# 1049
One of the most contentious debates about how to deal with a pandemic comes when the `Q’ word is used. Most public health officials will tell you that quarantines for influenza are both futile and counter productive. It remains, however, on the table since it provides at least the illusion of doing `something’.
Yesterday’s Time magazine article, Study: Quarantines Work Against Pandemics opens this unsavory can of worms again. Despite the headline, `quarantines’ were actually a very small part of the study. School closures and the cancellation of public gatherings were the real targets of study.
First though, let’s get our terms straight. Quarantine refers to the sequestering of people exposed, but not showing signs of a disease. Isolation refers to the sequestering of those who are symptomatic, and are presumed to be contagious.
Simply put, if a member of your household came down with avian flu, and was ordered to remain home, they’d be in isolation. If the Health Department ordered all other family members to remain home, even though they aren’t sick, until the incubation period has passed, they would be quarantined.
From a practical standpoint, isolation is nearly always easier to manage. Someone who is sick is more likely to remain home, than someone who simply has been in contact with a sick individual. Sick people are generally more easily recognizable, whereas someone who has been exposed but is asymptomatic (and possibly not infectious) looks like anyone else.
And there is the matter of convincing someone who, thus far, appears uninfected to stay at home with someone who is contagious. If a family has several children, and only one of them is sick, there will be a great temptation to send the other kids elsewhere, to get them out of the line of the viral fire.
The problem is, with influenza, it is believed that a person can be infectious, and shedding the virus, up to 48 hours before they show symptoms. Add in the incubation period, and someone could be infected yet appearing healthy several days before showing any symptoms.
The word `voluntary’ seems to be married to the `q’ word in most official utterances, making this a quarantine with a small `q’. Family members would be `encouraged’ to stay home if anyone is sick in their household, although lurking in the background is the assurance that the legal authority exists to enforce such voluntary actions. Whether the logistical ability of local authorities to enforce such quarantines exists is debatable.
Quarantine with a big `Q’, where groups of people are restricted in movement based on geography, isn’t talked about much. The idea that a town, or a neighborhood, might be cordoned off and egress restricted by troops simply doesn’t make much sense in an influenza pandemic. At least once a pandemic strain escapes its point of origin.
If a new pandemic strain emerged in a remote village in Indonesia, it might be possible to quarantine that area, flood the populace with Tamiflu, or even a vaccine, and quash the outbreak. But once the virus escapes a single location, quarantines with a big `Q’ become moot.
The prospect of `reverse quarantines’ does exist, particularly in some smaller, remote communities. Simply put, there may be attempts to seal off areas to prevent anyone who might be infected from entering. Gunnison, Colorado successfully implemented this strategy in 1918 during the Spanish Influenza, according to this entry in the Wikpedia.
Gunnison isolated themselves from the surrounding area during the Spanish Influenza epidemic for two months at the end of 1918. All highways were barricaded near the county lines. Train conductors warned all passengers that if they stepped outside of the train in Gunnison, they would be arrested and quarantined for five days. As a result of the isolation, no one died of influenza in Gunnison during the epidemic.
Whether this sort of strategy would work today, in a vastly more interconnected and mobile society than we saw in 1918, is hard to know. New Zealand at least plans on trying to stop the virus from entering their country. I’m sure other areas will try as well.
Once the virus escapes from Pandora’s box there will be no putting it back. Attempts at quarantine beyond the point of origin are likely to do little but enrage the population and stretch governmental resources to the breaking point. But, will someone try it?
Will the military, somewhere in the world, cordon off a city or a neighborhood or seal their borders, in a futile attempt to contain the virus?
I wouldn’t bet against it.
Particularly very early in a pandemic. There will be desperation attempts to do something, I’m sure, to slow the virus. They won’t work, of course, and in most cases I expect they will be dropped after a few days.
There will be huge public resistance to draconian measures, and of course, authorities will have the dilemma of exactly how to enforce a quarantine.
One has to hope that local officials, the military and even federal governments will rely on the advice of public health officials when it comes to enacting quarantine policy. That basically quarantine with a big `Q’ doesn’t work.
I’ve no problem with encouraging members of a household with someone who is infected to stay home until they can be cleared of possible infection, particularly if they hold non-essential jobs. It’s unenforceable, of course, but those that choose to cooperate might have some impact on the spread of the disease.
But let’s face it, using that standard, every doctor, nurse, or technician would have to quarantine themselves for two weeks after every patient they treated. It isn’t going to be practical to try to quarantine everyone who is exposed to the virus.
The reality is, once a pandemic strain of the flu makes it into the wild and begins to spread, there is little that can be done to stop or contain it. Attempts to do so are likely to be more disruptive than letting the virus run its course. I know many people are counting on somehow avoiding exposure until a vaccine can be developed, but with a vaccine at least 6 months, and probably closer to a year out from the start of a pandemic, avoiding exposure seems to me to be a long shot.
Of course, exposure doesn’t necessary equate to infection or illness.
While we won’t know the attack rate of the next pandemic until after it is over, previous pandemics have often only affected 25%-35% of the population, even when nearly everyone had presumably been exposed.
Like it or not, we all may end up exposed, and those of us who are susceptible to the disease will fall ill, while the rest of us will not. We will develop herd immunity, just as we did in 1918-1919, through exposure, and hopefully, at some point, through the availability of a vaccine. The virus will then lose its pandemic capability, and will likely become a seasonal flu, much as the H1 and H3 flu’s are today.
We will then be safe from a pandemic.
Until the next time.
