- WASHINGTON - In the event
of a bio-terrorist attack using a deadly and contagious disease such as
smallpox, public health officials want to be able to close roads and airports,
herd people into stadiums, and, if necessary, quarantine entire infected
cities.
-
- To make that possible, 50 governors this week are to
receive copies of a proposed law, drafted at the behest of the Centers
for Disease Control and Prevention in Atlanta, which could give states
immense power to control their populations.
-
- The proposed Model State Emergency Health Powers Act
may be months or years away from enactment by state legislatures. It may
be amended beyond recognition. But health officials say major new legislation
is crucial to keep smallpox, plague or hemorrhagic fevers such as Ebola
from spreading in the event of a terror attack. Unlike anthrax, they are
highly contagious.
-
- As a general principle, the draft law says authorities
could "require isolation or quarantine of any person by the least
restrictive means necessary to protect the public health."
-
- Broad quarantines envisioned in the draft have never
been invoked in the United States. They raise all sorts of logistical,
political and ethical questions in a mobile society, public health experts
concede. But such quarantines also may save lives.
-
- "If we don't do it, what would happen? I don't think
we've got any choice but to quarantine," said Dr. Lew Stringer, medical
director of North Carolina's special operations response team that handles
disasters and bio-terror.
-
- "The first thing you do is shut down the roads,"
he said. "Then you shut down the interstates, you shut down the schools,
you shut down the businesses. You're shutting down essential services,
not just nonessential ones."
-
- Local governments need to practice plans for quarantines
like fire drills to ensure they work in an emergency, said Dr. Scott Lillibridge,
the bio-terrorism assistant to Health and Human Services Secretary Tommy
Thompson.
-
- Thompson said Tuesday: "If we did have an outbreak
of smallpox," a possible quarantine "would certainly be one of
the avenues we'd have to explore."
-
- CDC authorities and a state's governor would exercise
their authority using mobilized National Guard units, said James Lee Witt,
former director of the Federal Emergency Management Agency.
-
- Lawyers and public health professors at Georgetown University
in Washington and at Johns Hopkins University in Baltimore drafted the
plan, in collaboration with representatives of governors, state and local
health officials and state attorneys general.
-
- Congress "should give public health authorities
strong powers to be able to isolate or quarantine people if necessary for
the public health," said the proposal's chief author, Lawrence Gostin,
professor and director at the two universities' Center for Law and the
Public's Health in Washington.
-
- Many states already have quarantine laws, but they may
not be constitutional, Gostin said. He said his proposal would probably
pass constitutional muster because it lets detainees ask a judicial-medical
board to get them out of quarantine.
-
- In Michigan, there are legal provisions for the governor
to declare a medical emergency and for state agencies to issue a quarantine,
said Geralyn Lasher, spokeswoman for the state Department of Community
Health.
-
- Between the Public Health Code, she said, and the Emergency
Management Act, "we have about all the areas covered" in case
of a bio-terrorism attack and the need to issue a quarantine.
-
- Gostin said the question of quarantines "is probably
the biggest issue because it involves liberty of individuals in the public."
He said the proposal would give officials authority to take control of
hospitals or stadiums to house quarantined people.
-
- But in the event of a quarantine, some people would likely
evade restrictions and spread the infection elsewhere, experts said.
-
- In one simulation, involving a fake plague that struck
at a rock concert in Chicago, questions arose about what to do with people
who insisted on breaking the quarantine, said Randy Larsen of the Anser
Institute, a security think-tank in Arlington, Va.
-
- Would a National Guardsman, he asked, shoot a grandmother
trying to evade quarantine?
-
- Maybe, Gostin said. "You have to use all reasonable
force." Sometimes, he added, that could mean lethal force.
-
- The proposed law is on the Web at www.publichealthlaw.net/MSEHPA/MSEHPA.pdf.
-
- Contact Assistant Nation/World Editor DENNIS ROSENBLUM,
who edited this report, at 313-222-6515. http://www.freep.com/news/nw/terror2001/quar7_20011107.htm
-
-
-
-
-
- HHS Set to Order Smallpox Vaccine for All Americans By
Ceci Connolly Washington Post Staff Writer Wednesday, November 7, 2001;
Page A09
-
- Health and Human Services Secretary Tommy G. Thompson
said yesterday that he expects to sign a contract this weekend to purchase
enough smallpox vaccine for every American but that he has warned the White
House the cost could be quadruple the $509 million he originally estimated
-- or equivalent to the department's entire $1.9 billion bioterrorism budget.
-
- Thompson said that he was disappointed the bids from
three companies came in around $8 a dose but that he hopes to settle on
a lower price in final negotiations on Friday, as he did in his recent
talks on the antibiotic Cipro.
-
- In addition to the 54 million doses already on order,
Thompson said he plans to stockpile 250 million doses of new vaccine, or
enough for "every man, woman and child" in the country.
-
- The previously announced administration effort to vaccinate
all Americans against smallpox, a deadly disease that was eradicated in
the 1970s, took on a renewed sense of urgency as one of the leading smallpox
authorities warned it was conceivable that former Soviet scientists were
helping to "weaponize" the smallpox virus for nations such as
Iran, Iraq, Libya and North Korea.
-
- "Many [Russian] scientists are really quite desperate
for money," said Donald A. Henderson, director of the new Office of
Public Health Preparedness. U.S. intelligence indicates that several have
been recruited by "rogue states" and were in a position to smuggle
out a vial of the virus, he said. "That's a very great worry."
-
- In addition, Henderson said, there is evidence that the
former Soviet Union succeeded in weaponizing the virus and manufactured
up to 100 tons annually at a plant outside Moscow. He described experiments
in which the Soviets planned to place smallpox warheads atop intercontinental
ballistic missiles. It is unclear whether any warheads were tested.
-
- "We do not have the confidence that the Russians
are not at this moment proceeding with research on biological weapons,"
Henderson said, noting that as recently as the early 1990s Russian scientists
tried to combine the smallpox and Ebola viruses in search of an even deadlier
agent.
-
- As the man who led the effort to eradicate smallpox in
the 1970s, Henderson is familiar with the potential consequences of a reemergence
of the disease. Because it is contagious and cannot be treated with existing
drugs, its virus is widely considered to be the most potent biological
weapon.
-
- "The likelihood of a smallpox release is much smaller
than an anthrax release," he said. "We're worried about it because
it could be far more serious."
-
- A person infected with smallpox often develops a fever
and, later, a rash. Smallpox vaccine administered within two or three days
of exposure has been effective in preventing the illness from developing,
he said. Historically, 30 percent of people infected with the smallpox
virus have died, he said, estimating that the eradication of the disease
two decades ago has saved 60 million people and protected 240 million others
from illness.
-
- Since the Sept. 11 terrorist attacks and the subsequent
anthrax attacks, Henderson has advocated an aggressive smallpox strategy,
including the stockpiling of vaccine. He reiterated yesterday that he would
not support widespread, mandatory vaccination but that he wants to have
the vaccine on hand in the event of an attack.
-
- "A smallpox outbreak anywhere in the world is potentially
an international disaster," Henderson said at a bioterrorism conference
at the Johns Hopkins Paul H. Nitze School of Advanced International Studies.
For that reason, he said, federal health officials have begun informal
talks with Japan, Brazil and several countries in Europe on the stockpiling
of smallpox vaccine.
-
- If even a single case emerged, Henderson said, he would
assume that it was the work of terrorists and would rapidly order quarantines
and vaccinations to "build a barrier of immunity."
-
- The United States has about 15.4 million doses of the
old smallpox vaccine available, and government researchers say it may be
possible to dilute those doses to vaccinate 50 million to 77 million people.
Thompson recently expanded and accelerated a contract with OraVex Inc.
(subsequently bought by British drugmaker Acambis PLC) for the delivery
of 54 million doses by the end of next year.
-
- A task force appointed by Thompson is reviewing the three
bids and debating safety, efficacy and possible human clinical trials.
Already, hundreds of volunteers in the United States are receiving the
vaccine as part of a rushed study on the efficacy of diluting the old vaccine.
-
- Later this week, newly formed smallpox teams at the Centers
for Disease Control and Prevention will take a crash course on the virus
with two former CDC experts. The class will focus on identifying, isolating
and treating the disease, said spokesman Tom Skinner. More than 100 CDC
epidemiologists have also received the vaccine, he said.
-
- Staff writer Justin Gillis contributed to this report.
http://www.washingtonpost.com/wp-dyn/articles/A51468-2001Nov6.html
-
-
-
-
-
-
- More data here: The Model State Emergency Health Powers
Act Following the tragic events of September 11, 2001, protecting the health,
safety, and general welfare of citizens is at the forefront of government's
responsibilities. Emergency health threats, including those caused by bioterrorism
and disease epidemics, may require the exercise of extraordinary government
functions. The Model State Emergency Health Powers Act grants specific
public health powers to state governors and public health authorities to
ensure a strong, effective, and timely response to public health emergencies,
while fostering respect for individual civil liberties. This version of
the Model Act, as of October 23, 2001, represents the final draft of a
committee assembled by the Center. Additional feedback may result in new
versions of the Act in the near future. The accompanying transmittal letter
is also available for download.
-
- http://www.publichealthlaw.net/Resources/Modellaws.htm
-
- Turning Point Program http://www.hss.state.ak.us/DPH/aphip/collabpubs.htm
-
-
-
-
-
- Title 42--Public Health CHAPTER I--PUBLIC HEALTH SERVICE,
DEPARTMENT OF HEALTH AND HUMAN SERVICES
-
- PART 70--INTERSTATE QUARANTINE [Code of Federal Regulations]
[Title 42, Volume 1, Parts 1 to 399][Revised as of October 1, 2000] From
the U.S. Government Printing Office via GPO Access [CITE: 42CFR70.1]
-
- [Page 517] TITLE 42--PUBLIC HEALTH
-
- CHAPTER I--PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH
AND HUMAN SERVICES
-
- PART 70--INTERSTATE QUARANTINE--Table of Contents
-
- Sec. 70.1 General definitions.
-
- As used in this part, terms shall have the following
meaning (a)Communicable diseases means illnesses due to infectious agents
or their toxic products, which may be transmitted from a reservoir to a
susceptible host either directly as from an infected person or animal or
indirectly through the agency of an intermediate plant or animal host,
vector, or the inanimate environment. (b) Communicable period means the
period or periods during which the etiologic agent may be transferred directly
or indirectly from the body of the infected person or animal to the body
of another. (c) Conveyance means any land or air carrier, or any vessel
as defined in paragraph (h) of this section. (d) Incubation period means
the period between the implanting of disease organisms in a susceptible
person and the appearance of clinical manifestation of the disease. (e)
Interstate traffic means (1) The movement of any conveyance or the transportation
of persons or property, including any portion of such movement or transportation
that is entirely within a State or possession-- (i) From a point of origin
in any State or possession to a point of destination in any other State
or possession; or (ii) Between a point of origin and a point of destination
in the same State or possession but through any other State, possession,
or contiguous foreign country. (2)Interstate traffic does not include the
following (i) The movement of any conveyance which is solely for the purpose
of unloading persons or property transported from a foreign country, or
loading persons or property for transportation to a foreign country.(ii)
The movement of any conveyance which is solely for the purpose of effecting
its repair, reconstruction, rehabilitation, or storage. (f) Possession
means any of the possessions of the United States, including Puerto Rico
and the Virgin Islands. (g) State means any State, the District of Columbia,
Puerto Rico, and the Virgin Islands. (h) Vessel means any passenger-carrying,
cargo, or towing vessel exclusive of (1) Fishing boats including those
used for shell-fishing; (2) Tugs which operate only locally in specific
harbors and adjacent waters; (3) Barges without means of self-propulsion;
(4) Construction-equipment boats and dredges; and (5)Sand and gravel dredging
and handling boats.
-
-
-
- [Code of Federal Regulations] [Title 42, Volume 1, Parts
1 to 399][Revised as of October 1, 2000] From the U.S. Government Printing
Office via GPO Access [CITE: 42CFR70.2]
-
- [Page 517]
-
- TITLE 42--PUBLIC HEALTH CHAPTER I--PUBLIC HEALTH SERVICE,
DEPARTMENT OF HEALTH AND HUMAN SERVICES
-
- PART 70--INTERSTATE QUARANTINE--Table of Contents Sec.
70.2 Measures in the event of inadequate local control.
-
- Whenever the Director of the Centers for Disease Control
and Prevention determines that the measures taken by health authorities
of any State or possession (including political subdivisions thereof)are
insufficient to prevent the spread of any of the communicable diseases
from such State or possession to any other State or possession, he/she
may take such measures to prevent such spread of the diseases as he/she
deems reasonably necessary, including inspection, fumigation, disinfection,
sanitation, pest extermination, and destruction of animals or articles
believed to be sources of infection.
-
- [[Page 518]]
-
-
-
-
- [Code of Federal Regulations] [Title 42, Volume 1, Parts
1 to 399][Revised as of October 1, 2000] From the U.S. Government Printing
Office via GPO Access [CITE: 42CFR70.3]
-
- [Page 518] TITLE 42--PUBLIC HEALTH CHAPTER I--PUBLIC
HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES
-
- PART 70--INTERSTATE QUARANTINE--Table of Contents Sec.
70.3 All communicable diseases.
-
- A person who has a communicable disease in the communicable
period shall not travel from one State or possession to another without
a permit from the health officer of the State, possession, or locality
of destination, if such permit is required under the law applicable to
the place of destination. Stop-overs other than those necessary for transportation
connections shall be considered as places of destination.
-
-
-
-
- [Code of Federal Regulations] [Title 42, Volume 1, Parts
1 to 399][Revised as of October 1, 2000] From the U.S. Government Printing
Office via GPO Access [CITE: 42CFR70.4]
-
- [Page 518]
-
- TITLE 42--PUBLIC HEALTH CHAPTER I--PUBLIC HEALTH SERVICE,
DEPARTMENT OF HEALTH AND HUMAN SERVICES
-
- PART 70--INTERSTATE QUARANTINE--Table of Contents Sec.
70.4 Report of disease.
-
- The master of any vessel or person in charge of any conveyance
engaged in interstate traffic, on which a case or suspected case of a communicable
disease develops shall, as soon as practicable, notify the local health
authority at the next port of call, station, or stop, and shall take such
measures to prevent the spread of the disease as the local health authority
directs.
-
-
-
-
- [Code of Federal Regulations] [Title 42, Volume 1, Parts
1 to 399][Revised as of October 1, 2000] From the U.S. Government Printing
Office via GPO Access [CITE: 42CFR70.6]
-
- [Page 518]
-
- TITLE 42--PUBLIC HEALTH CHAPTER I--PUBLIC HEALTH SERVICE,
DEPARTMENT OF HEALTH AND HUMAN SERVICES
-
- PART 70--INTERSTATE QUARANTINE--Table of Contents Sec.
70.6 Apprehension and detention of persons with specific diseases.
-
- Regulations prescribed in this part are not applicable
to the apprehension, detention, or conditional release of individuals except
for the purpose of preventing the introduction, transmission, or spread
of the following diseases Anthrax, chancroid, cholera, dengue, diphtheria,
granuloma inguinale, infectious encephalitis, favus, gonorrhea, leprosy,
lymphogranuloma venereum, meningococcus meningitis, plague, poliomyelitis,
psittacosis, relapsing fever, ringworm of the scalp, scarlet fever, streptococcic
sore throat, smallpox, syphilis, trachoma, tuberculosis, typhoid fever,
typhus, and yellow fever.
-
-
-
-
- [Code of Federal Regulations] [Title 42, Volume 1, Parts
1 to 399][Revised as of October 1, 2000] From the U.S. Government Printing
Office via GPO Access [CITE: 42CFR70.7]
-
- [Page 518]
-
- TITLE 42--PUBLIC HEALTH CHAPTER I--PUBLIC HEALTH SERVICE,
DEPARTMENT OF HEALTH AND HUMAN SERVICES
-
- PART 70--INTERSTATE QUARANTINE--Table of Contents Sec.
70.7 Responsibility with respect to minors, wards, and patients.
-
- A parent, guardian, physician, nurse, or other such person
shall not transport, or procure or furnish transportation for any minor
childor ward, patient or other such person who is in the communicable period
of a communicable disease, except in accordance with provisions of this
part.
-
- [[Page 519]]
-
- [Code of Federal Regulations] [Title 42, Volume 1, Parts
1 to 399][Revised as of October 1, 2000] From the U.S. Government Printing
Office via GPO Access [CITE: 42CFR70.8]
-
- [Page 519]
-
- TITLE 42--PUBLIC HEALTH CHAPTER I--PUBLIC HEALTH SERVICE,
DEPARTMENT OF HEALTH AND HUMAN SERVICES
-
- PART 70--INTERSTATE QUARANTINE--Table of Contents Sec.
70.8 Members of military and naval forces.
-
- The provisions of Secs. 70.3, 70.4, 70.5, 70.7, and this
section shall not apply to members of the military or naval forces, and
medical care or hospital beneficiaries of the Army, Navy, Veterans' Administration,
or Public Health Service, when traveling under competent orders: Provided,
That in the case of persons otherwise subject to the provisions of Sec.
70.5 the authority authorizing the travel requires precautions to prevent
the possible transmission of infection to others during the travel period.
-
- http://www.access.gpo.gov/nara/cfr/waisidx_00/42cfr70_00.html
-
-
-
-
-
-
- 42 U.S.C. 264 - The statute that authorizes these regulations,
i.e., Section 361 of the Public Health Service Act. UNITED STATES CODE
ANNOTATED TITLE 42. THE PUBLIC HEALTH AND WELFARE CHAPTER 6A--PUBLIC HEALTH
SERVICE SUBCHAPTER II--GENERAL POWERS AND DUTIES PART G--QUARANTINE AND
INSPECTION ß 264. Regulations to control communicable diseases (a)
Promulgation and enforcement by Surgeon General The Surgeon General, with
the approval of the Secretary, is authorized to make and enforce such regulations
as in his judgment are necessary to prevent the introduction, transmission,
or spread of communicable diseases from foreign countries into the States
or possessions, or from one State or possession into any other State or
possession. For purposes of carrying out and enforcing such regulations,
the Surgeon General may provide for such inspection, fumigation, disinfection,
sanitation, pest extermination, destruction of animals or articles found
to be so infected or contaminated as to be sources of dangerous infection
to human beings, and other measures, as in his judgment may be necessary.
(b) Apprehension, detention, or conditional release of individuals Regulations
prescribed under this section shall not provide for the apprehension, detention,
or conditional release of individuals except for the purpose of preventing
the introduction, transmission, or spread of such communicable diseases
as may be specified from time to time in Executive orders of the President
upon the recommendation of the National Advisory Health Council and the
Surgeon General. (c) Application of regulations to persons entering from
foreign countries Except as provided in subsection (d) of this section,
regulations prescribed under this section, insofar as they provide for
the apprehension, detention, examination, or conditional release of individuals,
shall be applicable only to individuals coming into a State or possession
from a foreign country or a possession. (d) Apprehension and examination
of persons reasonably believed to be infected On recommendation of the
National Advisory Health Council, regulations prescribed under this section
may provide for the apprehension and examination of any individual reasonably
believed to be infected with a communicable disease in a communicable stage
and (1) to be moving or about to move from a State to another State; or(2)
to be a probable source of infection to individuals who, while infected
with such disease in a communicable stage, will be moving from a State
to another State. Such regulations may provide that if upon examination
any such individual is found to be infected, he may be detained for such
time and in such manner as may be reasonably necessary. For purposes of
this subsection, the term "State" includes, in addition to the
several States, only the District of Columbia.
-
- Enhanced Surveillance Project(ESP) CDC is working with
state and local health departments and information system contractors to
develop real-time special event syndromic surveillance and analytical methods.
During special events, CDC Enhanced Surveillance Projects (ESP) monitor
sentinel hospital emergency department visit data to establish syndrome
baseline and threshold. Aberration detection models developed and analyzed
at CDC identify deviations in visit data and report to state and local
health departments for confirmation and appropriate epidemiological follow-up.
ESP has been tested at the World Trade Organization Ministerial in Seattle,
the Republican and Democratic National Conventions held in Philadelphia
and Los Angeles, respectively, and the Super Bowl/Gasparilla Festival in
Tampa, Florida. CDC will continue development and evaluation of ESP, in
order to provide guidance and resources to state and local health departments
for implementation of local real-time surveillance systems. http://www.bt.cdc.gov/EpiSurv/ESP.asp
|
