients left helpless inside.

But huge advances in public health since the old days of quarantines, particularly in the study of infectious disease, should reassure people that such a doomsday scenario is the smallest of possibilities, the CDC says.

"The public is a lot smarter than people think,'' said Dr. David Fleming, CDC's deputy director for science and public health. "This is common sense.''

What's not as clear is exactly who would enforce a quarantine. CDC lawyers have told state health officers that the law allows lots of options, from local police departments to a state National Guard regiment to the U.S. military.

It all depends on the danger of the outbreak, how soon it's detected and how widely the germs are believed to have spread, Cetron said.

The uncertainty has arisen partly because quarantining is a fairly rusty process. Mass quarantines haven't been seen in the United States for decades.

If there's one thing health experts learned from anthrax, it is that the public demands clear information from an authoritative government figure in the event of a bioterrorism crisis, said Gostin, who wrote the sample law.

"There should be very clear communication to the public,'' he said. "Failing that, you could have hysteria, confusion and even civil disobedience. You can't overestimate the importance of calm.''