[Mb-civic] MUST READ: Bush's risky flu pandemic plan - George J. Annas - Boston Globe Op-Ed

[William Swiggard]

Bush's risky flu pandemic plan

By George J. Annas  |  October 8, 2005

WHENEVER THE world is not to his liking, President Bush has a tendency 
to turn to the military to make it better. The most prominent example is 
the country's response to 9/11, complete with wars in Afghanistan and 
Iraq. After Hurricane Katrina, Bush belatedly called on the military to 
assist in securing New Orleans, and has since suggested that Congress 
should consider empowering the military to be the ''first responders" in 
any national disaster.
On Tuesday, the president suggested that the United States should 
confront the risk of a bird flu pandemic by giving him the power to use 
the US military to quarantine ''part[s] of the country" experiencing an 
''outbreak." So we have moved quickly in the past month, at least 
metaphorically, from the global war on terror to a proposed war on 
hurricanes, to a proposed war on the bird flu.

Of all these proposals, the use of the military to attempt to contain a 
flu pandemic on US soil is the most dangerous. Bush says he got the idea 
by reading John Barry's excellent account of the 1918 Spanish flu 
pandemic, ''The Great Influenza." Although quarantine was used 
successfully in that pandemic, on the island of American Samoa, Barry in 
his afterword suggests (sensibly) that we need a national plan to deal 
with a future influenza pandemic. He said last week that his other 
suggestions were the only ones he hoped public health officials and 
ethicists would consider, but they read like policy recommendations to 
me and apparently the president. Barry writes, for example, ''if there 
is any chance to limit the geographical spread of the disease, officials 
must have in place the legal power to take extreme quarantine measures." 
This recommendation comes shortly after his praise for countries that 
''moved rapidly and ruthlessly to quarantine and isolate anyone with or 
exposed to" SARS.

Planning makes sense. But planning for ''brutal" or ''extreme" 
quarantine of large numbers or areas of the United States would create 
many more problems than it could solve.

First, historically mass quarantines of healthy people who may have been 
exposed to a pathogen have never worked to control a pandemic, and have 
almost always done more harm than good because they usually involve 
vicious discrimination against classes of people (like immigrants or 
Asians) who are seen as ''diseased" and dangerous.

Second, the notion that ruthless quarantine was responsible for 
preventing a SARS pandemic is a public health myth. SARS appeared in 
more than 30 countries; they all reacted differently (some used forced 
quarantine successfully, others voluntary quarantine, and others no 
quarantine at all), and all ''succeeded." Quarantine is no magic bullet.

Third, quarantine and isolation are often falsely equated, but the 
former involves people who are well, the latter people who are sick. 
Sick people should be treated, but we don't need the military to force 
treatment. Even in extremes like the anthrax attacks, people seek out 
and demand treatment. Sending soldiers to quarantine large numbers of 
people will most likely create panic, and cause people to flee (and 
spread disease), as it did in China where a rumor during the SARS 
epidemic that Beijing would be quarantined led to 250,000 people fleeing 
the city that night.

http://www.boston.com/news/globe/editorial_opinion/oped/articles/2005/10/08/bushs_risky_flu_pandemic_plan/
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