Will Social Isolation Work?

A comment posed by Peter in response to my December 17, 2006 post titled: "Setting The Record Straight on Pandemic Preparedness" opens the question of the effectiveness of Quarantine, Isolation and Social Distancing.

Unfortunately, the terms "Quarantine," Isolation" and Social Distancing" are often used interchangeably. This leads to significant confusion when trying to predict the efficacy of various pandemic plans. Further, both "Isolation" and "Quarantine" had ominous terms. To engage in an intelligent discussion, we must begin with a common vocabulary:

Quarantine - The separation of a potentially exposed group from a known unexposed population.

Isolation - The separation of a known ill group from a known healthy population.

Social Distancing - The process of maintaining both physical distance and physical barriers to decrease the probability of spreading a disease.

Examples of each of these are common in history.

Quarantine has been attempted since time immemorial. The most extreme example (and the one Hollywood likes best) is the method used during the second Black Death (plaque) in Europe. In this method of quarantine, an army would surround a village. Anyone attempting to leave would be killed. When most or all of the villagers were dead of the disease, the village would be burned. Unfortunately, the plaque carrying rats would escape and the disease spread.

Isolation is a daily event in hospitals around the world because is it is easy. A person who is sick is easy to identify among a group of well people. This  sick individual (or group) can thus be separated from the health group in an attempt to decrease spread of the disease. The problem with isolation is that many diseases (including pandemic flu) ware contagious before the infected individual shows symptoms. This makes identification far more difficult. Further, isolation is equipment and staff intensive owing to the need to treat the sick patient without contaminating staff or others outside the isolation area.

Social Distancing is the method used in Singapore and Toronto to slow and eventually stop the spread of SARS. This method worked for several reasons. First and foremost, the healthcare systems in both countries allowed for enforcement of Social Distancing of healthcare workers at home as well as at work. This meant that healthcare personnel maintained their N95 masks and a minimum 2 meter separation from everyone even when off duty. The penalty for violation of this public health rule was sanction or imprisonment. In the words of one Toronto nurse,

" Imagine smelling your own stale breath as you tried to sleep alone in a separate room with your N95 mask still in place. My child was 5 years old... do you know how often you hold your 5 year old? I couldn't hold my child for that entire time."

Peter points out a valuable piece of planning information, Social Distancing (which he referred to as isolation) worked in 1918 and in 2004. The conference video Peter recommends proposes solutions not unlike those proposed by panels and committees on which I have proudly served. The point missed by all of these individuals, committees and expert panels; the point I missed until it was illustrated for me by James Shultz, Ph.D. at the University of Miami's Disaster and Extreme Event Preparedness Center aka DEEP Center (http://www.deep.med.miami.edu/). Dr. Shultz points out that Quarantine, Isolation and Social Distancing are "Separation by Prescription" and thus have significant psychological and social impact.

Separating people from their support systems, both personal and societal results in a loss of resilience. Resilience is the one tool we each have to turn a disaster around; it is through resilience that we ensure our resources exceed our needs.

There is a famous saying that was born in the early 1900's, "Don't throw the baby out with the bath water." In my original post I urged common sense in our approach to pandemic planning. I recommended against stockpiling medication and food. I recommended for good personal and public hygiene. Now I urge that we not throw out the baby of resilience with the bath water of preparation.

My original post: http://www.disaster-blog.com/2006/12/setting_the_rec.html

Peter's comment: http://www.disaster-blog.com/2006/12/setting_the_rec.html#comment-26952586