CHICAGO — A team in hazmat suits board your plane. One of them gives you a mask and escorts you to a hospital, where you’re held for seven days. There’s no air conditioning and the windows are sealed shut. Nurses take your temperature every few hours. You’re not allowed to leave. You have limited information and contact with the outside world. You’re given no choice in the matter. And you may not even be sick.
A quarantine official sprays disinfectant in a South Korean passenger jet from Chicago at Incheon international airport, wets of Seoul, on May 4, 2009.
This is quarantine.
Quarantine is a public health strategy used to stop the spread of contagious diseases. People in quarantine are confined to a medical facility, prohibited from leaving for days or even weeks. Chicago O’Hare International Airport is home to one of 20 quarantine stations at U.S. ports of entry where people who may have been exposed to an infectious disease are held and examined.
Quarantining is used for people who do not show any symptoms of an illness and don’t feel sick, although there is some evidence they have had contact with a contagious disease. Sometimes, they become sick and are treated in quarantine before the illness can spread. In these cases, quarantine protects the public from deadly diseases.
Sometimes, though, quarantined people are perfectly healthy – putting public health officials in the precarious position of balancing individual liberties and public health interests, which often don’t align.
“How do you handle quarantine when you’re dealing with individual people and individual freedoms?” said Dr. Michael Schmidt of Northwestern University’s Department of Emergency Medicine. “They’re difficult situations.”
Because quarantines are ordered for people who may not be sick, they can strip people of their personal freedoms when they never posed public health threat, said Colleen Connell, executive director of American Civil Liberties of Illinois.
“You really risk violating people’s civil liberties in a way that I think a court would be sympathetic to,” Connell said.
Connell argues that quarantine could result in racial profiling in cases where a certain disease occurs more frequently in a certain population. The power could also be abused to exclude certain populations from entering the country for national security concerns.
“The quarantine authority could be used in a political and punitive way rather than in a way that really truly reflects a public health risk,” Connell said. “I’m really not scared of the public health officials, I’m scared of the government with quarantining power.”
The federal and state governments and Centers for Disease Control have authority to order quarantines. The federal government last ordered a large-scale quarantine in 1918 during the Spanish flu pandemic. Large-scale quarantine orders are rare, because they require legal and public health resources beyond what is often feasible, said Illinois State Epidemiologist Craig Conover.
“Using the least restrictive measure possible is always desirable,” Conover said. “It can become a big job to issue a quarantine order for large groups of people.”
Illinois did not mandate any quarantines during H1N1, although public health officials discussed the more preferable strategy of voluntary “snow days” during which communities would close public places and restrict non-essential travel, Conover said.
By contrast, China implemented stringent quarantine orders during the height of H1N1. In 2009, more than 2,000 Americans, including students, journalists and doctors visiting the country, were quarantined, according to the United States Embassy in Beijing. CBS News’ Asia Bureau Chief Marsha Cooke was quarantined upon her arrival in the country on June 16, 2009. In a memoir that was published shortly after, she writes: “I’ve lost all personal liberty here and I can’t really explain how I feel to anyone. It’s a horrible, horrible feeling.”
But China’s harsh policies in H1N1 are an example of how quarantine can be an effective public health strategy. In the New York Times article “China’s Tough Flu Measure Appear to Be Effective,” Nov. 12, 2009, world health leaders credit China’s quarantine methods with slowing the spread of H1N1 in one of the world’s most populous countries. As of March, China has reported more than 127,000 cases and about 800 deaths from H1N1, according to reports from Chinese officials. Meanwhile, from April 2009 to March 2010, the U.S. saw about 60 million cases of H1N1 and more than 12,000 deaths, according to the CDC. China’s population is 1.3 billion, while the U.S. has a population of more than 309 million.
State or federal authorities in the U.S. could mandate a quarantine if there was ever a resurgence of small pox or a if an airplane passenger was carrying a highly contagious disease like SARS, Conover said.
“I think you’re balancing the impact of that person’s civil liberty and the public good, and how you’re trying to help protect the public,” Conover said.
