# 749
The idea that enforced quarantines might be required during a pandemic is once again in the news. This time, it is a report on the National Guard's operational readiness, should a pandemic strike.
First this report from Fox News, then a little discussion.
Report: National Guard May Be Needed to Enforce Quarantine in Flu Pandemic
WASHINGTON — Military and civilian health facilities will be overwhelmed if a nationwide flu pandemic hits the United States, and the National Guard may have to be called out to provide medical help and even enforce a quarantine, the Defense Department warned in a report released Wednesday.
As the Pentagon fights criticism from congressional Democrats that the war in Iraq is depleting the National Guard's ability to help out in domestic crises, the 86-page report says a possible pandemic could require National Guard assistance in supplying medical aid or isolating groups of people to minimize further spread of the disease.
About 3 million people could die as a result of a possible pandemic, with up to 35 percent of the population falling ill, reads the report dated August 2006 and titled "The Department of Defense Implementation Plan for Pandemic Influenza."
According to the report, in the event of a pandemic or a bioterror attack, the Defense Department may be called by the president to assist civilian authorities in minimizing the spread of disease by placing restrictions on interstate transportation. Jurisdictions, the report adds, would be overwhelmed and unable to provide essential commodities and services. In addition, the nation will not be able to rely on airlines.
The headline, which screams the dreaded `Q' word, is sure to have garnered a good deal of attention overnight.
Interestingly, this article cites 3 million deaths in the U.S., which is 50% greater than most federal estimates. A subtle clue that perhaps the early estimates of mortality are a bit optimistic.
Most public health officials doubt the effectiveness, or wisdom, of using mass quarantines during an influenza pandemic. Should a pandemic come our way, it is unlikely that it can be cordoned off by use of such tactics.
There are instances where a quarantine might be effective, very early in an outbreak, but only at the original site of the outbreak. If a remote village somewhere in the world is the first to experience H2H (Human-to-Human) transmission, it might be possible to cordon off that area, and apply a Tamiflu blanket to smother the disease.
But once the disease escapes the confines of a single geographic area, and begins to spread widely, quarantines are unlikely to help much.
I'm not particularly surprised that the military has considered how they might enforce a quarantine. It is their job to analyze all potential threats, and to be prepared to respond. If there's a scenario, you can bet they have a contingency plan for it.
If we had absolutely secure borders, and could shut off all international travel during a pandemic, perhaps quarantines might make some sense. But there is no way to keep the virus out of the country, and it will likely be coming at us from a hundred different directions.
There may be attempts, early in a pandemic, to play a game of whack-a-mole with the virus, in hopes of knocking it down each time it rears it's head somewhere in the country. The idea being that we might slow the progression of the disease, and buy some time.
And it might buy a few days. Time to close schools in adjacent states, or move resources into position.
But it is likely a futile exercise, for the virus will continue to come into this country on airline flights, and across our porous borders, from every direction. Once it begins to spread, influenza becomes ubiquitous, and nothing we do will stop its run.
And of course, the odds of actually keeping people from leaving a quarantined area are pretty slim. Frightened people will find a way out.
Unfortunately, people expect our government, and our military, to respond aggressively in a crisis. The political pressure will be enormous. No, no one wants to be quarantined. But they will likely demand that if an outbreak occurs in the next county over, that something be done to protect them.
So the government is faced with the decision to either throw up their hands in defeat, or try something, even if they doubt it will work.
Will we see quarantines, or restrictions in interstate transportation?
I suspect we will, at least in the opening days of a pandemic. There will be some states that may attempt to seal their borders, some towns that may try to keep anyone out who might harbor the virus, and some early hotspots that authorities may try to contain.
Any quarantines are likely to be short-lived, however. Even if it were possible to cordon off Town A, where the virus has been reported, it will pop up in the next town over. Once the genie is out of the bottle, there will be no putting it back.
Over the long run, the only form of quarantine that may make sense is a voluntary in-home quarantine when a family member falls ill. This would likely slow the progression of the disease through a community, although it would not stop it.
Obviously, the local health departments won't have the resources to enforce this sort of thing, and it will require the understanding and cooperation of the populace for it to work.
In either case, people will need to have the ability to stay in their homes for a prolonged period of time. Hence the need for food, water, and medicines stockpiled for each family. The government recommends two weeks supply, but many people agree that 6 to 12 weeks makes more sense.
With a Federal government, 50 State governments, and thousands of local jurisdictions all trying to deal with a crisis, we are likely to see a confused and inconsistent response, and mistakes will be made.
A pandemic is, by definition, an overwhelming event.
Decisions will be made by people at all levels of government, and not all of them will be good ones. We've never dealt with a threat such as this in our modern society, and many things will be tried.
However well intentioned, not all will succeed.
And as unhappy as that prospect is, we have to remember that those who will be making these decisions are fallible human beings who will be working under immense pressures, with limited resources, at great personal risk, and dealing with a crisis of unimaginable proportions.
While these people will be doing the very best they can, under the circumstances, no one should expect a well-oiled machine.
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