Quarantine as a Tool in Dealing with Epidemics - Coursework Example

Quarantine as a Means of Social Discrimination Table of Contents I. Introduction ………………………………………………………………. 3 II. ized People behind the Enforcement of Quarantine …...………….. 4 III. Main Considerations in Quarantine Decisions …………………………… 4 IV. Adverse Consequences of Quarantine …………………………………… 6 a. CASE 1 - New York City Epidemics of 1892 ……………….. 6 b. CASE 2 - The Bubonic Plague of Epidemics or ‘Black Death’ (1900 – 1910) ………………………………….. 10 V. Other Serious Consequences of Quarantine …………………………….. 12 VI. Modern Use of Quarantine Practices based on Reports ………………… 13 VII. Modern Solution for Communicable and Infectious Diseases …………. 15 VIII. Conclusion ……………………………………………………………… 17 References ……………………………………………………………………. 18 Further Readings ……………………………………………………………... 20 Introduction In so many ways, people are susceptible to infection caused by dangerous diseases. This includes malaria which is being passed by animals to human beings. Germ causing botulism that is due to contaminated water and food. Sometimes, measles and small pox are passed directly from one person to another. All these diseases are hazardous to ones’ health but not all these can be transferred from person-to-person. Infectious or contagious diseases in the past such as cholera, typhoid fever, dysentery, diphtheria, epidemic louse-borne typhus, bubonic plague, leprosy, and small pox were not a simple problem of health because these diseases can cause a major obstacle to the economic, social and psychological development of an individual regardless of the nationality or race a person have. Recent infectious diseases include SARS, birds’ flu and HIV/AIDS. These contagious diseases can be controlled with the use of vaccines, anti-virals like masks with anti-viral filter or antibiotics including the efforts that come from the public health professionals. (Avian Influenza, 2007) Among the many ways in which we can prevent the spread of communicable diseases or person-to-person transmittable diseases is through the use of a traditional strategy called ‘quarantine and isolation.’ There is a difference between quarantine and isolation. Quarantine is applicable to people who have been exposed to contagious diseases coming from other countries but may or may not become sick. These people receive special care. They are subjected to further observation with regards to the early signs of the disease. On the other hand, isolation is applicable to people who are already sick with contagious diseases. These people are isolated in one place in order to receive special care and at the same time protecting the uninfected people from getting exposed to the disease. (CDC, 2006) Today, the meaning of quarantine used in modern bioterrorism responses has been altered. The modern meaning of the term quarantine includes limitations in traveling, restrictions to join a public gathering, and isolating an individual who is sick to prevent the spread of a contagious disease. (Barbera et al., 2001) Authorized People behind the Enforcement of a Quarantine In the U.S., a government agency called the Centers for Disease Control and Prevention (CDC) is directly responsible with identifying, tracking and controlling of the spread of contagious diseases. (CDC, 2006) It is the CDC together with the state and local health departments that create plans in case emergency. In a situation where there is a suspected contagious disease in one area, CDC would immediately report the case to the state and local health departments. It is the state and local health departments that would post an alarm in order to get the people aware of the suspected spread of a certain disease and eventually educate them and direct them to get medical attention such as going through several diagnostic tests, inform them to stay at home and avoid having contact with other people who are not exposed with the suspected disease. Depending on the degree of the spread of contagious diseases, the federal, state or local health authorities would strictly impose an order for quarantine and isolation. Main Considerations in Quarantine Decisions In making decisions for the use of quarantine, there are three things a decision maker should consider. First is to make sure that the implementation of a large-scale quarantine is scientifically proven to be effective in minimizing and controlling the spread of disease. There is no valid publicity made that any type of quarantine in the scenario of a disease outbreak can be effective aside from the case of anthrax. (Barbera et al., 2001) Also, despite the fact that there are a lot of identified contagious diseases, only a limited contagious disease could cause a serious risk of wide-spread due to person-to-person transmission. Among these contagious diseases that can be spread from person-to-person, only a limited number of diseases can cause serious illness or death. We even have a lot of available treatment and prophylaxis options that can be used as a counter-act for most of these contagious diseases. The second issue that one has to consider involves logistics. Decision makers should be able to clearly identify a group of people or geographic area that is exposed to a high-risk of transmitting serious diseases considering that it is impossible to clearly define who among the group is heavily exposed and is at risk of spreading the disease. Placing a neighborhood under quarantine probation does not directly stop and cure the main carrier of the disease. (Markel, 1995; Barbera et al., 2001) In fact, placing the unaffected individual within the quarantine group would even increase the chances that these people could also be affected with the said disease. The confinement period for quarantine could take as long as a few days or weeks depending on the specific infectious agent. Therefore, the decision maker should make sure that there are enough basic health resources such as toilets, towels for baths, and other needed materials for personal hygiene, medicine and medical supplies, food and water is available to ensure the overall health safety and wellness of the people during the confinement period. (Gostin, 1990) Lastly, it is important for the decision maker to do a cost-benefit analysis prior to implementing a large-scale quarantine. Weighing the pros and cons of quarantine should be the basis of setting out an order of implementing such action. (Barbera et al., 2001) The decision maker should also so some necessary actions to solve and/or minimize the adverse consequences of imposing a mass quarantine regardless if it is within or outside a hospital setting. Adverse Consequences of Quarantine CASE 1 - New York City Epidemics of 1892 The New York City Epidemics of 1892 became one of the most controversial historical events regarding US imposed quarantines. At that time, there was a typhus fever and cholera outbreak in Europe. Because of the signs and symptoms of typhus and cholera that was detected among the immigrant passengers, the New York City Port Authority strictly imposed putting on quarantine the passengers aboard the ships that arrive directly from the said place. (Markel, 1995) A total of 2,243 passengers arrived at the Halifax and Virginia port on the 9th of April. These people were placed in quarantine because of the huge number of deaths upon arrival to New York City. (See Table 1 - Number of Passengers Under New York Harbor Quarantine on page 8) There were two (2) quarantine areas that were allocated for the passengers. However, the quarantine station and the quarantine lower bay can only accommodate a little more than a hundred passengers. A huge number of passengers arrived at the New York Harbor. Therefore, majority of these people were placed on quarantine without the necessary sanitation, food, water, medicine and other medical facilities. THE CHOLERA AND THE QUARANTINE - New York Harbor - 1) Newark 2) Jersey City and Hoboken 3) New York City 4) Brooklyn 5) N. Y. Bay 6) Quarantine Station 7) The Narrows 8) Fort Hamilton 9) Coney Island 10) Staten Island 11) Quarantine, Lower Bay 12) Keyport, New Jersey 13) The Highlands 14) Sandy Hook Source: HARPERS WEEKLY Table 1 - Number of Passengers Under New York Harbor Quarantine Port No. of Passengers % Death Upon Passage % Halifax 1,200 53% 50 57% Virginia 1,043 47% 38 43% Total 2,243 100% 88 100% Source: Harpers Weekly dated May 12, 1866. Because of the fact that the medical practitioners back in the early 1890s is not so knowledgeable about the proper way of handling a contagious disease such as typhus fever and cholera, they have decided to put into quarantine all the passengers including those that are not affected by the said disease. (Markel, 1999a – p.41) The quarantine process resulted to a positive and a negative effect. The good side is that the isolating the passengers from the rest of the community members was successful in terms of preventing the spread of the disease. However, the process also resulted to personal trauma on some of the passengers. (Markel, 1999b – p.45) At that time, it was very difficult to solve the case because of the absence of medical studies on the said disease. It was only in 1909 that Charles Nicolle of the Insitut Pasteur in Tunis revealed about the cause of the said disease typhus fever. (Markel, 1999c – p.49) Due to the limited supplies and facilities available at the quarantine area, it became very evident that passengers belonging to the lower socioeconomic standing designated on a more severe conditions than those passengers that belongs to a higher socioeconomic standing. The lower class people were placed below deck without the access to proper sanitary facilities during the entire period of confinement. This resulted to a widely spread of cholera among the poor leading to at least 58 deaths in one ship alone. (Markel, 1999d – p.87) There were 418 individuals died in the New York Harbor and Ellis Island. Around 85% of those who died are children below the age of 13 years old. (Horn, 2002) The number of deaths that occurred at the Ellis Island was also high. (See Table 2 on page 10) Markel also suggested that maybe the greatest mistake which resulted to deaths is the fact that the quarantine enforcer at that time did not transfer the suspected carriers of disease in place where there is sufficient medicine and medical supplies available. Another evidence of socio-economic discrimination is the selling of food. The government at that time sells the right to operate a restaurant within the Ellis Island at an Table 2 – Number of Reported Deaths from Ellis Island Source: New York Times, November 20, 1910, page 9 auction. This high cost of operating a restaurant also results to high costs of food. This is very clear that only those who have enough money could afford to eat. Others who have limited money would die from hunger. (Raab, 1998) CASE 2 - The Bubonic Plague of Epidemics or ‘Black Death’ (1900 – 1910) A pandemic originated in the Chinese province of Yunnan back in 1855 spread throughout the southern coast of China causing a disease outbreak. In 1894, it spreads in Hong Kong. Between the years 1894 and 1903, the said plague entered a total of 77 ports on at most 5 continents. It was in 1900 when the plague was introduced in San Francisco, North America. Most of these plague cases occurred in the port cities of Pacific and Gulf coasts in USA affecting mainly Arizona, New Mexico, Colorado, and Utah. (Riedel, 2005) The event that happened in the Chinese neighborhood in San Francisco California back between the years 1900 to 1910 is another example of social discrimination against social classes and races that could arise from the use of quarantine. (Risse, 1992; DPH, 2006) The first dead man affected by the plague was seen in the basement of the Globe Hotel located in San Francisco’s Chinese quarters. Immediately, Dr. Frank P. Wilson was called to examine the body of Wing Ching Ging, a 41 years old Chinese resident. After the physical examination and a microscopic study, the doctor confirmed that the man died from a bubonic plague. (Shah, 2001) The following morning, the city mayor ordered at most thirty-two police officers to separate all the white Americans from the Chinese residents and put all of the Chinese people under quarantine. No one was allowed to enter the place for some time. A house-to-house search was immediately done by the police officers; it was found out that there were a lot of sick and dead people around the area. For this reason, President McKinley immediately ordered to quarantine all Chinese and Japanese people throughout San Francisco area. (Edelson, 2003) According to Shah, “the blockade of Chinatown was an explicit act of racial discrimination against the Chinese resident.” He said that not all Chinese people were affected by the bubonic plaque but they were all seemed to be suspected of having infected with the disease because one of their brothers died from it. (Shah, 2001) The fact that the said disease originated from China and the first dead man was seen in Chinatown, a racial discrimination on the Chinese people was observed throughout the quarantine period. The health authorities set the boundaries for the quarantine focusing mostly on the Chinese households and businesses in Chinatown. This issue resulted to a huge economic damage for the Chinese business community. When Judge William Morrow realized that everything was “an act based more on discrimination than on maintaining the public’s health”, he immediately lifted the order of quarantine. In fact, the federal court concluded that the quarantine is unconstitutional because it was unfair. These people were actually a victim of the health authorities who are acting with an ‘evil eye and extending an unequal hand.’ (Edelson, 2003) Other Serious Consequences of Quarantine The use of quarantine method is clearly violating ‘human rights’ particularly the right to privacy, the right to non-discrimination, the right to considerate and respectful care and equal treatment in receiving health care regardless of the race, sex, socio-economic differences and status,. (World Health Organization, 2007) Aside from the social and racial discrimination attached with the use of a mass quarantine, economic costs and psychological consequences such as anxiety, depression and bereavement are often experienced by the person involved without even resolving the main problem. (Day et al., 2005) The economic costs include financial lost as a result of the social discrimination attached with the quarantine program. This can be directly because the business person is affected with a contagious disease and/or indirectly due to rumors and misconception of the people around. Modern Use of Quarantine Practices based on Reports Let us consider the case of a global severe acute respiratory syndrome (SARS) outbreak back in 2003. SARS is actually considered as a classic example of an infectious disease outbreak. Because of the historical experiences that we have, most of the present health care practitioners are more widely knowledgeable on how to control the spread of an infectious disease. In line with the SARS outbreak, most of the public health care officials in all the identified affected areas immediately called for an isolation method in order for them to treat the affected people. However, because of the huge number of people who are reportedly affected, many countries began introducing the use of a mass quarantine so they could immediately accommodate all individuals who are suspected of having infected with SARS. The coordination between different countries made the practice effective in controlling the spread of the disease. Despite the fact that the use of quarantine in modern days can be effective, there are still some cases that social and racial discrimination can be seen with the use of quarantine method. For example, same time when the SARS outbreak was high, MIT website posted a warning that the employees of a restaurant in Boston’s Chinatown are infected with SARS. (Zheng, 2005) Immediately the rumor spread by e-mail and by mouth. Since then, no customers would enter the said restaurant. Another example is a Vietnamese owner of a Chinese restaurant in New York City died because of SARS. (Zheng, 2005) Again, the rumors spread causing the businesses within the said community to be highly affected. Racial tension at this point was very high. After the said incident, the whole street of the said areas became deserted for awhile until the time it was found out that the news was not true. Only then their businesses slowly went back to normal. The SARS outbreak recently is almost similar with what happened with the Bubonic Plague outbreak that happened in the Chinatown of San Francisco back in 1900 – 1910. People often have a misconception about communicable diseases and the ethnicity of a person. Because of the lack of medical knowledge, most of the time, they tend to relate diseases with races and social standing in life. It is true that communicable diseases travel very fast not knowing that rumors travel even faster than a communicable disease. The fear of a widespread epidemic disease is common to all people regardless of race, age and gender. Another reported case when the quarantine program was applied to infectious diseases like typhoid fever and diphtheria. Both diseases were considered as a national health threat. The treatment between the rich and the poor remains the same. The rich people were given a special treatment the fact that they were allowed to quarantine their sick family members in their own houses and simply hire the services of a private physician while the poor individuals were taken to a municipal isolation wards and having their home signed with warning of the said disease. The issue of race and economic status has remained to be a major public health concerns. They even connect signs and symptoms of a highly infectious disease with ethnicity and race. This fact has remained unavoidable because of the human nature. When a person is experiencing a lot of fear, a lot of things go through their mind. Many times, this kind of thinking is uncontrollable. People tend to simply believe things which are not even scientifically proven to be true. Fear is usually present when infection control techniques and restrictive practices like quarantine and isolation are implemented to protect the health of the public. (Person et al., 2004) It is at this point when some people became fearful to the point that they become suspicious to all people who are Asian people regardless of their nationality. The first thing that would come to their mind is to put these Asian people into quarantine and isolation practices that are appropriate in controlling the spread of SARS. Some people simply do not understand the fact that quarantine is only applicable to areas where the disease is present or is widely spread within a community. When we talk about ‘fear’, we are not only looking at the side of the people within the quarantine area because those people who belongs to the same race and nationality where the infectious disease outbreak is present are also affected by it. A socially marginalized and stigmatized is often the major effect of a mass quarantine. (Person et al., 2004) This also causes some people to avoid admitting that they have the early clinical symptoms of the disease. Therefore, in the end, they fail to seek proper medical assistance for cure. Modern Solution for Communicable and Infectious Diseases In many cases, there are alternatives ways that are proven to be effective in treating communicable or infectious diseases other than the use of a large-scale. These alternatives can be less challenging in terms of implementing the procedure and is less likely to result to adverse consequences. Today, cholera can be easily prevented and treated through the use of a cholera vaccine. (MedicineNet, 2005) The death rate associated with cholera has also increased a lot. It is not even considered as a very serious disease like it used to be back in early 1900s. Between the years 1995 – 2000, there were only 36 cases of cholera reported. Among the 36 patients, only 1 death occurred. The rest were all hospitalized and was given proper treatment and care. (Steinberg et al., 2001) Figure 1 – Historical Data of Cholera and Typhoid Fever on Children Affected Source: http:www.umaine.edu In mid-1990s, the use of Streptomycin was approved by the Food and Drug Administration (FDA) to be the cure and treatment for plague. Because of the limited supply of Streptomycin in US, medical experts have suggested the use of gentamicin as an alternative form of treatment although it is still not approved by the FDA. For mass casualty of plague, an oral drug and other antibiotics like tetracycline, doxycycline, chloramphenicol, and fluoroquinolones can be used as an alternative drug. (Riedel, 2005) Up to now, there is still no modern scientific study that has been conducted with regards to the person-to-person transmission of plague. In the olden days, health care workers prevent the spread of plague epidemics by wearing masks, gowns, gloves, and eye protection. They also recommend that patients has to be isolated for at least 2 days of taking antibiotic medication until such time that improvement in the clinical diagnosis occurs. Conclusion There is a saying that History repeats itself. The historical events of the United States back in the late 1800s shows that the past quarantine actions is an evident that this method of controlling the spread of diseases may cause more harm than minimizing the spread of contagious diseases. In a large-scale quarantine today, we could expect similar problems specifically the negative social impact and concerns of the suspected carrier of a communicable disease to occur. As the current medical technology continuous to improve, the practice of quarantine method should already be considered as a thing from the past. Today, antibiotic and anti-viral medications including routine vaccinations are widely available in the market. These medicines and vaccines can be use as a way of preventing and minimizing the spread of many diseases. *** End *** References: 1 Avian Influenza (2007) ‘Masks Bird Flu’ Dated: December 26, 2006 Retrieved: March 30, 2007 2 Barbera J. et al. (2001) ‘Large-Scale Quarantine Following Biological Terrorism in the United States: Scientific Examination, Logistic and Legal Limits, and Possible Consequences’ ©2001 American Medical Association. JAMA, December 5, 2001 – Vol.286, No.2711-2717 Retrieved: March 30, 2007 3 CDC (2006) ‘Controlling the Spread of Contagious Diseases: Quarantine and Isolation’ Last Updated: February 23, 2006 Retrieved: March 30, 2007 4 Day et al. (2005) ‘When Is Quarantine a Useful Control Strategy for Emerging Infectious Diseases?’ Practice of Epidemiology Retrieved: March 30, 2007 5 DPH (2006) ‘Bubonic Plague: San Francisco Department of Public Health – 1906 Earthquake & Fire’ Last Updated: March 14, 2006 Retrieved: March 30, 2007 6 Edelson (2003) ‘Quarantine and Social Inequality’ Retrieved: March 30, 2007 7 Gostin L. (1990) ‘The Future of Public Health Law’ Am H Law Med. 1990;16:1-32 8 Horn C. (2002) ‘The Forgotten of Ellis Island: Death in Quarantine, 1901-1911’ June 25, 2002 Retrieved: March 31, 2007 9 Markel H. (1995) ‘Knocking Out the Cholera: Cholera, Class and Quarantines in New York City - 1892’ Bulletin of History of Medicine 1995; 69:420-457 10 Markel H. (1999) ‘Quarantine! East European Jewish Immigrants and the New York City Epidemics of 1892’ Baltimore: Johns Hopkins University Press, 1997. ISBN 0-8018-5512-8. pp. 41, 45, 49, 87 11 MedicineNet (2005) ‘Is a Vaccine Available to Prevent Cholera?’ Retrieved: March 31, 2007 12 Person et al. (2004) ‘Fear and Stigma: The Epidemic within the SARS Outbreak’ Center for Disease Control and Prevention (CDC) Retrieved: March 30, 2007 13 Raab, GP (1998) ‘Opens the Door to Frauds: How Food is Sold to Immigrant at Ellis Island’ Originally published in The New York Times, December 13, 1894. Retrieved: March 31, 2007 14 Riedel S. (2005) ‘Plague: From Natural Disease to Bioterrorism’ Baylor University Medical Center. 2005 April;18(2):116-124 Retrieved: March 30, 2007 15 Risse G. (1992) ‘A Long Pull, A Strong Pull, and all Together: San Francisco and Bubonic Plague in 1907 – 1908’ Bull Hist. Med. 1992;66:260-286 16 Shah, N. (2001) ‘Contagious Divides’ Berkeley University of California, 2001. 17 Steinberg et al. (2001) ‘Cholera in the United States, 1995 – 2000: Trends at the End of the Twentieth Century’ Retrieved: March 31, 2007 18 The New York Times (1910) ‘Mothers in Sorrow Leave Ellis Island’ Retrieved: March 31, 2007 19 World Health Organization (2007) ‘Patients’ Rights’ Retrieved: March 30, 2007 20 Zheng D. (2005) ‘Encountering the Other: SARS, Public Health, Race Relations’ The Journal of American Popular Culture – 1900 to Present Retrieved: March 30, 2007 Further Readings: The Forgotten of Ellis Island: Deaths in Quarantine, 1909-1911 Read More