AT WHAT COST

At What Cost

Humans have long been considered the biggest threat to themselves. This doesn’t just refer to physical conflict and the many wars fought over the last century, but also our ability to spread bacteria, viruses, parasites, and fungi. With a rapidly increasing population, infectious diseases are continuing to be a large problem worldwide. “As the first infectious disease to emerge as a new cause of human illness in the 21^st century, SARS underscores the growing importance of health issues in a globalized world” (Monaghan, 2004). Severe acute respiratory syndrome (more commonly known as SARS) is an atypical pneumonia caused by a virus that spread to over 8000 people across the globe when it surfaced in the early 2000’s. While SARS is not currently an immediate threat, it is worth discussing as the potential for resurging exists and it is a highly infectious disease.

While there is a lull in the havoc this disease causes, it is important to consider what actions should be taken if it resurfaces. Patients infected with SARS, as well as their families and others suspected to be at risk, should be quarantined. Beijing attempted this strategy when SARS originally surfaced by closing schools and forcibly locking both patients and healthcare workers in hospitals during the peak of the infections. While I believe that is an extremely inappropriate response, there are good arguments to be made in favour of quarantining individuals. First, it is important to understand that “isolation” refers to the separation of infected, symptomatic individuals, while “quarantine” refers to the separation of individuals who have been exposed to the infection, but are not yet ill. SARS has a four to six day incubation period. This means patients may have the disease for almost a week before they begin experiencing any symptoms. This, combined with the 10% mortality rate and spread via the droplet route, provide a strong case for quarantining individuals exposed to the deadly disease.

The two biggest counter arguments against quarantine are the potential cost, especially in a country that largely subsidizes medical treatment, and the ethical dilemma involving human rights. At first glance, it seems obvious that an extreme financial burden would be created by quarantining individuals just because they may have been exposed to an infectious disease like SARS. That being said, studies have already put this myth to rest. In a study presented in the Journal of Infection the “results indicate that quarantine is not only effective at containing newly emerging infectious diseases, but is also cost saving when compared to not implementing a widespread containment mechanism” (Gupta et al., 2005). A more compelling argument against quarantine is that it imposes on the right to freedom of movement. Is it acceptable for the government to place an asymptomatic individual in quarantine because a co-worker they have been working closely with or a family member has a confirmed infectious disease? After the AIDS epidemic in the 1980’s, the Siracusa principles were created to help determine when restriction to human rights can be justified. To summarize these principles, quarantine will be done in the best interest of the public, in accordance with the law, and without discrimination or unjustly restriction. It is worth considering that while quarantine may seem like a violation of the rights of the quarantined individual, letting them potentially spread a deadly disease they have been exposed to infringes on the rights of the rest of the population that they come into contact with. Sometimes small financial sacrifices or ensuring potentially infected individuals do something they may not want to must be done for the greater good.

All this information may initially be overwhelming, but lets look at what can be done in order to ensure our country doesn’t face another large scale SARS outbreak. First, there are many low-cost infection control changes that can be implemented. These can include the installation of Plexiglas shields at triage, increased hand sanitizer stations, and signage regarding respiratory hygiene and hand washing. These low cost implementations are not only beneficial for SARS, but for many other infectious diseases as well. Next, quarantine zones should be implemented for those exposed to the illness. This should be done in accordance with the Siracusa principles previously mentioned to minimize restriction on human rights. Lastly, financial support should continue to be given to those who require quarantine. As studies have already proven that quarantine is cheaper in the long-run, the government should have no issues in justifying the financial assistance of those requiring quarantine.

In conclusion, SARS is one of many extremely infectious diseases. Individuals suspected of being at risk should be quarantined for the greater good of quickly preventing the disease from the carnage it is capable of. This should be done in a way that makes sense financially and also minimizes restriction on human rights. Maybe the next time there is an outbreak of a deadly disease like SARS, the casualty count will be much lower.

To hear how Hong Kong has been changed, watch this video: Ten years on, the SARS outbreak that changed HK

RESCUE

Barbisch, D., Koenig, K.L., Shih, F.-Y., 2015. Is There a Case for Quarantine? Perspectives from SARS to Ebola. Disaster Medicine and Public Health Preparedness 9, 547–553. https://doi.org/10.1017/dmp.2015.38

Gupta, A.G., Moyer, C.A., Stern, D.T., 2005. The economic impact of quarantine: SARS in Toronto as a case study. Journal of Infection 50, 386–393. https://doi.org/10.1016/j.jinf.2004.08.006

Lander, F., er, 2014. Human rights and Ebola: the issue of quarantine | Global Health. Translational Global Health.

Martin, E., 2015. SARS, in: Concise Medical Dictionary. Oxford University Press.

Monaghan, K.J., 2004. SARS: DOWN BUT STILL A THREAT. National Academies Press (US).

SARS, questions and answers, 2003. Ontario. Ministry of Health and Long-Term Care.