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January 24, 2020

Weekly line: China has quarantined cities to stop the new coronavirus. Could the US do the same?

Daily Briefing

    By Ashley Fuoco Antonelli, Senior Editor 

    Cases of the new coronavirus that's been spreading throughout China and other countries are rising rapidly—and this week the virus reached the United States, sparking concerns among health professionals and the public alike.

    From outbreaks to drug shortages: How can hospitals prepare for disasters?

    But it's China's unprecedented steps to control the outbreak that have taken the public health community by surprise, and has raised questions about whether a similar situation—and response—could ever arise in the United States.

    Chinese officials declare 'war' on new virus, implement city-wide quarantines

    Amid criticism that Chinese officials delayed initial reports and haven't been properly responding to the outbreak, officials on Thursday entered into what they deemed a "state of war." China implemented travel restrictions on Wuhan, where the outbreak originated, and 12 nearby cities, essentially quarantining an estimated 35 million people, according to the New York Times. While cars still were able to exit Wuhan as of early Thursday afternoon, authorities said they were screening all passengers entering and leaving Wuhan for symptoms of the coronavirus.

    NPR reported that officials' "sudden decision to lock down [Wuhan, a] city of 11 million residents, who were given less than eight hours' notice of the suspension of public transportation, suggests the severity of the outbreak has alarmed China's leaders."

    Experts call restrictions 'unprecedented'—and doubt they'll even work

    Many experts noted that the travel restrictions are unprecedented, both in China and worldwide.

    Eric Toner, an internist and emergency physician who is a senior scholar and scientist at Johns Hopkins University's Bloomberg School of Public Health, told Daily Briefing, "This is by far the largest ever attempt at a geographic quarantine."

    The Washington Post's Marisa Iati and Reis Thebault report that Howard Markel, a professor of history and medicine at the University of Michigan, called the quarantine "mind-boggling," adding, "I've never read about or seen a bigger one than they're proposing."

    Adding to the "mind-boggling" nature of the restrictions is the fact that experts say evidence has shown the quarantines likely won't do much good at this stage in the outbreak.

    Toner told Daily Briefing that while "no other country, including the United States, has ever tried to do this in the modern age, it is clear from prior attempts at smaller-scale geographic quarantines that they do not work." He continued, "I think there is no chance that this effort will stop the spread of this virus. Cases have already been found in every province in China. People in the affected cities will do whatever they can to escape the quarantine and this could accelerate the spread."

    Similarly, Rebecca Katz, a professor and director of the Center for Global Health Science and Security at Georgetown University, told Daily Briefing, "The virus has already left the city." So while quarantines "may slow geographic spread," they "won't stop it," she said.

    There's also uncertainty about what the quarantines mean for those remaining within the closed-off cities' limits. Toner said the quarantines could "cause great harm" to affected individuals.

    "Those stuck within the quarantine will experience shortages of food, civil unrest and will be at a higher risk of infections. There is also the question of how the quarantine will be enforced. The police and military have been deployed," Toner said. He asked, "What will they do with someone who refuses to comply? What level of force is authorized? What training and protective gear have the police and soldiers been given?"

    Katz similarly raised the possibility of harmful effects, saying the quarantines "may lead to public panic or shortages of things like food." She said, "It is almost unfathomable to think about the logistics of quarantining [millions of] people," adding, "One sincerely hopes that sufficient services will be provided to the population of Wuhan and the other quarantined cities to provide for their health and wellbeing."

    Could the US ever take similar steps?

    Reports of the Chinese quarantines and travel restrictions broke as news of the United States' first new coronavirus case began to surface, leading many to question whether the United States is prepared to handle a new disease outbreak—and whether U.S. officials, too, could impose city-wide quarantines.

    Katz told Daily Briefing that, to date, the United States has "never" implemented a quarantine on the scale of those currently taking place in China. She said the "closest examples we have" in the United States "come from the 1918 [Spanish] influenza [outbreak], when population movement was very different."

    But the United States has used smaller-scaled quarantines, mostly at ports of entry, to control disease outbreaks in recent years. The Post in 2014 noted that CDC has 20 quarantine stations at various ports of entry and land crossings in the United States that "deal with travelers who enter the country with communicable diseases—or at least showing signs of such illness." CDC notes that it "has the legal authority to detain any person who may have an infectious disease that is specified by executive order to be quarantinable."

    And in the midst of the West African Ebola outbreak, some state officials put their quarantine powers to use. After Thomas Duncan arrived in the United States from Liberia in 2014, and subsequently was diagnosed with and died from Ebola, authorities quarantined individuals who had contact with Duncan and implemented policies to quarantine some travelers and health workers entering the country from West Africa. Those quarantines, which were done on a case-by-case basis, sparked fierce debate and, in some instances, legal challenges.

    U.S. law appears to give federal and state governments the authority to issue larger-scale quarantines if officials deem it's necessary—although this authority hasn't been used in modern times. Congress in 1878 passed the National Quarantine Act, which gave the federal government power to work with state governments to implement quarantines. And in 1944, the Public Health Service Act tasked the federal government with protecting the United States from the spread of communicable diseases from foreign countries and between states.

    For now, officials are arguing that any U.S. outbreak will be mild. Nancy Messonnier, director of CDC's National Center for Immunization and Respiratory Disease, said she doesn't expect many cases of the virus in the country.

    Further, even if there is an outbreak in the United States, experts say there are better methods to mitigate it.

    Toner told Daily Briefing that "the fundamental" factors officials will need to consider when addressing any outbreak are "how transmissible" the virus is and "the spectrum of illness it causes." He said, "If it is as contagious as flu or the common cold, then containment will be impossible. But if the illness is quite mild in most people, then this does not present a major threat—it's just another coronavirus" like those that already "cause about a third of common colds."

    He added, "If, on the other hand, it transmits more like SARS or MERS, i.e. limited person-to-person transmission except in those who are very ill, then containment will be achieved by rapid identification and isolation of these who are sick."

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