Video: Quarantine flaws?

By Brock N. Meeks Chief Washington correspondent
msnbc.com
updated 10/18/2005 6:00:49 PM ET 2005-10-18T22:00:49

The traditional duties of the U.S. quarantine system aren’t sufficient in today’s world to adequately thwart the intentional or accidental introduction of deadly viruses like bird flu on American soil, according to a group of U.S. health experts.

The quarantine system, run by the Centers Disease Control and Prevention, is in need of a strategic shift in how it operates on a day-to-day basis, said Dr. Georges Benjamin, head of the American Public Health Association and chairman of a group of health experts that produced a report on the U.S. quarantine system at CDC’s request.

Historically the quarantine stations focused on the “detection of disease in persons, animals, cargo and conveyances during the window of time shortly before and during arrival” at U.S. ports of entry, the study says.  However, the pace of global travel has dramatically changed, Benjamin said. “The environment [the CDC quarantine stations work in] has changed,” he said. “We have many more people, many more ports of entry and many more diseases.” 

In the 1930’s and 40’s, most people came into the country by boat, giving a disease time to incubate and therefore a greater likelihood that it could be detected at a U.S. quarantine station.  Today that incubation window has shrunk to nearly zero lead time.

“So you’re not going to pick up a person up, even if they have influenza, walking off an airplane,” Benjamin said, “you’re just going to miss that person. And it only takes one or two of those to cause a huge epidemic.”

The study recommends that the CDC be given broad new powers to oversee the U.S. quarantine system and put the agency in explicit control of monitoring for infectious disease. 

Currently there are 18 quarantine stations established or in the process of being finalized, said Jennifer Morcone, a CDC spokesperson.  That’s up from a mere eight stations in 2003.  By the end of fiscal year 2006 the CDC hopes to have 25 stations located at airports and border crossings throughout the U.S., she said.  When those 25 stations go operational they will cover about 75 million of the estimated 120 million that travel to the U.S. every year, according CDC’s commissioned report. 

But hundreds more staff are needed, the report says, as is a revamped strategy for training current staffers and “surrogates,” as Benjamin calls the employees of Customs and Border Protection and U.S. Coast Guard, that must step in to handle health inspection duties at the vast majority of the nation’s 474 official entry points.

“A lot of the work [the quarantine system does] is done through surrogates and because of that we wanted the CDC to take a strategic step back and become managers of the whole system,” Benjamin said.  “They kind of have the task already but it’s not explicit, there wasn’t a single person in charge and we felt they needed to be more explicit about them being in charge and managing the system.”

The entire quarantine system also is in need of more resources; the entire system was essentially dismantled over time.

Historically, there were quarantine stations at every U.S. port of entry, Morcone said.  “And if you were entering the United States you were screened for infectious diseases, like smallpox, before you entered the states.  However, “after we felt that we had licked infectious diseases, the quarantine station network was dismantled because it didn’t seem to be a prudent use of public health resources,” she said.

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Then in 2003, in response to “to concerns about disease importation and bioterrorism and building on the SARS [severe acute respiratory syndrome] experience, the CDC realized the quarantine station network was a valuable asset and began to increase the number stations and enhance the training and response capability and modernize the functions of the quarantine stations at airports,” Morcone said.

The report says the CDC quarantine system should “shift their primary focus from inspecting people and cargo at individual ports to assuming leadership of activities of the broader quarantine system across local, state and national levels.”  However, the report also notes that the traditional duties of the quarantine system are valid and should not be abandoned altogether.

Morcone said the CDC is working on all the report’s recommendations, developing a national plan and working on forging closer ties with state and local health officials, a traditionally tough task. 

“Since colonial times, tension over the control of U.S. quarantine functions has existed between states and localities on one side and federal government on the other,” the report says. 

Storied history
Little was done to prevent disease from entering the fledging U.S. colonies, despite the fact that quarantines were a proven strategy reaching back to the 14th century. 

The colonies considered protection from disease to be a local matter; however, repeated yellow fever outbreaks moved the Congress to pass a federal quarantine law in 1878.

While not shifting all power to the federal government, the legislation did make it easier for the central government to take a more hands-on role in future epidemics, such as the 1892 U.S. cholera outbreak. The federal government, citing the 1878 law, took a greater role in enforcing quarantine requirements.  That move led to yet another law being passed in 1893 that further solidified the government’s role in quarantine matters.  By 1921 quarantine stations across the U.S. had been federalized and in 1944, with the creation of the Public Health Service, the federal quarantine role was clearly defined.

At the height of the U.S. quarantine system, in 1967, there were 55 stations employing more than 500 people.  By 2002 there were only eight quarantine stations left, run by about 40 people.

The CDC’s quarantine stations are, however, just a cog in what is called the “quarantine system network,” that is comprised of various state and federal agencies as well as local health organizations.

To make all those parts “fit” and effectively manage the quarantine system, the CDC is currently working on a national risk assessment and will develop a national strategic plan at that will “prioritize their activities and focus resources on people, animals, goods and conveyances from abroad that pose the greatest risks to the health of the U.S. population,” the study says.

Meanwhile, President Bush tossed a huge rock into the quarantine management pond two weeks ago when he revealed that he was considering using U.S. military forces to enforce quarantine in the event of a national health crisis.  To do so would require legislation; just the suggestion that the military might be used for quarantine enforcement sent shock waves through some parts of Congress and state and local leaders, who are traditionally the first to handle any type of quarantine.

Bush acknowledged the move was dicey.  “It’s one thing to shut down airplanes,” Bush said. “It’s another thing to prevent people from coming in to get exposed to the avian flu.” 

But Bush said he would press for the authority to do so.  “I think the president ought to have all… assets on the table to deal with something” like a pandemic flu crisis,” he said.

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