What Determines Whether A Virus Is a Global Epidemic? And How Far Is Too Far In Terms Of Stopping It?

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The ethics of quarantining humans have long been debated.

From as far back as the bubonic plague in 1370 Venice, to the more recent Ebola and SARS crises, fear of the spread of highly infectious diseases has historically forced health authorities to quarantine people whom they think may be carrying an infection. Now, let’s not go forgetting the difference between ‘isolation’ and quarantine. Isolation is used for patients with infectious tuberculosis, for example, while quarantine is used to separate and restrict the movement of well persons who may have been exposed to a communicable disease to see if they become ill.

Both come with consequences, and ethical considerations.

This week, the United States confirmed it has its first case of a new highly contagious virus that appeared in Wuhan, China, last month. The deadly coronavirus has already affected more than four hundred people, and killed nine within China. But with the first case detected on U.S. soil, the world is panicking. The virus has traversed half the globe and landed in one of the world’s largest countries, forcing health authorities to react quickly in a bid to minimise the potentially disastrous consequences.

Officials at the US Centers for Disease Control and Prevention said the United States will be more strict about health screenings of airplane passengers arriving from Wuhan immediately. Meanwhile, the World Health Organisation will gather today to decide whether or not coronavirus will be declared a global emergency, and that decision will dictate whether countries will need to begin implementing travel or trade bans. Even before that happens, though, countries have begun implementing quarantine stations at major airports and hospitals. In China, the National Health Commission (NHC) has authorised hospitals across the country to quarantine any suspected carriers of the deadly virus as well as people they have come into contact with, even against their will. It raises the age old ethical debate about whether or not quarantining is ethical.

The unfortunate fact of the matter is, we just cannot trust everyone to accurately self-monitor and report their conditions upon coming into contact with a contagious infection. So it forces us as a society to decide: are we prepared to leave a decision as important as whether or not to declare a potential infection, up to individuals, individuals who may choose not to disclose that information, thinking themselves to be invincible? I think not.

Take, for example, the guy from Wisconsin who last year violated a measles quarantine so he could go to the gym, claiming as his excuse that he was “going stir crazy”. Or Andrew Speaker, the American who flew to his wedding and then honeymoon from the U.S. to France, Greece, Italy, Czech Republic and Canada before returning home, all while affected with multi-drug resistant tuberculosis. In his defence, medical personnel at the hospitals where he was tested assured him he was okay to travel, but shortly after he boarded his plane to Paris sent out urgent appeals to authorities in other countries to detain him. Once he learned of how potentially infectious he was, he chose to fly commercially via two separate countries before returning to the U.S. where he was promptly sued by several fellow airline passengers. See, people just don’t comprehend the sheer enormity of the threat they present to society by breaking quarantine or by interacting with the public, and so the onus simply cannot fall to the public to act responsibly.

On the opposite end of the spectrum, take those instances where quarantine has been too much for the public. After the Ebola outbreak in 2014, a neighbourhood in Liberia was cordoned off for 10 days after patients fled a medical centre into a nearby slum, forcing the local government to isolate the neighborhood until the incubation period was over.

A spokesperson from Doctors Without Borders, the medical organization that was on the ground working to control Ebola, said following the incident, “It has been our experience that lockdowns and quarantines do not help control Ebola, as they end up driving people underground and jeopardizing the trust between people and health providers”.

There are countless considerations and debates when it comes to health and ethics; end-of-life issues, patient data privacy, the right type of care for elderly people, as far as whether or not great natural protein powders should be considered medicinal or as a regular food. How to effectively and ethically quarantine is another biggie on the list.

Really, quarantine should only be considered if other less restrictive measures have failed; and only within communities who are not complying with public health authorities. Quarantine should be viewed as a last resort in every instance; but more importantly, the focus must be on supporting public health rather than issuing quarantine orders as punishment. That way, quarantine can have its intended impact; to safely and effectively stem the spread of an infectious disease.

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