[QUOTE=Paul in Saudi]
Another question, how do you build a room where the air comes in, but does not go out?
[/QUOTE]
The vast majority of isolation cells are negative pressure cells, as others have said. Many jails have no such cells, since they cost between $90,000 and $125,000 each to construct. The only other place to quarantine such a person would be at a hospital, which would not have the resources to hold someone involuntarily on a long-term basis.
I have no problem with a non-complaint drug-resistant-TB patient being quarantined indefinitely and involuntarily. There is simply too high a risk of infection among the population; the disease is highly communicable and this individual’s strain is highly drug-resistant. The tightest restrictions available outside of lockup would not – could not – prevent him from infecting others. You would have to trust him to ALWAYS take appropriate precautions and NEVER expose anyone to his exhalations. The risk that he would not be sufficiently vigilant is too great; he already has a history of non-compliance. Sure, he says he gets it now and he didn’t then, but the potential public health reprecussions if he breaks that trust are simply too great.
Involuntary quarantine has a long history, including the establishment of community “pest houses” in the U.S. in the 19th century. Persons with small pox would be ordered by a judge to go to the pesthouse to live and to remain until they died or were deemed no longer contagious by the local doctor. The problem was that these pesthouses, as unsecure facilities (usually out in the country away from the town), did not include any mechanism to MAKE people remain. They frequently ran away, often to another community where they were unknown, and so the pesthouses tended to exacerbate rather than contain the spread of disease. Thus the advent of secure quarantine, where the patient was placed in a place where he or she was not able to just walk away.
Further, the distrust of quarantine subjects has a long history in the States. The most famous quarantine subject was Typhoid Mary. After spending years in quarantine, she was released upon her strict promise that she would never work as a cook again. Instead, she returned to cooking, caused another typhoid outbreak (in a hospital) and was placed back in quarantine, where she remained for decades until she died. (With no way to quarantine her in a facility without risk of infection of others, Mary was quarantined on an island.) Historians taking a sympathetic view of Mary point out that she was not trained to do anything other than cook and that she received no social support services after her initial release, which is quite true. But she still remains the best-known example of what can happen when you trust an infected individual to both understand the gravity of their condition and to be responsible enough to never risk exposing another person – even if it would be better and easier for for the patient to risk exposing others, and even if the patient can rationalize that the actual risk of infection is surely very low.
On preview: A mask is actually an acceptable barrier to the spread of TB. The problems include: many masks don’t fit correctly; people tend to fiddle with them; and people find them uncomfortable or stigmatizing so they take them off.
And why isn’t he allowed to shower?
And why isn’t he allowed to shower?