No fly disease regs don't fly

Better late than never. When the Bush administration proposed sweeping airport quarantine rules in 2005, even those of us most concerned about avian influenza thought it was a fruitless policy on scientific grounds, not to mention issues of civili liberties and economics. The airlines hated it, too:

The regulations, proposed in 2005 during the Bush administration amid fears of avian flu, would have given the federal government additional powers to detain sick airline passengers and those exposed to certain diseases. They also would have expanded requirements for airlines to report ill passengers to the CDC and mandated that airlines collect and maintain contact information for fliers in case they later needed to be traced as part of an investigation into an outbreak.

Airline and civil liberties groups, which had opposed the rules, praised their withdrawal.

The Air Transport Association had decried them as imposing "unprecedented" regulations on airlines at costs they couldn't afford. "We think that the CDC was right to withdraw the proposed rule," association spokeswoman Elizabeth Merida said Thursday.

The American Civil Liberties Union had objected to potential passenger privacy rights violations and the proposal's "provisional quarantine" rule. That rule would have allowed the CDC to detain people involuntarily for three business days if the agency believed they had certain diseases: pandemic flu, infectious tuberculosis, plague, cholera, SARS, smallpox, yellow fever, diphtheria or viral hemorrhagic fevers such as Ebola. (Alison Young, USA TODAY)

It isn't that pandemics don't happen. We just had one. Or that air travel doesn't spread disease. The 2009 pandemic spread so fast largely because of air travel. Ironically it was the 2009 pandemic that did the proposed rules in because it was obvious they would have done nothing to stop the spread. They just wouldn't work. Indeed even for the poster child for this kind of measure, the flying TB lawyer, it didn't work -- nor was any harm done to anyone because of the failure.

This was the kind of "public health theater" typical of administrations that have no other solutions. The Bush administration was famous for this but the Obama White House had a similar response around the Christmas underpants bomber episode. Now we'll be virtually strip searched at the airport by scanner, likely to no avail. They'll find nothing that way but some other simple workaround by a terrorist wannabe will reveal a new security hole. The galling thing is that people in these administrations know this, too. Even in the Bush White House there was controversy we now learn:

Even in the Bush administration, some were skeptical of the CDC's 2005 proposal, said Stewart Baker, assistant secretary for policy at the Department of Homeland Security from 2005 to 2009. "There were a lot of questions about how plausible it was to treat airports as a place where you could stop and inspect and quarantine people," Baker said Thursday.

Now he tells us? Makes me ant to take off my shoes and whack him over the head with them.

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Identifying sick people is not that easy. Some time ago while commenting at another blog I looked up some statistics about using thermal scanners to identify people with elevated temperatures at airports. This was done to see if such methods could be used to slow the spread of flu. Such scanning was implemented at an airport in Canada and one in China (I think). I don't remember the exact numbers, but basically of many thousands of scanned people, not one actual case of flu was identified, although a number of people were pulled aside for positive readings.

There were components to the proposed regulations that didn't make any sense, but as someone who is tasked with tracking down passengers possibly exposed to communicable diseases on aircraft, I can tell you that it's not an easy thing to do (and exposures happen more than people might think). Contact information is often unavailable or incorrect.

The workaround to contact information is having every passenger fill out a health questionare like they did in Asia dueing the SARS outbreak. Providing false information is punishable by law.

But really, you can be just as easily infected on a bus, train, baseball game, or movie theater. These proposals are all about giving government more control over peoples freedoms. Get them used to being treated like cattle on planes, and you can do the same anywhere.

I suspect that the faster spread of new viruses via travel before they become too deadly helps spread herd immunity and is thus preventing a repeat of a 1918 event. Quarantines may be counterproductive in that case.

Indeed contact tracing is a Herculean undertaking. Several papers throughout the years suggest it costs way more than just treating the illness as--or if--it occurs. We have to modernize our approach to infectious disease exposures of public health significance. Mitigating is better than containment . Now only if we could convince individual states to drop the nonsense of enhancing quarantine policies. 14 century measures in the 21st century just don't work.

BTW Revere, I love my iPad so don't delay running out and getting one-waiting for vacation is too long to be without.

By BostonERdoc (not verified) on 06 Apr 2010 #permalink