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CDC pushes for emergency act to allow quarantinesBy Eunice Moscoso / Cox News Service 11-07-01
WASHINGTON -- The Centers for Disease Control and Prevention is pushing for an "emergency health powers act" that would allow states to quarantine people in the case of a biological attack, the nation's top health official said Tuesday.
"If we did have an outbreak of smallpox, that would be, certainly, one of the avenues that we would have to quickly explore," said Secretary of Health and Human Services Tommy Thompson, in a briefing with reporters.
Thompson said that such an event would require the government to quickly develop "concentric circles" of disease containment in order to inoculate people and prevent the spread of the infectious disease.
In addition, Dr. James Hughes, director of the CDC's National Center for Infectious Diseases, said there "could be circumstances" when dealing with a contagious disease "where quarantine authorities would need to be exercised to enhance our ability to control the problem."
The plan, put together with the National Governors Association and other groups, states that a person subject to quarantine shall "obey the public health authority's rules and orders" and that failure to do so "shall constitute a misdemeanor."
It would also allow states to "use and appropriate property as necessary for the care, treatment, and housing of patients."
Scott Lillibridge, a special assistant for bioterrorism at HHS, said that such powers invoke "worst case scenarios" such as people being imprisoned, but that those are "very, very unrealistic portrayals."
The powers could be used in a public health setting to limit the spread of disease by "closing certain establishments" or "interdicting transportation," he said.
quarantine
-- Martin Thompson (mthom1927@aol.com), November 07, 2001
Health agency proposes quarantine plan for statesPosted: 11:06 p.m. EST Tuesday, Nov. 6
By SETH BORENSTEIN Knight Ridder Newspapers
WASHINGTON — In the event of a bioterrorist attack using a deadly and contagious disease such as smallpox, public health officials want to be able to close roads and airports, herd people into stadiums, and, if necessary, quarantine entire infected cities.
To make that possible, 50 governors this week will receive copies of a proposed law, drafted at the behest of the Centers for Disease Control and Prevention in Atlanta, that could give states immense new power to control their populations.
The proposed "model state emergency health powers act" may be months or years away from enactment by state legislatures. It may be amended beyond recognition. But health officials say major new public health legislation is crucial to keep smallpox, plague or hemorrhagic fevers (such as Ebola) from spreading in the event of a terror attack. Unlike anthrax, they are highly contagious.
As a general principle, the draft law says authorities could "require isolation or quarantine of any person by the least restrictive means necessary to protect the public health."
Broad quarantines envisioned in the draft have never been invoked in the United States. They raise all sorts of logistical, political and ethical questions in a mobile society, public health experts concede. But they also may save lives.
"If we don't do it, what would happen? I don't think we've got any choice but to quarantine," said Dr. Lew Stringer, medical director of North Carolina's special operations response team that handles disasters and bioterror.
"The first thing you do is shut down the roads," he said. "Then you shut down the interstates, you shut down the schools, you shut down the businesses. You're shutting down essential services, not just nonessential ones."
Communities not only need to plan for quarantines; they've got to practice them like fire drills so they work in an emergency, said Dr. Scott Lillibridge, the special bioterrorism assistant to Health and Human Services Secretary Tommy Thompson.
Addressing possible quarantines, Thompson said Tuesday: "If we did have an outbreak of smallpox, it would certainly be one of the avenues we'd have to explore."
CDC authorities and a state's governor would exercise their authority using mobilized National Guard units, said former Federal Emergency Management Agency Director James Lee Witt.
"If you look at something that's really contagious, you can try to limit the area that it would be in as much as possible," Witt said. But he added that the real question is: "How far would you go in containing it?"
Lawyers and public health professors at Georgetown University and Johns Hopkins University, in Washington, D.C. and Baltimore respectively, drafted the 40-page model law, in collaboration with associations representing governors, state and local health officials, and state attorneys general.
Congress "should give public health authorities strong powers to be able to isolate or quarantine people if necessary for the public health," said the proposal's chief author, Lawrence Gostin, professor and director at the two universities' Center for Law and the Public's Health in Washington.
Many states already have quarantine laws, but they are antiquated and may not be constitutional, Gostin said. He said his proposal would probably pass constitutional muster because it gives detainees the ability to ask a judicial-medical board to get them out of quarantine.
The question of quarantines "is probably the biggest issue (among emergency health law concerns) because it involves liberty of individuals in the public," Gostin said. He said the proposal would give officials authority to seize control of hospitals or even stadiums to house quarantined people.
The United States has a long and checkered history with quarantines, starting with a federal law passed in 1878 to cope with yellow fever outbreaks. In the early 1900s, local public health authorities carried out quarantines. They rarely isolated more than a few people and never did so effectively in a large city.
In that era, San Francisco tried to quarantine Chinese-Americans during a tuberculosis epidemic, but the tactic did not stop the disease's spread, Gostin said.
The CDC still has a quarantine division with 81 staffers and field offices in Miami, San Francisco, New York, Atlanta, Chicago, Los Angeles, Seattle and Honolulu. The division deals with health- hazardous individuals and products entering the country.
In the event of a quarantine, it's likely that people would evade restrictions and spread the infection elsewhere, experts said.
In one simulation, involving a fake plague that struck at a rock concert in Chicago, questions arose about what to do with people who insisted on breaking the quarantine said Randy Larsen, director of the ANSER Institute of Homeland Defense, an Arlington, Va., security and science think-tank.
"What are your rules of engagement?" asked Larsen, who also teaches military strategy at the National War College.
Would a National Guardsman, he asked, shoot a grandmother trying to evade quarantine?
Maybe, said Gostin. "You have to use all reasonable force to exercise that power." Sometimes, he added, that could mean lethal force.
http://web.realcities.com/content/rc/news/attack/tallahassee/195661840 8.htm
-- Martin Thompson (mthom1927@aol.com), November 07, 2001.