Avian Flu and the response

Tuesday, October 04, 2005
I caught the President's news conference clips today and he again mentioned a potentially expanded role for the military in domestic affairs--this time with respect to the potential ability of the military to enforce quarantines of cities or regions IN THE UNITED STATES in the event of an outbreak of Avian Flu (H5N1 flu in a human to human transmission form). The president's remarks raise two troubling issues for me.

While quarantine has a long and honorable role in public health, it is at best a 19th century concept that MAY be less applicable in the 21st century. Make no mistake--it works, but it is draconian in its fullest form. The Canadian experience with SARS has some graphic lessons about the ability of a free society with a history or personal liberty to enforce a quarantine. Personal mobility also cuts against our ability to employ this particular public health weapon.

The issue of larger importance to me, is an increasing interest in employing the regular military forces of the nation to effect domestic ends. Tacitus' Annals speak to the impact of the thirteenth legion's incursion into Roman home territory and the subsequent rise of Praetorianism during the early empire. More recently Oliver Cromwell's protectorate and his use of the roundhead army speaks to the potential for mischief. In fact, I think it was the experience of the Protectorate that shaped our colonial aversion to a standing army--Locke, Hobbes, and Harrington all talk to the issue in their writings.

In the aftermath of Katrina, and with the potential for a flu pandemic within the coming 12 months, I sense there is some public support for the domestic use of our federal forces--this, to me, is a serious policy question that deserves a very careful and reasoned discussion that has thus far been lacking.

I will go through more detailed arguments in future posts, but wanted to put this topic on the table for discussion.

Press Conference Transcript

12 comments:

terrye said...

Was there any use of troops during the influenza epidemic in the early 20th century?

It is worrisome.

Knucklehead said...

Terrye,

Other than the first few hundred cases being recognized in US military camps and various bases being closed (quarantined) I don't recall ever seeing anything about the military playing any response roll.

Here's a little timeline.

I'm not a fan of using the military internally within the US for emergency response or law enforcement. I can see modifying posse comitatus to clearly identify certain military specialties (MPs, medical, comms, drivers, that sort of thing) and specific types of equipment in relatively small numbers for specific and short durations to be transferred, upon specific request, to governors. But that is already possible via the National Guard so it would be supplemental.

If we want a national emergency management corps we should fund and build one. Leave the military as far out of it as humanly possible.

chuck said...

It is hard to isolate the flu through quarantine because it is spread by migrating birds; one of the reasons it shows up in fall and is geographically dispersed.

One advantage I could see to using troops is they may be vacinated if a vacine is available. Public health in the country has been underfunded and in decline since its heyday 50 to 100 years ago. Antibiotics and vacines did it in. Well, that is my guess, anyway.

Rick Ballard said...

My compliments on an excellent initial post.

I remain appalled by the casualness with which some pundits urged the use of federal troops for peacekeeping/police functions due to the breakdown of order in NO. I can understand the media newsreaders lackwittedness but the punditry should know better - the lessons cited in this post were very familiar to the Founders. Of course, they had only to look at the troops forcibly quartered among them to have a clear understanding of the opportunity for misuse that an army represents. Does the punditry in this country so misunderstand human nature and power that they believe that its misuse in the US is impossible?

I haven't read the President's remarks but if he actually is thinking of using federal troops to enforce quarantine then I would think that a fullblown media effort on the part of the CDC is very much warranted.

RogerA - has the anticipated morbidity rate for this virus been established?

RogerA said...

Rick--Thanks--Martin Meltzer of the CDC has done several very significant analyses of the economic impact of a pandemic flu in the United States--His work is published in the on-line Journal of Emerging Infectious Diseases available on the CDC web site--I will get busy and put together some links--but his projections are based on a mortality rate of .02 and infection rate from .15 to .30. In addition the CDC has several programs availble for projections.

Knucklehead said...

The idea of running a full-fledged quarantine is nearly preposterous in modern America. We can't close our borders - imagine the problem of closing transport internally.

When the SARS scare went around I (through family members) was exposed to how the emergency response aparatus would be tasked to deal with an epidemic. It would be a matter of staffing hotlines, public communications, voluntary "quarantine", and distribution of medical professionals and the resources they need. Troops would add little or nothing that I can detect other than, perhaps, transport which is not something in short supply in the US.

An avian flu epidemic would have very different attributes than a natural disaster such as hurricane or earthquake.

I'm somewhat lost about why this new fascination with deploying troops domestically has developed.

RogerA said...

Terrye--knuck is correct; although the 1918 flu hit the military disproportionately high--unlike most influenza it had a higher mortality among young age cohorts.

Chuck: the bird migrations spread avian flu--the pandemic issue comes in once its transmissible human to human.

Other big concerns become: who gets vaccinated, because IF (and a big IF) is if we do get a virus there wont be enough for everyone.

RogerA said...

oops--if we get a vaccine (not virus)

RogerA said...

I think interest in the using the military comes directly from the Katrina experience--deploy the 82d, they get things done, get a couple of military guys like LTG Honore and VADM Allen--straight talkers etc--and we learn the wrong lessons from that--yet another bad outcome from lousy media coverage.

flenser said...

In the event of another outbreak like the one in 1918, it's likely that tens of millions might die in the US alone, with scores of millions sick. I expect that nation-wide martial law might have to be imposed, simply to ensure that basic services are provided and that food distribution is uninterrupted. I doubt that anyone will be worrying much about the use of the military.

We are much more interdependant now than back in 1918.

Knucklehead said...

Flenser,

I tend to doubt the doomsday scenarios when it comes to epidemic infectious diseases in a modern nation. While we are certainly more tightly packed together than ever before we also have significantly better ability to track vectors and treat symptoms (help patients survive), as well as increased ability to find and produce vaccines, today than we did in 1918.

That said we do have some medical expertise here at YARGB so I may get, ummm..., a quick smackdown on this.

flenser said...

Knuck

One the one hand we have better medical know-how available to us than in 1918. They did not have antibiotics back then for example, and many flu victims died of secondary infections after being weaked by the flu.

On the other hand, the population back then was still mostly rural. People lived in relativily self-contained communites, so isolating disease carriers was an easier proposition. A highly contagious disease in our hyper-mobile society will spread uncontrollably.

Even under ideal circumstances, i.e now, our ability to produce vaccines is very limited. If the whole world starts clamoring for one tomorrow, ninty-nine percent of them will be out of luck.