What of quarantine?

Quarantines were briefly discussed in the comments on this thread. A recent study in the journal “Health Affairs” carried out jointly by researchers at Harvard and the CDC determined attitudes about quarantine in Singapore, Taiwan, Hong Kong, and the U.S.

One thing to note: remember quarantine is for individuals who have been exposed, but are not showing signs of illness. Those who *are* sick would be put into isolation (likely at a hospital–if there are available beds). Just so no one gets those two confused…

U.S. perspective on compulsory quarantine. In the United States, compulsory quarantine, under which those who refuse to comply could be arrested, was supported by 42 percent of the public across all demographic groups. African Americans were significantly more likely than whites or Hispanics to move from initially favoring the measure to no longer favoring it when told they could be arrested for noncompliance. This difference across racial groups held after age, sex, income, education, and urbanity were adjusted for.

Preferences for place of quarantine. The survey asked people if they would like to have their family members quarantined at home or elsewhere. It also asked about where they themselves would like to be quarantined, should the need arise. There were significant differences on both of these measures, with U.S. respondents strongly preferring home quarantine in both cases. In comparison, smaller numbers of those in the other three countries would prefer to have family members quarantined at home and to be quarantined at home themselves. When asked if they would still want to be quarantined at home if they were required to wear a mask at all times to protect healthy family members, 60 percent of those in the United States, 22 percent of those in Hong Kong, 28 percent in Taiwan, and 40 percent in Singapore said yes.

Majorities in both Singapore and Taiwan reported that they would be very worried about infecting health family members if quarantined at home. Approximately four in ten U.S. respondents would be very worried about this, as would 47 percent of Hong Kong respondents

Interesting differences. They picked Singapore, Hong Kon, and Taiwan specifically because they’d had recent experience with quarantines, and so may be a bit, well, “wiser” than US citizens when it comes to the difficulties that come with a quarantine order. It’s striking that such low numbers in Hong Kong and Taiwan–where “bird flu” and SARS have recently taken tolls on the public’s health–would choose not to be quarantined at home with their unexposed loved ones, while so many of those in the US would choose to remain there (potentially exposing others in their family to the disease).

Who would they trust to provide accurate sources of information? Read on…

Trusted sources of information. Respondents varied across the four regions with regard to whom they would trust as a source of useful and accurate information about an outbreak of a serious contagious disease. In Hong Kong, Singapore, and Taiwan, majorities said that they would trust government public health authorities a lot, compared with only 40 percent in the United States. U.S. blacks were significantly more likely than U.S. whites or Hispanics to report that they would not trust the government at all. Slightly more than half of Hong Kong and Singapore respondents would trust the news media a lot, while only one-quarter of U.S. and Taiwanese respondents would do so. Employers were generally not seen as a trusted source of information across the four regions. In the United States, half of the public would trust a family member or friend a lot, compared with approximately one-third in the other three regions.

Sadly, this doesn’t surprise me much at all. The response to Katrina further eroded any confidence the public had in government agencies to keep them safe. Add into that all the supposed conspiracies by scientists and the government, and it’s no wonder there’s such a high level of distrust. But–notice that half would trust a family member or friend. That’s why I emphasized in the previous thread that we’d need the help of “ordinary” citizens to help reassure and convince people in the event of a quarantine–pastors, teachers, others in positions of trust.

Preparation for quarantine. The survey found widespread support for the use of quarantine in all four countries. However, the U.S. public has had very little experience with it. It seems reasonable to conclude, therefore, that the United States would have an even higher rate of noncompliance. To increase compliance, public health authorities need to plan in advance. They should prepare trusted spokespeople to explain to the public the steps that need to be taken to halt the spread of the disease and stress the need for compliance.

And this is what I said as well–we’re not prepared, and we need to do a lot more. Again, this is something that needs direction at the federal level, with the nitty-gritty details being taken care of at the local level (since they’re the ones who will most likely be actually enforcing it–local public health officials, policemen, etc.) Of course, this is again something that takes not only coordination and planning, but also money and staff that local agencies don’t have.

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8 Replies to “What of quarantine?”

  1. It’s striking that such low numbers in Hong Kong and Taiwan–where “bird flu” and SARS have recently taken tolls on the public’s health–would choose to be quarantined at home with their unexposed loved ones, while so many of those in the US would choose to remain there (potentially exposing others in their family to the disease).

    Actually if you look at the data, those in the other countries (not US) actual prefer to be quarantined elsewhere and not at home. According to the data, 30 percent of those in the United States “prefer to be quarantined somewhere else”, 70 percent of those in Hong Kong, 59 percent in Taiwan, and 42 percent in Singapore. Perhaps those in Hong Kong, Taiwan, and Singapore are a little bit “wiser” than US citizens

  2. That makes sense. I will have to say that I am actually afraid to be living in this country (US) if such an outbreak occurs. I was always impressed by the Japanese culture where it is common place to wear a mask to inhibit the spread of whatever illness. Due to the concentration of people in cities such as Tokyo, I am not suprised that this has become an accepted practice.

  3. I would presume that the mandatory wearing of masks to limit spittle propogation would be job one in a real epidemic. I wonder just how effective a counter-measure they are.

  4. They’ve not been shown to be very effective–mostly because they’re not used properly and rigorously. People pull them up to smoke, or wear them but then still touch their hands to their eyes (another way many infections–including influenza–can be spread), or assume a false sense of security and get lazy about handwashing, etc. They can be helpful when used correctly, but the population generally doesn’t do so.

  5. Interesting… When I thought of being quarantined, I immediately assumed that my whole family would be treated as exposed and quarantined as well, and imagined the alternatives as being (1) all of us placed together with a bunch of other quarantined people, or (2) all of us quarantined together at home. Given those choices, of course I’d pick the home quarantine. But apparently the Hong Kong and Singapore residents did not have those assumptions at all, possibly because they have more real experience with quarantines.

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