# 3331
Quarantine, or in this case involuntary isolation, is a subject that comes up fairly often when we talk about infectious diseases.
There are, admittedly, rare times when either strategy can be appropriate.
To get the terms straight, isolation refers to separating those who are infected and contagious, from the rest of society.
Quarantine means separating those who have been exposed, but are not yet showing signs of illness, from the rest of the population.
First today’s article, then some discussion.
Delhi makes swine flu patients' hospitalisation mandatory
New Delhi, June 12 : With the rise in the number of swine flu cases in India, the Delhi government late Friday invoked the Epidemic Act, making it mandatory for any person who has tested positive for A(H1N1) to get admitted in identified hospitals.
“The Delhi government has invoked the Epidemic Act. Under Section 2 of the act, it is mandatory for a person infected with the flu to get admitted in an identified hospital. If the person refuses to do do, police would be asked to detain him,” Delhi Health Secretary J.P. Singh told IANS.
The decision was taken Friday night after a 35-year-old man, who had come here from New York via London, showed swine flu-like symptoms.
The man had come to India June 2 and had gone straight home from the airport. He had refused to get admitted to the Ram Manohar Lohia Hospital despite being tested for swine flu. The virus got transferred to his 60-year-old mother who was looking after him.
This was the first case of human-to-human transmission of the swine flu in the national capital and the second in the country.The first such case was reported from Hyderabad.
Officials said the mother and son had refused to be admitted in the hospital and demanded “home quarantine”. However, on Wednesday night they were bought to the RML Hospital. Hours later, they left on their own without informing the hospital authorities.
“They have been admitted to an identified hospital near the airport and they are being monitored and kept in isolation,” Vineet Chawdhry, joint secretary in the central health ministry, told reporters Friday.
India has reported 16 cases of swine flu - five in the national capital, eight in Hyderabad, two in Coimbatore and one in Goa.--- IANS
When you are dealing with a particularly virulent disease like Ebola, or Bird Flu, then isolation and/or voluntary quarantine can make a lot of sense.
At least as long as cases are isolated, and the illness is not already spreading in the community.
And in fact, people who get the H1N1 swine flu (or any other flu) should practice voluntary isolation as much as possible, until they are no longer contagious.
But in India, fears of this novel H1N1 virus have provoked the Central government in Delhi to activate their Epidemic Act, and order the mandatory isolation of `swine flu cases’ in designated hospitals.
Given the densely packed population, marginal living conditions, and lack of medical resources for hundreds of millions of at-risk people, one can understand the Indian government’s concern.
What has been, so far, a relatively mild virus in North America and Europe could exact a much higher toll on the Indian Subcontinent.
India’s experience in 1918 was much bleaker than the US, or Europe.
The desire to contain this virus is understandably strong.
But as this story already demonstrates, people are often unwilling to be isolated, particularly if they don’t believe themselves to be seriously ill or a danger to others.
The problems with this strategy include:
- The threat of involuntary isolation may very well deter some people from even seeking medical care, which could increase the spread of the virus.
- Since flu victims can be contagious for up to 24 hours before showing symptoms, forced isolation would likely come too late to prevent transmission to others.
- At some point, it simply won’t be practical to try to hospitalize all H1N1 cases. Eventually the number of infected patients will exceed the number of hospital beds.
For those concerned that we could see this type of response here in the United States - in most developed countries - forced quarantines and isolations are not viewed by public health officials as being an appropriate response to influenza.
I’ll spare my readers any indignant expressions of moral outrage here. Officials in India are working with different laws, customs, sensibilities and conditions on the ground than we are.
I’ve no idea what I might be willing to try in their place.
The big point is that these sorts of draconian measures are unlikely to achieve the desired goals, may end up being counterproductive, and at some point will become unsustainable.
The good news is, it probably won’t take terribly long for Indian officials to figure that out.
