By Faye Flam
CORONAVIRUS is spreading at an accelerating rate, but inappropriate quarantines and travel bans could cause more havoc than the disease itself. The World Health Organization (WHO)has a duty to protect human health, but also an obligation to protect the world’s citizens from the human rights violations or unnecessary economic hardship that panic could cause. So far, they’re doing a good job of striking this tricky balance.
The WHO has advised against the far-reaching travel bans that some conservative US lawmakers want to impose on China, where the outbreak started. Last week’s announcement that the US will quarantine 195 people evacuated from Wuhan, China, makes sense as long as the people are held in a safe, comfortable environment.
But going too far will not solve the problem, and may even make it worse. Mass quarantines driven by panic have backfired, says Amy Fairchild, dean of the Ohio State University College of Public Health. In 1892, for example, people blamed Jewish immigrants for an outbreak of typhus, and they were rounded up and forced to live in tents on an island in the East River. The crowding of sick people with healthy ones only caused the disease to spread further.
It’s even counterproductive for the Chinese to quarantine Wuhan, as they’ve tried to do, because it’s too late to contain the disease, says Eric Toner, a doctor and senior scientist for the Johns Hopkins Center for Health Security and Bloomberg School of Public Health. Attempts at mass confinement only make people want to flee.
The WHO is also right to advise against travel bans, says Toner. It’s too late, since the disease has already traveled far from China. Travel bans now will create little benefit and much economic harm.
The 2003 SARS outbreak is the most commonly invoked past precedent to the current outbreak, since it was caused by a coronavirus and originated in China.* Fairchild, who has worked on WHO guidelines and written about the organization’s response to that outbreak, says it prompted the most extensive quarantines and travel restrictions in global history — perhaps, in retrospect, too restrictive. Some 30,000 people were quarantined in Canada.
Scientists believe the current coronavirus looks less deadly, but may be more contagious. Fairchild says she hopes public health officials will contain the disease in a way that respects human rights — quarantining people at home, for example, and making sure everyone detained is in a safe environment with food and clean water. Compensating the quarantined can also help, she says: By making sure people aren’t financially ruined by a quarantine, officials can encourage compliance.
Quarantine is a scary word, says Rebecca Katz, director of the Center for Global Health Science and Security at Georgetown University. In the past, it has been done in a way that can feel like punishment, but if done right, it should be seen more like jury duty — something nobody wants to do, but should, for the good of society.
Fairchild says tracing people’s contacts and tracking down those likely to have been in contact with known cases could help limit the quarantine to only those people most likely to be exposed to the disease. That might be seen as a violation of privacy, but in an outbreak this serious, the benefits outweigh the harms.
But decisions on quarantine should be based on science, not politics or fear. During the 2014 Ebola outbreak, there was no need for authorities to quarantine a nurse from Maine who had returned from treating patients in West Africa. She was confined to a tent behind a hospital in New Jersey, though she was never infected.
Virologist David Sanders of Purdue University cites that case as an example of panic, since there was almost zero probability that the nurse was contagious — Ebola is spread by contact with bodily fluids of very sick patients or dead bodies, not by symptom-free people.
Right now, the WHO is walking a fine line with limited and ever-changing information. There’s still little understanding of how transmissible the virus is, or how deadly.
Toner ran simulations last October of a flu pandemic and a novel coronavirus outbreak. He said they anticipated interruptions of travel and trade, limited supplies of medicines and medical supplies, economic and societal consequences and spread of misinformation. “Those have turned out to be pretty much right on.”
Following WHO recommendations can minimize these human-caused problems. For now, panic and inappropriate responses to the virus threaten to cause more disruption than the virus itself.
* There’s some confusion on whether SARS was a pandemic. The term has been used to distinguish global influenza outbreaks such as 2009 H1N1 from seasonal flu, but there’s no clear cutoff for other outbreaks. In popular culture, people usually associate the term pandemic with a high number of casualties.