Attitudes Toward[s] Quarantine In A Public Health Emergency In US...



Can we see what is coming ... ? Also note that while the majority of each countries population opposes quarantines, the implication seems to be that it is coming (whether we like it, or not!)...

Attitudes Toward The Use Of Quarantine In A Public Health Emergency In Four Countries

Countries worldwide face the threat of emerging infectious diseases. To understand the public’s reaction to the use of widespread quarantine should such an outbreak occur, the Harvard School of Public Health, with the U.S. Centers for Disease Control and Prevention, undertook a survey of residents of Hong Kong, Taiwan, Singapore, and the United States. A sizable proportion of the public in each country opposed compulsory quarantine. Respondents were concerned about overcrowding, infection, and inability to communicate with family members while in quarantine. Officials will need specific plans to deal with the public’s concerns about compulsory quarantine policies. [Health Affairs 25 (2006): w15–w25 (published online 24 January 2006; 10.1377/hlthaff.25.w15)]

Countries worldwide face the global threat of newly emerging infectious diseases such as severe acute respiratory syndrome (SARS) and pandemic influenza. These types of diseases can create serious problems for international and local public health authorities and health professionals: They can be highly contagious and can lead to death or serious illness. Such diseases also can have major economic impacts.1 These concerns are often heightened by the lack of proven vaccines or effective treatments for those who become infected. Thus, the importance of containing these diseases before widespread transmission occurs becomes a priority for public health policy and planning.2

Measures available to public health authorities around the world to control such epidemics include encouraging citizens to wear masks in public to prevent the spread of airborne illness, canceling public events or closing schools, isolating cases and quarantining contacts, monitoring and enforcing compliance, and screening for illness. In many countries, public health officials have the authority to make these measures compulsory.

To understand the public’s reaction to the possible use of widespread quarantine, we conducted a survey of residents of Hong Kong, Taiwan, and Singapore, where the use of quarantine for these purposes was widespread during the SARS epidemic, and residents of the United States, who have had very little recent experience with widespread quarantine. The survey was conducted by the Harvard School of Public Health, in collaboration with researchers at the U.S. Centers for Disease Control and Prevention (CDC), with assistance from public health officials in the other countries or regions surveyed.


Concern about infectious diseases. Prior research has shown that when people are more concerned about a health threat, they are more likely to change their behavior.6 In countries with higher numbers of SARS cases, respondents reported significantly higher levels of concern about the disease. Respondents in Hong Kong, Singapore, and Taiwan were significantly more worried than U.S. respondents that they or a family member would become ill with SARS in the next twelve months (Exhibit 1). Those in Singapore also were significantly more likely than those in the United States to report being very concerned about becoming ill with avian flu.


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 (Exhibit 1). 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 (Exhibit 2). This difference across racial groups held after age, sex, income, education, and urbanity were adjusted for.


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 (Exhibit 6). Although strong majorities in all four regions said that they would trust their own doctor or another health professional a lot as a source of information, they differed in their level of trust of other sources. 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 (data not shown). 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.



The issue of how to make quarantine effective is important to countries worldwide and is not only related to the SARS epidemic. President George W. Bush, through an executive order, recently added pandemic influenza to the list of quarantinable diseases.7 The threat of pandemic flu or an epidemic of disease caused by bioterrorism makes it imperative that we understand the lessons learned about the use of quarantine in prior epidemics.

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. Findings from other sources suggest that regions with quarantine experience still had problems with compliance, as evidenced by increasing fines and arrest penalties.8 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.

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