The quarantine quandary.

• Author: Akers, Becky
• Position: REFLECTIONS - Essay

When globetrotting groom Andrew Speaker was discovered to be carrying tuberculosis (TB) germs in May 2007, virtually no one questioned that the state should and could protect us from him. Apparently, healthy citizens suddenly lose their rights upon becoming ill; contagious folks who disobey public-health officials may be forcibly quarantined and isolated--that is, imprisoned without a trial. Like tribesmen throwing virgins into volcanoes, Americans assume that sacrificing one unlucky person's rights will preserve their lives.

But does quarantine really protect the healthy? Or is it smoke and mirrors, designed to convince us that rulers are looking out for us when they are actually helpless? After all, Speaker easily outfoxed governments on two continents during his homeward odyssey. When the Centers for Disease Control and Prevention (CDC) suggested that he surrender himself to Italian authorities and claimed to have added him to the federal No-Fly List, Speaker booked tickets on a foreign airline instead. He and his wife flew to Canada, rented a car, and drove across the border into New York State. Speaker was finally hospitalized where he wanted to be and only because he chose to be, with no thanks to bureaucrats. But then, with help from a complicit media, they were busy exaggerating his infectiousness--just as they did with Typhoid Mary a hundred years ago.

More than mere historical and philosophical curiosity is at stake here. The Department of Homeland Security (DHS) and the CDC eagerly await their chance to quarantine us in the event of bioterrorism or a pandemic. Spokesmen for both bureaucracies have enunciated the moral of Speaker's story, lest anyone misinterpret it: the government needs more and stronger laws, more and stronger authority. Is "public health" yet another of Leviathan's inexhaustible excuses for controlling Americans?

Rulers have long tried to persuade their citizens that they can stave off maladies. These attempts follow a common, callous pattern: the state turns people afflicted with certain illnesses into pariahs who may be exiled, imprisoned, or even executed. The abuse often extends to their families, friends, and neighbors, regardless of their health.

European and Asian countries were among the first to experiment with quarantines when they posted armed men around infected regions in the 1300s. These guards were permitted to murder anyone fleeing--and spreading--the contagion. Milan's government forced those suffering from plague to forsake the city for the surrounding forest until they recovered or died. Ragusa quarantined newcomers from areas cursed with plague in facilities that must have been primitive at best: victims endured "purification by sun and wind" for a month, surely the longest of their lives ("History of Quarantine" 2004). New York City's government topped this inhumanity in 1916 when it ripped children diagnosed with polio from poor parents. Wealthier families remained intact because they supposedly could hire nurses--and lawyers to fight such tyranny.

Dead men pay few taxes, which may be one reason that the state almost always sides with the healthy against the ill. Then, too, even at the height of the most severe epidemic, those who are well usually outnumber the stricken. (1) Moreover, almost all sufferers will not only seek medical advice, but follow it. Government can safely play the numbers game against the few who do not.

If we grant rulers the power to police contagious people, where do we draw the line? Should the state not only imprison the victim, but also doctor him against his will? Who will treat him: physicians the government appoints or those the patient chooses? What happens if their opinions conflict as to whether the patient is contagious--or even ill at all?

When ABC's Diane Sawyer interviewed Andrew Speaker, he said that public-health officials told him he "wasn't contagious, not dangerous." He "repeatedly asked doctors, 'Is my family at risk.' ... I was not advised to take special precautions around them" (Muir 2007). Speaker mentioned his plans to travel to Greece for his wedding, but no one prohibited his going ("Global Health Scare" 2007).

Yet the hysteria that greeted the asymptomatic Speaker's return to the United States had bureaucrats scrambling to change the story. Dr. Martin Cetron of the CDC tried to make the newlywed sound like a fugitive from medical justice: "When we ... finally caught up with this individual in Rome, [we] share[d] the information about the progressive culture results and [made it] clear that under no uncertain terms [sic] should he use aircraft." Yet even as Cetron pandered to the public's fears, he admitted, "We believe that his degree of infectiousness is quite low" ("People Potentially Exposed" 2007).

Dr. Neil Schluger, who treats tuberculosis at Columbia Medical Center in New York, pointed out that Speaker's "wife apparently has not been infected with tuberculosis and presumably she's had close contact with him for an extended period of time.... Secondly, when he coughs up phlegm and it's examined under the microscope, we don't see a lot of TB germs in the phlegm--and that's also a sign that he's probably not very infectious" (Muir 2007). Skeptics might question whether he was sick at all: after Speaker was hospitalized in Denver, his doctors "announced that a third consecutive test of his sputum--called a smear test--failed to find any TB bacteria. Speaker has consistently been 'smear negative' since he was diagnosed with TB in January" (Deans and Young 2007). Ironically--some might say criminally--the federal bureaucracy so anxious to apprehend Speaker may have been the source of whatever germs he carried. Speaker's father-in-law, Bob Cooksey, is a doctor at the CDC. He announced on May 31, 2007, "I do work at the Centers for Disease Control and Prevention. I have worked at CDC for 32 years. I am a research microbiologist in CDC's division of tuberculosis elimination." How coincidental that the son-in-law of a man who plays with tuberculosis germs contracted the disease. But of course an august bureaucrat at the CDC would never transmit infection. "As part of my job, I am regularly tested for TB," Cooksey continued. "I do not have TB, nor have I ever had TB. My son-in-law's TB did not originate from myself, or the CDC labs, which operate under the highest levels of security" (Slevin 2007). Let us pray that the security of labs housing specimens of smallpox, ebola, and other deadly germs is better than their managers' judgment. After tests revealed that Speaker actually suffered from MDR TB, a milder form than the XDR TB that the CDC had misdiagnosed, "the CDC said it still would have publicized the case even if it had known the true diagnosis when Speaker was traveling in Europe" (Roos 2007). Talk about your bullheaded bureaucrats.

From the state's perspective, how infectious Speaker was--or even if he was--does not matter. Far more useful was the public's panic, its belief that Speaker might kill with a cough anyone within spitting distance, and its certainty that only the government can save hapless citizens from annihilation. These ideas allow public-health boards to pose as heroes rescuing us from the selfish sick who insist on interaction rather than isolation.

Government's pretension of protecting the public's health bamboozles almost everyone, even those who love liberty. However much people loathe Leviathan, they are willing to trust it in this one instance. But medical bureaucrats are as political and manipulative as any others. We see this in Speaker's story and in the tale of another asymptomatic whom New York City's Board of Health exploited early in the twentieth century.

Mary Mallon was a single woman and Irish immigrant who worked as a cook for wealthy families in the 1900s. Not only did she seem wholesome and healthy, but she was a skilled chef whose peach ice cream was everyone's favorite. Mallon was thirty-five years old when her employers took her with them to their summer rental on Long Island. Within a few weeks, half the household took sick with typhoid--as had other households for whom Mallon cooked.

Public-health officials eventually fingered her as the source. But "Typhoid Mary" vehemently denied that she was sick or ever had been. And she wasn't. Medical historians theorize that she may have either inherited typhoid bacteria from her mother or suffered a bout of it as an infant of which she was never told. In any event, she apparently carried typhoid bacteria all her life, infecting others while remaining healthy herself (as do approximately 3 to 5 percent of recovered typhoid victims). New York's health department arrested her, hauled her kicking and screaming to a hospital to test her urine and stool for typhoid, and then exiled her to an islet in the East River.

Not only did Mallon fight literally for her liberty as she was dragged away, but she later fought legally when she sued the health department. At trial, she presented the findings of an independent lab to which she had sent samples of her waste for a year. The lab's results consistently showed her free of typhoid. However, the health department had continued its tests as well, and it contended that three-fourths of her...