More Pesky Facts

The other day, W. floated the idea that we might need to rely on the military in case of a flu pandemic. Many saw this as a further development of his instinct to use the military in any disaster, since he has been lobbying for expanded military powers in the wake of the hurricanes. But, as an op-ed in the Boston Globe suggests, the biggest problem with this suggestion isn't that it would violate strong traditions of our military and our civil liberties. The biggest problem is that it won't work and many people will die.

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.

Not only can't we evacuate Houston, we cannot realistically quarantine its citizens. The real public health challenge will be shortages of health care personnel, hospital beds, and medicine. Plans to militarize quarantine miss the point in a pandemic. The enemy is not sick or exposed Americans -- it is the virus itself. And effective action against any flu virus demands its early identification, and the quick development, manufacture, and distribution of a vaccine and treatment modalities.

In 1918 the Spanish flu was spread around the US primarily by soldiers, and it seems to have incubated primarily on military bases. It is a misreading of history that a lesson from 1918 is to militarize mass quarantine to contain the flu. And neither medicine nor public health are what they were in 1918; having public health rely on mass quarantine today is like having our military rely on trench warfare in Iraq.