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    SARS plans don't include quarantine

    U.S. health officials count on voluntary isolation, not quarantine, to prevent spread of the illness.

    By LEONORA LaPETER, Times Staff Writer
    © St. Petersburg Times
    published April 11, 2003

    In Hong Kong, health officials quarantined residents of an apartment building, sending them to isolation camps.

    Canada ordered a 10-day quarantine for people who visited an Ontario hospital, and Singapore announced plans to quarantine foreign workers arriving from countries afflicted with the mysterious severe acute respiratory syndrome.

    Around the world, officials have begun invoking little-used quarantine laws to protect citizens from sick patients and those with whom they've had contact.

    President Bush signed an order last week giving U.S. health officials the right to quarantine those infected with SARS. It was the first time a disease had been put on the list in 20 years, since hemorrhagic fevers such as Ebola were added.

    But health officials say the possibility of invoking a widespread quarantine here -- isolating individuals who are not sick but have been exposed to SARS -- is remote. They have instead chosen to ask those who show symptoms of the disease to stay home and avoid contact with others.

    "The key is isolation; that's the backbone of our infection control strategy," said Dr. Steven Wiersma, the state epidemiologist with the Florida Department of Health. "Quarantine is an emotionally charged word. It is a tool in the toolbox of public health officials, and it involves restricting the movement of well people. We've had powers of quarantine a long time but it's rarely used. Right now the key to our prevention efforts is isolation, not quarantine."

    While health officials have the right to enforce a quarantine within their jurisdictions, quarantines in the U.S. have typically involved small numbers of travelers who have come into contact with curable diseases, such as tuberculosis or cholera.

    The last large-scale quarantine in this country involved the Spanish flu from 1918 to 1919. The last federal quarantine was in 1963 for one person detained to prevent the spread of smallpox.

    But it might be a question of semantics. In Florida each year, more than 60 people with tuberculosis who fail to take their medication as prescribed are ordered by the court to the A.G. Holley State Hospital for TB patients in Lantana for treatment, said Ray Collins, the hospital's superintendent.

    "But I don't ever recall the word 'quarantine' " being used," he said. "It's court-ordered."

    To be sure, the idea of quarantining the healthy along with the sick is a controversial one, and local health officials were reluctant to even speculate what they might do.

    "It would be on a case-by-case basis on the judgment of health officials involved," said Dr. Julia Gill, an epidemiology program manager with the Pinellas County health department. "Unfortunately, we can't foresee every possible scenario. While we have our policies in place . . . every situation is different and has to be approached with the knowledge you have at the time."

    Wiersma said the 11 suspected SARS cases in Florida so far have not been as virulent as the cases in Asia and Canada, prompting him to suggest officials might consider it a milder version of the disease. He expressed hope that Florida -- with 16-million residents and 70-million visitors a year -- may be able to contain the disease without a quarantine.

    And Tommy G. Thompson, U.S. secretary of Health and Human Services, said in a statement that quarantine authority would be used only if someone posed a threat to public health and refused to cooperate with a voluntary request.

    So far more than 150 people in the United States have shown symptoms of the disease and the numbers grow by the day. No one in the United States has died from the disease, which has stricken 2,781 people and killed 111 worldwide, according to the World Health Organization. Symptoms of SARS include coughing, fever and shortness of breath.

    At area hospitals, a patient brought in with SARS would be placed in an isolation room with negative air flow. Anyone going into the room would wear goggles, a mask, plastic gown and gloves.

    "So far, we're concerned and aware and we're as ready as we're going to be," said Dr. Keith Rosenbach, communicable diseases director for Hillsborough's health department and an infectious diseases physician at Tampa General Hospital. "There's a lot of infection control built up from other diseases. We're not reinventing the wheel."

    -- Information from Times wires was used in this story.

    Quarantine procedure

    On its Web site, the Centers for Disease Control and Prevention outlines in general terms how long a quarantine for a dangerous contagious disease might last if it became necessary:

    Passengers on a plane believed to be carrying a person infected with such a disease would be delayed for several hours while health authorities determine the risk. The passengers would be released and contact information obtained.

    If a passenger was determined to be sick with the contagious disease, other passengers would be quarantined to a facility where they would be monitored.

    Passengers who sat near or had contact with the infected person might be quarantined for a longer time frame. In cases of SARS, health officials recommend isolating individuals for 10 days after symptoms subside.

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