An Abridgement Too Far?
#248
The tempo of internet discussions on exactly how our Federal Government will respond to an Avian Flu pandemic has picked up steam in recent days, fueled in part by vague references on the Fed’s part to `quarantines’ and `isolation’ in policies now under consideration.
Given the lack of an effective vaccine, and the meager supply of antivirals on hand, policy makers are now talking more about NPI, or Non Pharmaceutical Interventions, to help control a pandemic. Among these measures are `social distancing’, the use of masks and gloves in public, the closure of schools, along with isolation and quarantine.
The fear of internment camps is one that crops up on the Internet whenever a crisis looms. There is precedent in this country, after all. The Japanese internment camps of WWII are within the living memory of many Americans. And conspiracy theorists have long pointed out the provisions in the McCarran Act of 1950, a product of the Cold War, where the government was empowered to set up `concentration camps’ in the event of a national emergency.
So it is natural, I suppose, that when words like `quarantine’, ‘travel restrictions’, and `martial law’ are mentioned as possible options during a pandemic, that people gravitate towards the worst possible interpretations.
But are any of these fears really justified?
Would our Federal government resort to draconian measures in order to contain, or at least impede the spread of a bird flu outbreak? And if so, would they be justified under any circumstances to do so?
I can only speculate here, as I have absolutely no inside knowledge of what our government is planning. What follows is strictly my personal opinion. Caveat Lector.
The use of isolation and quarantine are legitimate public health measures that could be useful in some types of disease outbreaks. No question. While they may be seen as an infringement of individual rights, they have also been shown to limit the spread of disease in the past. It has always been a delicate balance, but in public health matters, the needs of the many have traditionally outweighed the rights of a few.
Of the two, isolation is the easiest to justify. If someone were infected with a highly infectious disease, most people would accept the need to remove that person from direct contact with healthy people to avoid further spread of the disease. Isolation rooms are used in every hospital in the country, and this is nothing new.
The worry, increasingly expressed on the Internet, is that this policy might include `medical concentration camps’, or community `flu centers’ where infected individuals might be forcibly sequestered. Fears that health officials will be knocking on every door, checking family members for fever, and `removing’ suspected influenza victims abound.
Farfetched? Well, we have heard of similar strategies being used in villages in places like Indonesia and Thailand, so it obviously isn’t impossible. But it should be remembered that these containment strategies that have been tried are meant to stop a pandemic at the source, and would be of little use once the genie is out of the bottle.
While I have serious reservations that this sort of policy would work, I suppose that during the very earliest stages of a pandemic, some misguided communities might try it. The fear of a killer influenza would be a powerful motivator, and the desire to separate the infected from society will be strong. After the first week, however, I doubt anyone would bother.
This idea is flawed on many levels, and I would expect that if it were tried at all in this country, it would be abandoned very early on in a pandemic.
First, the logistics of checking every household, and of confining those suspected of infection, are nothing less than mind boggling. It would require the creation of a place to put these individuals, a large commitment of staff (medical, support, and security) to deal with them, and a large stockpile of equipment and supplies.
Second, unless the authorities were only dealing with a handful of cases in the community, the disease would already have spread beyond any hope of control by these measures. Influenza is generally so contagious, that by the time authorities are aware of a few glowing embers; the conflagration has already started.
And third, once the virus has established itself in the community, any facilities set up for receiving victims would be quickly overwhelmed. The attack rate of a novel influenza is assumed to be at least 30%, and could be twice that. There is simply no way for any community to confine, in a central location, 10%, 20%, or 30% of their population.
Hospitals will, of course, attempt to use isolation rooms or wards, and anyone turning up at the emergency room with suspected H5N1 infection will likely be sent to one of these bio-secure facilities, whether they like it or not. Again, this is a policy that is likely not to survive long into a pandemic, as these wards will be filled to capacity in a matter of days.
The `rules’ enforced during a pandemic are likely to change as the crisis evolves. I expect aggressive attempts at containment in the opening days, followed by resignation that the battle has been lost shortly thereafter.
I believe it will become apparent, very early on, that the only viable form of isolation is in each person’s home. The hospitals will be filled, and overflowing, and any ad hoc `flu centers’ will be swamped. The idea that massive `flu camps’ will be established is highly unlikely. The authorities will be lucky if they can maintain minimum staffing in hospitals, much less setting up `medical’ concentration camps.
Unless you happen to be among the unlucky few to be first infected, the odds are you will simply be sent home, and told to stay put.
Those without a home, or a family support system, will present a serious problem for authorities, and they may be special cases that find themselves `guests’ of the local medical authorities. It is, admittedly, a bad solution for a terrible problem. But there may be no other option. The alternative is to have infected patients wandering and dying in the streets.
The issue of quarantines is a much stickier one, and here, once again, the government’s actions are likely to evolve quickly as the pandemic spreads.
Quarantine is used to restrict the movement of people who have been exposed to the virus, but who are not (as yet) showing signs of infection. This would include family members of an infected individual, or anyone suspected of having had close contact with an infected patient.
A Quarantine is most commonly issued on a household level. The immediate family of an infected individual is ordered to remain at home until the incubation period of the disease has expired, and they can be presumed to be free of the virus. If a second person comes down with the virus, the quarantine `window’ is extended.
The federal government’s recommendation of having two weeks of food and water on hand is based, in part, on the perceived need for those exposed to remain home for an extended period of time. Given the likely incubation period of the virus, there are many who believe that 2-weeks is an insufficient supply to have on hand.
Issuing a quarantine order, and enforcing one, are obviously two entirely different matters.
In the opening days of a pandemic, it is possible that health authorities might be able to monitor quarantined households, when their numbers are small. But once the number of infected households reaches a certain level that would clearly become impossible. It is a simple equation of available manpower.
A quarantine could conceivably be issued for a greater geographical area than an individual household. Apartment complexes, where people live in close proximity, could find their entire facility under quarantine even though only one resident was infected. Nursing homes, and hospitals are other likely sites for quarantine.
And there are fears that larger quarantines might be imposed; neighborhoods, or even entire cities.
This would, in my opinion, quickly turn into a disaster. People in a larger area would justifiably feel that they were unlikely to have been exposed, and posed no danger to the outside world. But they would know, the longer they remained, the greater the chance of exposure, and so their desire to flee would be paramount. A mass exodus, and confrontations with authorities would result.
This would become a nightmare to try to control. It would require the use of extensive military forces, and the decision to use force against our own citizens. Presumably, our Leaders are smarter than that, and won’t even be tempted to try it.
A community quarantine is only useful if you are reasonably sure that there is only one or two foci of infection, otherwise, while you may cordon off the disease temporarily in one spot, it is performing a flanking maneuver in the next town over, spreading beyond your control. It would not be appropriate for an influenza pandemic.
If (and it’s a big `if’) a large-scale quarantine were attempted, I feel reasonably sure it would be lifted in a matter of days, as it is a fatally flawed concept when dealing with influenza, and likely to cause more problems than it would solve.
While imperfect, voluntary quarantining of households where infected victims reside is probably the only practical implementation of this policy. It would likely help reduce the spread of the disease, but would certainly not stop it.
Frankly, once begun, without a vaccine there is no way to stop an influenza outbreak. To think otherwise is to indulge in unbridled fantasy. The best you can hope for is to slow the spread.
I fully expect that local authorities, and perhaps even those at State and Federal levels, will make many mistakes early in a pandemic. Fear often overrides reason. There will be scattered attempts to stop the spread of the disease that have little or no hope of success, and some of those efforts may produce unwanted side effects. In some cases, the rights of individuals may be abridged in their desperate attempts to get control of an escalating crisis.
But I honestly feel the fears of wholesale government control, internment camps, and of them running roughshod over our lives, are being overstated.
The bottom line is, the authorities simply don’t have the manpower or resources to pull it off. They are going to have their hands full dealing with more immediate problems, including a reduction of their own forces by 40% due to the virus, and will quickly accept that they have little power to implement or enforce quarantines or enforced isolation.
For the most part, I expect that these measures will, out of necessity, be voluntary.
If a severe pandemic comes, there will be terrible decisions that will have to be made at all levels of government. Some are likely to be perceived by many of us as authoritarian and as infringements of individual rights. And in all likelihood, they may well be. There may come a time when the government feels, rightly or wrongly, that they have no other choice. There will be enormous pressures brought to bear against the government to `do something’ during a pandemic.
Questions over the use of conscription to replace fallen healthcare workers, priorities for vaccines, the allocation of scarce resources and medical triage, and even the imposition of martial law continue. All are possible in a severe enough crisis. And no matter what is decided, or how they are implemented, the rights of some segment of the population will be infringed upon.
I’m convinced that there is no evil intent in any of these unsavory options; no desire to use the upheaval of a pandemic to subjugate the populace, and certainly no eagerness on the part of authorities to implement them. I imagine they dread the prospects every bit as much as the citizens who would endure them. The political price that would be paid, after the pandemic ended, would be enormous.
But depending upon the severity, and length of a pandemic, some of them may become necessary. They would be bitter pills to swallow, on top of the grief and hardship that a pandemic would bring. One has to hope that our government, and governments around the world, will take these steps only as a last resort, and that they are quick to discontinue them at the earliest possible opportunity.
A pandemic, should it come, is more than a public health crisis, and it threatens more than just the lives of individuals. It threatens everything we hold near and dear: our freedoms, our economic security, and even our way of life.
There are no winners in a pandemic.
The better prepared we are going into one, the fewer of these terrible choices that may have to be made during a crisis.
Something to think about, as we continue to watch this viral threat grow ever nearer.
