Disease under house arrest


Quarantine: Today the details are high-tech, but the principle hasn't changed in centuries - isolating the infected to control contagion.

March 25, 2003|By Erika Niedowski | Erika Niedowski,SUN STAFF

In Quarantine, a 1989 science fiction thriller, some zealous officials whose society was ravaged by a killer disease took drastic steps to isolate the infected. The execution might have been a little flawed - the sick were dropped through a chute to a concentration camp - but the practice is based on sound science.

Trying to stem the global outbreak of severe acute respiratory syndrome, or SARS, public health practitioners in 14 countries on three continents have been employing a range of infection-control measures, including isolating hospital patients in special air-tight rooms and ordering suspected carriers to stay at home.

In a rare step yesterday in Singapore, Health Minister Lim Hng Kiang invoked the Infectious Diseases Act, forcing the quarantine of 740 people for 10 days.

The government promised to send groceries and medical workers to residences, but it also threatened heavy fines for anyone who violated the quarantine.

In the United States, where 39 SARS cases are being investigated, quarantine inspectors with the Atlanta-based Centers for Disease Control and Prevention have intercepted five airplanes or ships carrying people who had fallen ill after visiting the affected areas overseas.

Those individuals were whisked away to health care facilities while the remaining passengers were temporarily detained so authorities could determine how to contact them later if necessary.

Since ancient times, quarantining sick people has been an effective strategy to stop disease. With the outbreak of the most recent illness, scientists are still relying on early detection and early isolation.

"We know that we can apparently prevent spread of this illness by use of appropriate precautions in health care environments," Dr. Julie L. Gerberding, head of the CDC, said last week.

The captain of a ship or plane entering the United States from a foreign location is required by the CDC to report certain infectious illnesses.

Quarantinable diseases include cholera, tuberculosis, diphtheria, plague, smallpox, yellow fever and various viral hemorrhagic fevers, such as Ebola.

The CDC doesn't actually have the authority to quarantine someone who is suspected of having SARS - a relatively new flu-like disease whose cause hasn't been definitively identified - because it isn't on that list.

States develop their own regulations for quarantining patients who pose a public health threat; hospitals are required to have infection-control experts who can determine when isolation and quarantine are necessary.

Some public health officials actually debate whether to use the term quarantine at all, which has long carried a stigma.

The word comes from the Latin quaresma, which means forty. According to the CDC, the practice originated in the 14th century, when ships arriving in Venice from ports infected with plague had to sit offshore for 40 days before they were allowed to land.

In the United States, keeping people protected from infectious disease was largely seen as a local matter during the Colonial era.

But outbreaks of yellow fever prompted Congress to pass legislation in 1878 that laid the groundwork for federal oversight of quarantine activities. In 1892, after the introduction of cholera from overseas, the law was reinterpreted to give the federal government more authority.

Gradually, local quarantine stations were transferred to federal control.

A century ago at New York's Ellis Island, once the gateway for immigrants, doctors examined tens of thousands of men, women and children for about 60 symptoms that might indicate disease - and quarantined those they felt posed a public health threat.

Today, the U.S. Public Health Service is the agency responsible for preventing the introduction and spread of infectious disease to this country from foreign ones.

Under its authority, the Division of Global Migration and Quarantine may detain and medically examine people (or animals) suspected of carrying a communicable disease.

The division, which is part of the CDC's National Center for Infection Control, maintains eight quarantine stations at airports in Atlanta, Miami, Chicago, New York, Honolulu, San Francisco, Los Angeles and Seattle, Wash.

Every day for the past 10 days, quarantine officials have been meeting more than 50 flights arriving from Hong Kong, China and other affected areas in Southeast Asia.

They have distributed more than 60,000 medical alert cards urging individuals to monitor their health for seven days and see a doctor if they develop a fever, cough and trouble breathing. In some cases, they have boarded planes to assess whether sick passengers showed symptoms of SARS.

Of course, the ability to prevent infection depends on public health workers identifying as quickly as possible how the disease is being spread - something they almost always do even before they know its cause.

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