Wall Street Journal - April 1, 2003
Matt Pottinger and Richard Borsuk, Staff Reporters of The Wall Street Journal

Now Canada, Singapore and Hong Kong all have imposed quarantines to combat the spread of severe acute respiratory syndrome, or SARS, the new and highly contagious form of pneumonia that has infected more than 1,750 people world-wide and killed 62 since November.

But as the U.S. grapples with its own budding outbreaks of the disease, as well as with the threat of bioterrorism inside its borders, the experiences of these places highlight how difficult it would be for U.S. state and federal officials to execute a mass quarantine, let alone do it effectively. Among the challenges: tracking down thousands of people who have been in contact with infected people, getting to them before they can potentially be spooked by news articles and scatter or go into hiding, and squaring the quarantine order with civil-rights laws.

Consider Hong Kong, where SARS appears to be spreading fastest. The government invoked quarantine regulations initially designed to combat an outbreak of bubonic plague in the 1890s.

At dawn Monday, dozens of Hong Kong police officers wearing surgical masks descended on Amoy Gardens, a residential high-rise, to order its inhabitants to stay in their homes for 10 days. But when they got there, they found nobody home in well over half the block's 264 apartments.

Residents had been reading news reports about the outbreak unfolding around them and many packed their bags and scattered long before the authorities arrived -- potentially carrying the infection elsewhere.

Hong Kong officials now are working with police to try to track down those people. The mass quarantine "is something we've never done before, and it's something we hope we will never, ever have to do again," said Yeoh Eng-kiong, the city's secretary of health, welfare and food. He publicly urged residents who fled to come forward, and promised that the government "will definitely not send them back" to Amoy Gardens, but send them to newly designated quarantine centers instead.

In Canada, where health officials over the weekend reported about 100 "probable and suspect" cases -- up from 61 cases on Friday -- several thousand visitors and employees of two Toronto-area hospitals are under quarantine at home, and people living with them have been told to wear surgical masks while in the home. But out of fear of violating civil liberties, the quarantines so far are voluntary, raising questions about how easy they will be to enforce.

Health officials also warn that quarantines can be counterproductive because they may deter people from seeking treatment, as many are afraid of being stuck in their homes even if they don't have the disease.

Lawrence Gostin, a law professor at Georgetown University in Washington, D.C., who has helped U.S. states write laws to combat bioterrorism, says the application of mass quarantines on a population already potentially exposed to a virus is problematic and rarely successful.

"You could be talking about 1,000 people today, but that can very quickly go to 10,000," he said. "Mass quarantines have almost always been ineffective and the spinoff effects on the economy can be quite devastating."

Quarantines, Mr. Gostin said, also can have a perverse effect. "I think that coercive quarantines can have the effect of driving epidemics underground," he said, adding that people suffering a disease's symptoms may choose not to seek treatment for fear of being quarantined and kept from their jobs, loved ones or regular activities. Large-scale quarantines also present logistical problems in terms of bringing food and health care to quarantined individuals, he said.

Mass quarantines historically have been used in the U.S. to contain outbreaks of disease such scarlet fever, polio and smallpox.

Singapore, the strictly governed city-state, has more powers at its disposal than most governments to deal with the health threat, and most observers feel that if a quarantine will work anywhere, it's there. "We think the quarantine strategy is working," a Singapore Health Ministry spokeswoman said Monday.

Yet, even Singapore's quarantine hasn't managed to stop cases from trickling in through other gaps, including the free flow of air travelers the city depends on to keep its economy thriving as an open financial, trade and tourism hub. After nearly 1,000 10-day quarantine orders were issued last week to seemingly healthy people, authorities announced that two residents who returned from travel in SARS-affected areas have the illness.

Instituting a mass quarantine would be even harder in the U.S., thanks in part to HIV, the virus that causes AIDS. The American Civil Liberties Union and other advocacy groups successfully challenged proposed laws in California in the mid- and late-1980s seeking the mandatory quarantine of HIV-infected individuals. Of all the countries suffering from AIDS, only communist Cuba has enforced the mandatory isolation of HIV carriers. It also is the only country that has mandatory, nationwide HIV testing.

Yet even when quarantines are implemented, they frequently fail to work.

Perhaps the best-known, and most ineffective, effort at quarantine in the U.S. involved the New York City outbreak of paralytic poliomyelitis in the summer of 1916. That epidemic -- the city reported 9,000 cases -- produced such a panic that children literally were taken from their mother's arms to isolation wards, and masses of people were arrested for quarantine violations.

In an episode that became known as the "shotgun quarantine," neighboring communities actually posted armed sentries to keep city residents from entering their towns.

Still, it would be four more decades before summers in the U.S. would be free of the occasional closed swimming pool and spot quarantine. Indeed, despite relentless quarantine efforts, the U.S. registered 58,000 cases of polio in 1952 -- the most ever. Mass vaccinations began three years later with a vaccine developed by Jonas Salk, and the illness all but disappeared from the U.S.

-- Karen Richardson in Hong Kong and Peter Fritsch in Singapore contributed to this article.

Write to Matt Pottinger at matt.pottinger@wsj.com and Richard Borsuk at richard.borsuk@wsj.com

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