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SARS epidemic unmasks age-old quarantine conundrum

In Thailand, hotels are requiring visitors George Washington University. ST MONITORING ATION from certain countries to check in at sepa- But such measures, Barbera says, SARS rate counters. In India, airline pilots are re- are bound to fail. “When you fusing to fly to some parts of the world. In look carefully at quarantine his- Singapore, thousands of people must stay tory, it was always a failure,” home and appear in front of government- Barbera says. “The objective is to installed cameras at random times, and the contain disease, not to contain Roman Catholic Church there has banned human beings.” APT. 1006 confessions until further notice. At best, quarantine can delay This is just a small sampling of responses the spread of a disease and buy to the threat of severe acute respiratory time, says Barbera. Even then, syndrome (SARS). As of 14 April, the dis- he adds, governments must be ease, which originated in the Guangdong rational and provide workers’

province of China, had claimed the lives of compensation or workers’ insur- Susan Wolsborn 122 people in seven nations and infected ance to those in quarantine and, WE'RE CALLING IT "REAL WORLD SINGAPORE" more than 3,000 others. The leading hy- most important, educate the pothesis is that the flu-like illness is caused public on how best to protect themselves. ance required for it to succeed. by a new strain of coronavirus. For many nations, this is the first quar- Sattenspiel has constructed mathemati- Since the World Health Organization antine experience in decades. In the US, for cal models of quarantine based on simula- sounded the alarm about SARS in March, example, the last mass quarantine was dur- tions of the 1918 flu epidemic. “If you’re http://www.nature.com/naturemedicine universities, international companies and ing the 1918–19 Spanish flu epidemic, really able to limit everybody and keep all governments are recalling people from when the government closed down those people from moving, it does work,” Hong Kong, major airlines have canceled schools, shops and church services, inter- she says. “It’s just that you never have a flights to the region and the WHO has re- rupted train and ship routes and began perfect quarantine because you’re trying to leased an unprecedented travel advisory. placing people in quarantine camps. The convince perfectly healthy people to stay Governments across the world have also global response to SARS, 85 years later, has put. There’s always going to be people who been struggling to find ways to defend not been much different. “We will do, in find a way around it.” against the disease and many have invoked this country, whatever is necessary to con- In Hong Kong, for example, authorities long-dormant quarantine laws. Several tain the spread of the epidemic,” said first used barricades and tape to seal people nations, including Vietnam, Malaysia, Anthony Fauci, head of the US National inside Amoy Gardens apartment building, Taiwan, New Zealand and Australia, are ei- Institute of AIDS and Infectious Diseases. which produced several hundred of the ther barring visitors from SARS-affected na- “If that’s quarantine, so be it.” city’s SARS cases, then placed them in tions or are requiring them to wear masks Isolation of infected individuals is stan- quarantine camps. But when police arrived

© Group 2003 Nature Publishing for 10 days under threat of hefty fines. In dard procedure in treating infectious dis- at the building, residents of more than half Hong Kong and Singapore, the govern- eases such as tuberculosis. Quarantine, on the apartments were missing and still re- ments have placed thousands of people the other hand, applies to people who main at large. under forced quarantine. have been exposed to the disease but may The Singapore government enforced “It’s totally predictable—those are the not yet be ill. Separating exposed people large-scale quarantines soon after the dis- kinds of things that are going to occur,” says and restricting their movements is in- ease first struck and hired a security com- Joseph Barbera, co-director for the Institute tended to stop the spread of that illness— pany to place electronic cameras at the for Crisis, Disaster and Risk Management at but it doesn’t, says Lisa Sattenspiel, homes of those under quarantine. It also associate professor of began issuing electronic wrist tags to mon- anthropology at the itor the movements of quarantine viola- University of Missouri. tors. In spite of those measures, Singapore’s “Isolation at least does numbers rose on 14 April to 147 cases, the something,” she says. third highest in Asia. “Quarantine is much, That may partly be because of the high much less effective.” ratio of ‘superspreaders’ or hypertransmit- Although experts have ters of SARS, some experts say. But others maintained for hun- warn that the harsh environment may dreds of years that quar- drive people to seek alternative medicines antine doesn’t work, and steer clear of hospitals for fear of governments intuitively being taken from their families. Still, “if turn to it because it you have 20 [exposed] people and only 10 keeps people from mov- in quarantine, that’s better than none in ing around, Sattenspiel quarantine,” says Fauci. “That’s what’s says. But what they called a common-sense mathematical (AP photo/Anat Givon) Life as usual—almost: residents of Hong Kong go about their daily don’t realize, she adds, model.” business wearing masks to protect against SARS. is the level of compli- Apoorva Mandavilli, New York

NATURE MEDICINE • VOLUME 9 • NUMBER 5 • MAY 2003 487