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June 04, 2007

The case of the tubercular honeymooning lawyer

Tom Mayo has collected a good deal on information on the question of quarantine raised by the case of Drew Speaker, the tubercular honeymooning lawyer, here and here.

The CDC's proposed regulation linked to in the first of Tom's posts above includes some good background info on the legal bases for imposing quarantine.

Current thinking sees limited value in quarantines, generally, however.  This is why, even though state and local governments have the authority to quarantine individuals as an exercise of the police power, it doesn't happen much at all.

An excerpt from a JAMA article abstract that's a few years old sums it up nicely.  The article is focused on responses to bioterrorism -- though the same conclusions are equally applicable to infectious disease spread by other means, be it TB, bird flu, or other disease.  The conclusion:

Imposition of large-scale quarantine -- compulsory sequestration of groups of possibly exposed persons or human confinement within certain geographic areas to prevent spread of contagious disease -- should not be considered a primary public health strategy in most imaginable circumstances. In the majority of contexts, other less extreme public health actions are likely to be more effective and create fewer unintended adverse consequences than quarantine.

The case of the tubercular honeymooning lawyer may well be one of that minority of cases where quarantine is appropriate, however.  I'll leave it to the infectious disease and epidemiology experts to work that one out.

Let's not even get started on whether the release of his identity is a HIPAA violation.  He never should have been identified publicly, but it was probably unavoidable, given the ever-expanding ring of folks who were brought into the contact tracing exercise.

Update 6/6/07: The WHO says:

local health officials should have told airlines to keep Andrew Speaker from boarding a plane once they concluded he was likely to defy advice and go ahead with plans to fly to Europe to be married.

Update 6/28/07: Tip of the hat to the Health Affairs Blog, which posted last week:

Today (June 22), the World Health Organization and the Stop TB Partnership announced that they were launching a $2.2 billion, two-year plan that aims to set international public health systems on a path to providing access to drugs and diagnostic tests to all MDR-TB and XDR-TB patients by 2015.

-- David Harlow


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