Vast quarantine role advocated for states
Plan would let agencies shut roads, cities during a biological terror attack

Detroit Free Press 11/07/02: Seth Borenstein

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WASHINGTON -- In the event of a bio-terrorist attack using a deadly and contagious disease such as smallpox, public health officials want to be able to close roads and airports, herd people into stadiums, and, if necessary, quarantine entire infected cities.

To make that possible, 50 governors this week are to receive copies of a proposed law, drafted at the behest of the Centers for Disease Control and Prevention in Atlanta, which could give states immense power to control their populations.

The proposed Model State Emergency Health Powers Act may be months or years away from enactment by state legislatures. It may be amended beyond recognition. But health officials say major new legislation is crucial to keep smallpox, plague or hemorrhagic fevers such as Ebola from spreading in the event of a terror attack. Unlike anthrax, they are highly contagious.

As a general principle, the draft law says authorities could "require isolation or quarantine of any person by the least restrictive means necessary to protect the public health."

Broad quarantines envisioned in the draft have never been invoked in the United States. They raise all sorts of logistical, political and ethical questions in a mobile society, public health experts concede. But such quarantines also may save lives.

"If we don't do it, what would happen? I don't think we've got any choice but to quarantine," said Dr. Lew Stringer, medical director of North Carolina's special operations response team that handles disasters and bio-terror.

"The first thing you do is shut down the roads," he said. "Then you shut down the interstates, you shut down the schools, you shut down the businesses. You're shutting down essential services, not just nonessential ones."

Local governments need to practice plans for quarantines like fire drills to ensure they work in an emergency, said Dr. Scott Lillibridge, the bio-terrorism assistant to Health and Human Services Secretary Tommy Thompson.

Thompson said Tuesday: "If we did have an outbreak of smallpox," a possible quarantine "would certainly be one of the avenues we'd have to explore."

CDC authorities and a state's governor would exercise their authority using mobilized National Guard units, said James Lee Witt, former director of the Federal Emergency Management Agency.

Lawyers and public health professors at Georgetown University in Washington and at Johns Hopkins University in Baltimore drafted the plan, in collaboration with representatives of governors, state and local health officials and state attorneys general.

Congress "should give public health authorities strong powers to be able to isolate or quarantine people if necessary for the public health," said the proposal's chief author, Lawrence Gostin, professor and director at the two universities' Center for Law and the Public's Health in Washington.

Many states already have quarantine laws, but they may not be constitutional, Gostin said. He said his proposal would probably pass constitutional muster because it lets detainees ask a judicial-medical board to get them out of quarantine.

In Michigan, there are legal provisions for the governor to declare a medical emergency and for state agencies to issue a quarantine, said Geralyn Lasher, spokeswoman for the state Department of Community Health.

Between the Public Health Code, she said, and the Emergency Management Act, "we have about all the areas covered" in case of a bio-terrorism attack and the need to issue a quarantine.

Gostin said the question of quarantines "is probably the biggest issue because it involves liberty of individuals in the public." He said the proposal would give officials authority to take control of hospitals or stadiums to house quarantined people.

But in the event of a quarantine, some people would likely evade restrictions and spread the infection elsewhere, experts said.

In one simulation, involving a fake plague that struck at a rock concert in Chicago, questions arose about what to do with people who insisted on breaking the quarantine, said Randy Larsen of the AnserInstitute, a security think-tank in Arlington, Va.

Would a National Guardsman, he asked, shoot a grandmother trying to evade quarantine?

Maybe, Gostin said. "You have to use all reasonable force." Sometimes, he added, that could mean lethal force.