April 30, 2009

Why No Quarantine for Travelers from Countries with Swin Flu Outbreaks?

After the American Century

This semester I have been teaching a course on disasters and culture. Eerily, each time we took up a new kind of disaster as a topic, the news media reported on just such a catastrophe. We read about earthquakes and shortly afterwards several Italian towns were rocked to their foundations. We examined fires, and immediately a large area in Australia broke into flames. We took up floods, and in Fargo and vicinity the Red River rose to the highest levels ever recorded. So I had some trepidation as we took up the subject of epidemics, a case study based on a documentary film about the 1918 flu epidemic. And sure enough, shortly afterwards, the swine flu burst out in Mexico. Before going further, I want to reassure readers that we have completed the assigned readings now, so even if the course was somehow provoking disasters, that should be over now.

As the swine flu outbreak heads towards what seems certainly to be pandemic status, I keep thinking about the familiar notion that all human beings are potentially no more than six degrees of separation away from one another. I realize that being able to reach just about anyone with no more than five or six intermediaries, using telephones, emails, and other communication systems, is not at all the same thing has the movement of a disease through direct human contact. The flu virus enters someone's body about a week before he or she knows it, during which time the illness spreads to strangers, friends, and family. The epidemic spreads rapidly because during the early stages the illness has not yet manifested itself. During this period, when the flu is only latent, an infected person can unintentionally give the flu to countless other people, especially if they travel during that time. And all of these newly infected people are just six degrees of separation from me, or you.

I am not a mathematician, but it seems obvious that as the disease spreads, its separation from me diminishes not as a straight line, but geometrically, and my increasing proximity to being exposed to someone with it would be graphed as a sharply curving line. In short, avoiding exposure is not going to be easy. So far, at least, no one taking my course has come down with swine flu. But then, it has not yet officially reached Denmark, though it has been diagnosed in a German patient in Hamburg and one man suspected of having the illness is being held for observation in Copenhagen.

The disease seems to be moving very fast, and it seems that health authorities are only able to react to help those who are sick, not retard the swine flu's progress. Curiously, back in 1918, an illness moved more slowly, because almost no one then flew. And yet in 1918 it was common to hold travelers in special quarantine facilities if they were merely suspected of carrying a deadly illness. Ninety years ago, it was likely an illness would manifest itself before a ship passenger crossed either the Atlantic or the Pacific. Don't we need to establish quarantine facilities near all airports? If a planeload of people arrives from Mexico, where the swine flu began, does it make sense to let them disperse into the general population? Or does it make sense to hold them all for observation, regardless of whether they seem ill or not? That would be expensive, you say. Well, how much is a human life worth?