- ATLANTA, Ga. - Federal health
officials are quietly making plans for quarantining Americans who might
be exposed to a highly contagious smallpox patient, addressing sensitive
questions of how to hold people, possibly against their will, in case of
a bioterrorism attack.
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- The planning, still in draft form, addresses complex
logistical and policy questions, including where people would be kept while
waiting for officials to confirm a smallpox case and administer vaccinations
if necessary.
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- Most Americans older than 30 were inoculated for smallpox
as children, but medical experts doubt the decades-old inoculations would
still protect them from disease.
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- "It's not pretty to think through these type of
doomsday scenarios, but it's important to start to put yourself there and
imagine things unfolding if you want to anticipate how to react,"
said Marty Cetron, a quarantine expert at the Centers for Disease Control
and Prevention.
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- Within the next few weeks, the plan will be circulated
among top federal officials and others involved in the preparation, said
Cetron, who co-chairs a CDC working group on the issue.
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- The group began with this scenario: Officials get word
that an international flight is headed for the United States with a smallpox-infected
passenger. The case would be fairly easy because the people would be in
one place and health officials wouldn't have to track them down.
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- Still, if the passengers weren't held for treatment,
CDC experts estimate that a plane filled with 500 people including one
with smallpox could result in dozens -- maybe hundreds -- of sick people,
including passengers on the plane who got sick and the people they would
infect.
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- The vaccine is only effective within four days of someone
being exposed to smallpox, so if people leave the scene it would be difficult
to find them in time.
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- Under the plan, officials would stress that people would
be better off staying in quarantine because that's where the vaccine and
other medications would be available. That's a big change from past centuries,
when people in quarantine were written off, Cetron said.
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- "It's a fundamental difference to spend as much,
if not more attention, on monitoring and preserving the health on the people
inside the box," Cetron said.
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- Once planning is complete for this scenario, the CDC
group plans to tackle more complicated situations, such as a smallpox patient
in a sports stadium or an infected person wandering through an airport.
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- Smallpox was declared eradicated in 1980, but samples
of the deadly virus still exist in both the United States and Russia. Bioterrorism
experts consider the possibility of a smallpox attack one of the most frightening
threats because one infected patient could infect many others.
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- Federal officials are now considering vaccinating as
many as 500,000 health care workers and emergency personnel who would be
first to see any smallpox case. But because the vaccine carries significant
risks, including death, officials do not want to resume mass vaccinations.
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- Rather, the plan is to vaccinate others only if they
are exposed to the virus, or exposed to someone who is exposed.
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- The airliner scenario is not entirely fictitious. In
December, a flight from Taiwan bound for Newark, N.J., was delayed for
about four hours in Seattle after an anonymous tipster told U.S. Customs
Service agents that a passenger had smallpox. It turned out to be a hoax.
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- The draft CDC plan calls for taking the airplane to a
hangar or another facility where passengers can get off without going into
the airport, she said. The suspicious passenger would be isolated from
the others, but everyone would be kept in quarantine while officials did
tests to determine if the passenger was in fact infected with smallpox.
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- Still unresolved: how long to keep people if a smallpox
exposure is confirmed. Options include one to two days, or long enough
to give the shots; seven days, long enough to see if the vaccination worked;
or 17 days, when no one would be contagious anymore.
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- "It is such a sensitive topic. Those kinds of decisions,
to actually use a quarantine, will be made at very high levels," Cetron
said.
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