Boston Globe Editorial: Bush's Solution to Everything is Military, Even in Flu Pandemic

Good piece by George J. Annas on Boston.com:

WHENEVER THE world is not to his liking, President Bush has a tendency to turn to the military to make it better. The most prominent example is the country's response to 9/11, complete with wars in Afghanistan and Iraq. After Hurricane Katrina, Bush belatedly called on the military to assist in securing New Orleans, and has since suggested that Congress should consider empowering the military to be the ''first responders" in any national disaster.

On Tuesday, the president suggested that the United States should confront the risk of a bird flu pandemic by giving him the power to use the US military to quarantine ''part[s] of the country" experiencing an ''outbreak." So we have moved quickly in the past month, at least metaphorically, from the global war on terror to a proposed war on hurricanes, to a proposed war on the bird flu.

Of all these proposals, the use of the military to attempt to contain a flu pandemic on US soil is the most dangerous. Bush says he got the idea by reading John Barry's excellent account of the 1918 Spanish flu pandemic, ''The Great Influenza." Although quarantine was used successfully in that pandemic, on the island of American Samoa, Barry in his afterword suggests (sensibly) that we need a national plan to deal with a future influenza pandemic. He said last week that his other suggestions were the only ones he hoped public health officials and ethicists would consider, but they read like policy recommendations to me and apparently the president. Barry writes, for example, ''if there is any chance to limit the geographical spread of the disease, officials must have in place the legal power to take extreme quarantine measures." This recommendation comes shortly after his praise for countries that ''moved rapidly and ruthlessly to quarantine and isolate anyone with or exposed to" SARS.

Planning makes sense. But planning for ''brutal" or ''extreme" quarantine of large numbers or areas of the United States would create many more problems than it could solve.

First, historically mass quarantines of healthy people who may have been exposed to a pathogen have never worked to control a pandemic, and have almost always done more harm than good because they usually involve vicious discrimination against classes of people (like immigrants or Asians) who are seen as ''diseased" and dangerous.

Second, the notion that ruthless quarantine was responsible for preventing a SARS pandemic is a public health myth. SARS appeared in more than 30 countries; they all reacted differently (some used forced quarantine successfully, others voluntary quarantine, and others no quarantine at all), and all ''succeeded." Quarantine is no magic bullet.

Third, quarantine and isolation are often falsely equated, but the former involves people who are well, the latter people who are sick. Sick people should be treated, but we don't need the military to force treatment.