Quarantine won’t work. Never has. There are two reasons why.

The first is epidemiological. Despite numerous attempts throughout history, quarantine efforts have shown very little value in stopping an epidemic.

We know this and we know why. Infectious diseases are quite good at what they do, which is to be fruitful and multiply. Influenza, with its airborne droplet and casual contact transmission modes, is one of the most highly infectious of the lot. People nearing the end of the incubation phase of an infection, still feeling perfectly healthy, are shedding virus at maximum rates and are, therefore, maximally infectious. Thermal scanners won’t pick them up.

I qualified my statement, writing “very little” instead of “no”, because there is one historical incident in which quarantine seems to have been partially successful: it comes from Australia’s attempts to keep the 1918 Pandemic out of this country. Then, quarantine of shipping probably delayed introduction of the epidemic into Australia until early in 1919. This spared Australia from the first and second, deadliest, waves of transmission. The third wave was far less virulent.

But that was only a partial success, achieved at a time when the fastest means of personal transport was on horseback and the only means of intercontinental travel by ship. If Cordon sanitaire couldn’t be completely affected, despite vigorous effort, under those conditions, it is hubris to think it would work with today’s speed of travel and volume of human movement.

The second reason quarantine won’t work is human nature. Strict social controls are anathema to free peoples.

Social controls work in highly regimented, closed societies. If Kim Jong Il says jump, 22 million North Koreans obediently (fearfully) cry out “how high?” in unison.

Now imagine standing in front of a group of homecoming Aussies, tired and worn out from a long journey (even if it is a hedonistic vacation), and informing them that they shouldn’t go home. Any idea what responses you’d get? They wouldn’t be in unison, either.

The public now perceives swine flu as being no worse than seasonal flu. In the decision criteria most people will employ faced with the alternatives of enforced confinement (hotel, fever ward, cruise ship), vs. going home, or voluntary confinement at home vs. going to work in an economic environment where a job is to be protected at all costs, the choice of disregarding the government edict will be an easy one to make. And one that fits the larrikin Australian psyche.

In public health we are damned if we do and damned if we don’t. There is much glory to be gained in jumping into the fray when a catastrophe strikes and doing your bit to mitigate the effects of a disaster. Prevention success, resulting as it does in a non-event, carries no glamour.

Let’s assume for the moment that we do follow a policy of enacting strict social control measures, with harsh penalties for non-compliance. Now let’s make the more tenuous assumption that they provide some, but not complete, disruption of transmission. Let’s say 15% reduction in morbidity.

Such a reduction would justify such measures. But since this would be a real time intervention and not a controlled study, we would only be able to estimate the actual benefits. Now, what is the likely result? Would the public heap praise on the public health effort, rejoicing in the smaller peak in the graph of the epidemic curve? Or would they focus on the loss of business and freedom of movement and the civil sanctions imposed on those who violated quarantine. Would they cry “heroes” or would they cry “nanny state”?

Hudson Birden is Senior Lecturer, Public Health & Clinical Leadership, at the NSW North Coast Medical Education Collaboration

Peter Fray

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