The Return of Quarantine

This story on the wires today: For the first time in four decades, the CDC has quarantined a man infected with extreme-drug-resistant tuberculosis. The item provokes three thoughts: 1) It's a growing truism that the ease of international travel is a boon to infectious disease (see SARS). But that doesn't make the ease of aviation-propelled infection any less alarming. And the real appeal isn't just that airplanes make it easy for a pathogen to skip across the globe - it's also the luxurious incubation time that close-contact airplane travel provides (what virus wouldn't love 200+ humans sitting inches from each other and swapping breath for 9 hours?), so that when the original carrier lands, his fellow passengers will help him finish the job.

2) Quarantines are an ethical issue waiting for a 21st century reconsideration. In the last few months, there have in fact been several stories like this one - Americans who turn up with TB and are quarantined, sometimes against their will - sometimes with the possibility that they'll die there. The difference now is that those have been almost invariably handled as a local matter, while in this case the CDC is at work. So to me, that means the issue of quarantines - when to do it? to whom? under what circumstances? - beg for some sort of clarity.

So what's the prevailing policy out there? A quick search of the CDC website reveals a rather officious, distant tone on the subject (much of it seems related to SARS, which happened four years ago). At the other extreme, some civil libertarians are all too ready to scream outrage at the police state - Is Sickness a Crime? they shout. Well, as the 100-year-old case of Typhoid Mary reminds us - yes, sometimes.

There's been some new thinking on the ethics of quarantine policies in policy and academic circles, specifically in relation to pandemic influenza and XDR tuberculosis, but ethics is different than policy. By and large the rhetoric on the subject seems outdated and out of step with the prospect. And if a pandemic does happen, and given that we are rather on edge these days, this could be a policy crisis in the offing. 3) good thing he was headed to Georgia anyway, where the CDC happens to be based (bonus points for those who know why - no fair Googling the answer!).