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archives.seattletimes.nwsource.com
Nation & World : Wednesday, November 07, 2001
Plan aims to head off outbreaks
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 but also to practice them
so they work in an emergency, said Dr. Scott Lillibridge, the special
bioterrorism assistant to Health and Human Services Secretary Tommy Thompson.
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.
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.
Many states already have quarantine laws, but they are antiquated and may
not be constitutional, 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.
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 proposal also 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.
The proposed emergency health powers law:
www.publichealthlaw.net/MSEHPA/MSEHPA.pdf |
