I dunno, is this a Great Debate? Let me start it here.
Over here is the story of a young man who got some really nasty drug-resistant tuberculosis in Russia. He was diagnosed in Arizona and put into a quarantine facility and told to wear a mask if he went out in public. He didn’t.
He went to local stores and restaurants unmasked. So the court ordered mandatory, supervised, quarantine. Maricopa County does not have a quarantine facility so they put him the prison ward. Since he is housed with Really Bad People, he cannot have an internet or phone connection. The situation would drive most of us nuts.
So many people commenting on the linked story are outraged he is being jailed.
I am not. It is true his conditions are bad, he ought not to be with prisoners. That being said he has a really bad disease. Lesser methods of keeping it in check failed. If he continued his behavior people would almost certainly become sick, and might well die.
Yeah, I think he needs to be quarantined, even if it is against his will. However, they do understand that he is not a criminal, and they said he HAD access to a phone and a computer, but those were taken away for security reasons. THAT, I think, is very unfair - unless they can show that the patient posed a genuine security risk to the prison, I don’t get that.
Yeah, but he seems to be in a the jail ward and the Nasty People in that ward cannot be allowed near unsupervised communication. The county does need a better facility for him. Still, I say lock him up.
Wait. When did prisons have the ability to quarantine someone with a disease spread by aerosol droplets? And if a prison cell can be made secure against that danger, why not a hospital room?
Very stupidly. You could have gas sinks for O2 and CO2, but unless they’re destroying every single item that ever enters that room, all that happens is that Daniels is in a room where “air gets pumped in, but not out” and that the Koch bacilus can still get out on items he’s touched, his clothes, the clothes of medical personnel, etc.
The level IV biocontainment units have gas sinks and systems to pass air through several kinds of filters (solid and liquid ones); they don’t just… eat air!
I agree that he needs to be treated and isolated, but there have to be better ways to do it.
Same as for isolation units in hospitals, although it’s more accurate to say that the room is kept at a lower pressure than the outside. That ensures that air leaks blow clean air INTO the room rather than contaminated air OUT of the room. The contaminated air is pumped out and appropriately filtered or disinfected before it gets near anyone else.
While I think jailing the guy is rather extreme, part of me wants to believe that he did it to himself. The guy has a severe and highly communicable infectious disease. He was told to remain under quarantine and to wear a mask when he went out in public – obviously for the safety of the very public he wanted to go out in. He did not. He went out, breathing his virus all over the place. That’s not illegal – millions do it every day when they get a cold – but this is far more than a cold, so for that he is a dumbass. What if he had SARS and violated his quarantine? That’s a worse case, granted, but drug-resistant TB isn’t a walk in the park either.
I think he does need to be under quarantine against his will. He’s sick and his negligence could spread it. They need to contain it any way they can. They ought to have a facility with at least some basic amenities though – TV, internet and a phone, for starters. He deserves that at minimum, and I think they should transfer him somewhere that has a proper quarantine facility.
After looking at the cited article I think there are enough extenuating circumstances to give the guy a second chance at the outpatient facility.
He has seen what North Americans (I’ll group Canadians in here, although I would hope we would have a friendlier secure facility available) think of his behaviour. He knows first hand what the consequences are of not doing what he is told, which he did clearly did not realize earlier. He was being stupid, not malicious. Put him under the tightest restrictions available outside of the lockup and remind him that if he gets caught even trying to break quarantine again he’ll go back where is is now.
If a mask was sufficient quarantine, then he probably doesn’t need the room with the tiny demons who pull out the CO2 and push oxygen back through the otherwise-impermeable membrane. He needs not to be within several feet of people who would otherwise breath in his contaminated exhalations.
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.
We’ve a number of ‘negative pressure’ rooms in our prison system. Hospitals have similar rooms , but they don’t have the security to prevent a person from waltzing out and spreading the disease.
I’m not sure about the shower situation. Maybe the don’t let him out of the negative-pressure cell ever? That would seem a little extreme considering that a mask is a pretty good barrier to TB transmission – but then I don’t know just how virulent this guy’s strain of TB is. If they don’t let him shower solely for policy reasons – like maybe, guys in segregation don’t get showers – that would be less defensible IMO. For the same reason, I’m not sure I understand (or approve of) the lack of amenities; the guy hasn’t been charged with a crime so I don’t see why they shouldn’t make his enforced isolation as comfortable as possible.
The guy would have to stay in quarantine until he no longer presents a significant public health risk. The linked article says:
And why isn’t he allowed to shower?