Recently, I watched a discussion on a cable news morning program regarding a 27-year-old tuberculosis (TB) patient in Phoenix, Arizona. The case was somewhat alarming. The man is infected with Extensively Drug Resistant TB, or XDR-TB. Unlike Multi-Drug Resistant TB (MDR-TB), which is resistant to two of the drugs used for TB treatment, XDR-TB is resistant to all combinations of available drugs and is therefore essentially untreatable. Because this particular patient refused to wear a mask in public, county public health authorities obtained a court order to take the man into custody and place him in an isolation room at the hospital.
My consternation about the discussion arose when one of the three cable news hosts became very vocal about how wrong it was to forcibly isolate the patient. Although the other two hosts pointed out the danger to the public, the dissenting host was adamant in his condemnation of forcible isolation. He refused to listen to the whole story. Parts of the story he ignored included the fact that XDR-TB is resistant to all available drugs and is therefore essentially untreatable. XDR-TB is found sporadically around the world, with notable clusters of cases in Asia, the former Soviet Union, and in Africa. In a World Health Organization (WHO) outbreak study in South Africa, 52 of 53 HIV-infected patients died within an average of 26 days after being diagnosed with XDR-TB. The emergence of XDR-TB is of great concern to public health authorities worldwide. I won't try to go into more detail here, but if you are interested you can get more information about TB and XDR-TB by going to www.cdc.gov/nchstp/tb/default.htm.
I mentioned the above cable news show in detail because it reminded me that the whole topic of isolation and quarantine is something that is not usually a regular part of discussion outside of the medical and public health community. Still, at a time when we face the eventual certainty of a worldwide influenza pandemic and the possibility of other deadly, highly infectious disease outbreaks, as well as the ever-present threat of biological terrorism directed against our citizens, it might be good for everyone to at least know what isolation and quarantine are and when they might be used.
Definition of isolation and quarantine
Isolation is the separation and restriction of movement of ill people to stop the spread of that illness to others. The action in Arizona is an example of isolation. People in isolation may be cared for in their homes, in hospitals, or at designated health care facilities. Quarantine, in contrast, applies to people who have been exposed to a contagious illness and may be infected but are not yet ill. Separating exposed people and restricting their movements is intended to stop the spread of that illness should they in fact become ill and infectious. Quarantine can be highly effective in protecting the public from disease. Localities that used quarantine during the 1918 influenza pandemic had fewer illnesses and deaths and the waves of illness through the population passed more quickly.
The morning cable news program host was understandably concerned with individual rights under our constitutional and law-based government. So what justifies taking the drastic action of forced isolation? A 1931 Missouri decision (Ex Parte Lewis, 42 S.W.2d 21 [Mo.banc 1931]) stated: "It is well settled that laws and ordinances prescribing regulations for the promotion of the health and welfare of the people are referable to the police power, and, if reasonable, are not obnoxious to the due process clause of either the state or Federal Constitution."
On the federal level the following is found in Compagnie Francaise de Navigation a Vapeur v. Louisiana Board of Health (186 U.S. 380 [1902]): “That from an early day the power of the states to enact and enforce quarantine laws for the safety and protection of the health of their inhabitants has been recognized by Congress, is beyond question.”
In addition, many states and localities have begun to enact legislation to further clarify this longstanding power of government to protect the health and welfare of the public from deadly diseases by isolation and quarantine of infectious individuals.
In our country, it does somehow seem "wrong" to deprive someone of freedom of movement, even when it is temporary. However, failing to do so would be potentially disastrous to many more people. One final point to consider is that quarantine or Isolation is not usually as dramatic as the Arizona case. The typical case involves a voluntary act by the sick or possibly sick individual and almost never requires imposing the ultimate power of the government.
The following are some links to websites with additional information for those who wish to explore the topic in more depth.
Two excellent King County/Seattle, Washington links on this topic
www.metrokc.gov/health/isoquarantine/index.htm
www.isolationandquarantine.com
A public participation site with good information
http://www.fluwikie.com/pmwiki.php?n=Issues.IsolationAndQuarantine
The CDC Public Health Law Program
www2.cdc.gov/phlp/quarantine.asp
An Arizona Health Department presentation on the topic
www.azdhs.gov/pandemicflu/pdf/isolation_and_quarantine.pdf
A very in-depth discussion of quarantine and isolation issues related to SARS
www.answers.com/topic/communicable-diseases-isolation-and-quarantine