pandemic prep (OR NOT)

The Fear ContagionA Flu Quarantine? No, Sir
By Wendy Orent
Sunday, October 16, 2005; B01
For two years, a deadly strain of chicken flu known as H5N1 has been killing birds in Asia. While slightly more than 100 people are known to have contracted the disease, and 60 of them have died, there is still no sign that the flu has begun to spread from person to person.
That hasn't prevented a recent outbreak of apocalyptic warnings from health officials and experts about the specter of a worldwide pandemic. In Hurricane Katrina's wake, health officials in the United States are talking more and more about pandemic preparation. Some of these ideas -- such as stockpiling vaccines -- are sensible, whether or not bird flu turns into a human disease and begins to spread rapidly.
But other ideas aren't. A few scientists have suggested "priming" people with a dose of the new vaccine against H5N1 before we even know whether a pandemic is coming. Vaccinating large numbers of people against a disease that may never appear carries its own risks. Remember the swine flu debacle of 1976? At least 25 people died from vaccine complications and no epidemic ever erupted. That should be warning enough.
Another dangerous idea for pandemic preparation has come from President Bush. Earlier this month, he suggested using the military to enforce a quarantine. "Who [is] best to be able to effect a quarantine?" he asked rhetorically at a press conference. "One option is the use of a military that's able to plan and move."
The very term quarantine can be misunderstood (not to mention the military's role). Did the president mean gathering those exposed to flu in a single location and forcing them to stay there? Did he mean isolating them in their homes? Cordoning off whole communities where cases crop up? Not all quarantines are alike; each carries its own risks and benefits.
If this were idle presidential speculation, it wouldn't be worrisome. But he isn't the only one talking about quarantines and calling in the troops. In an Oct. 5 interview on "The NewsHour With Jim Lehrer," Julie Gerberding, director of the Centers for Disease Control and Prevention, also wondered whether the government would need to turn to "containment" or "quarantine the people who are exposed." She too remarked that the military or the National Guard might be summoned "to maintain civil order, in the context of scarce resources or an overwhelming epidemic. . . . It would be foolish not to at least consider it and plan for that as a possibility."
This is an example of a cure that is as frightening as the disease. It is hard to imagine how the military would oversee a quarantined area. If a health worker, drug addict or teenager attempted to break the quarantine, what would soldiers do? Shoot on sight? Teenagers and health workers were the people who most often violated quarantine rules in Toronto during the severe acute respiratory syndrome (SARS) scare in 2003. Moreover, the use of a quarantine to control a flu pandemic isn't only a potential threat to life and civil liberties; it's also a waste of money, resources and time. The reason: There isn't any kind of quarantine that will do any good -- at least not for a pandemic influenza.............