Isolation & Quarantine
Measures in Response to a Smallpox Emergency
Considerations
During a Smallpox Response
When considering
the implementation of these various levels of isolation/quarantine
and other control measures, public health authorities and policy
makers must be prepared for various things.
Communication
will be essential. When people understand the reasoning behind
the control measures such as quarantine, they may be more likely
to voluntarily comply, making enforcement much easier. In addition,
they must be kept informed of all developments. Information will
help to prevent public panic. Must be given some idea of a timeline
for how long control measure will be in place and what things may
prompt relaxation of the levels of restrictions or increased duration
of current restrictions so they will be prepared.
Authorities
must also consider how various quarantine levels would impact the
movement of critical personnel and supplies into and out of the
area, and how to maintain essential services while at a certain
level. As discussed earlier, larger quarantines will require larger
amounts of enforcement personnel. If a community’s law enforcement
resources are limited, planners should arrange for mutual aid with
other law enforcement agencies for larger-scale quarantine measures.
Planners might
consider the utilization of mass vaccination of the entire community
if possible in order to shorten the time needed for quarantine
restrictions if it is felt the outbreak may not be controlled quickly
with more limited vaccination strategies. The advantages of a mass
vaccination would be:
- It could
decrease community panic and unrest.
- It could
decrease level of restrictions needed, especially if higher levels
difficult to implement and maintain.
- It may bring
about more rapid control of outbreak.
The biggest
challenge regarding the national and international control of an
infectious disease in today’s society is the presence of
a highly mobile society. People can travel all over the world within
a day.
Unanswered questions
remain about quarantine in modern day disease control:
- How well
can authorities implement larger scale quarantine or isolation
measures. Current day experience is really with individuals not
communities.
- How quickly
should quarantine measures that would restrict travel be implemented
in order to prevent the spread of smallpox outside of an infected
area?
- Should areas/countries
that have less capabilities to respond to an important (i.e.
limited vaccine or public health/medical resources) implement
travel restrictions to/from an area with cases sooner and with
greater enforcement than areas that are more prepared to detect
and contain an importation? (Disparity in response capability
makes standardized international guidelines for quarantine and
travel restrictions difficult).
- How do we
deal individual and economic impact of travel restrictions that
may be in place for longer periods of time?
Planners must
be prepared to deal with the limited public memory of population-based
quarantine. The majority of the population will not have seen this
public health measure in practice before, and planners will need
to address current standards of civil liberties if they can expect
to counteract resistance. These dialogues and educating the public
about these issues need to take place before the panic of an outbreak
is in place. Authorities are often reluctant to take on these issues,
but given the very nature of bioterrorism, they must be addressed.
There are currently
limited vaccine supplies in most areas of the world and these limited
vaccine resources will probably always exist. We must also assume
that there could be multiple locations that are affected. We even
have to consider the unlikely, but potential scenario with a modified
strain of smallpox that is not prevented by current vaccines. In
this instance, quarantine measures may be the only method of slowing
the spread of disease.
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