isolating cities

[gsgs]

are there any plans of any city which is going to completely isolate
themselves in a severe pandemic ?

I'd like to see a list of these cities.

We know, it may work from the models and from
the example of Gunnison in 1918.

 

[Sunshine123]

Re: isolating cities

GSGS, to isolate a city is more a military action. I know the military has plans on how to isolate a city, and it is not pretty. To initiate quarantine is a public health matter.

 

[tropical]

Re: isolating cities

"plans on how to isolate a city, and it is not pretty"

We saw such procedures in many Hollywood movies ...

 

[Sunshine123]

Re: isolating cities

Yes Tropical, The 'Theater of War' has many arenas.

Learn well from Hollywood. After all, that is their point.

You can take that to the bank.

 

[tropical]

Re: isolating cities

http://www.ncjrs.gov/App/publications/Abstract.aspx?id=192370

<TABLE cellSpacing=1 cellPadding=1 width="100%" border=0><TBODY><TR><TD class=text>NCJRS Abstract

</TD></TR><TR><TD>
The document referenced below is part of the NCJRS Library collection.
To conduct further searches of the collection, visit the NCJRS Abstracts Database.


</TD></TR></TBODY></TABLE><TABLE class=text id=absTable cellSpacing=1 cellPadding=1 width="100%" border=0><TBODY><TR><TD colSpan=2>How to Obtain Documents</TD></TR><TR><TD colSpan=2></TD></TR><TR id=NCJPan><TD vAlign=top align=right width="20%">NCJ Number: </TD><TD width="80%">NCJ 192370 </TD></TR><TR id=titlePan><TD vAlign=top align=right width="20%">Title: </TD><TD width="80%">Large-Scale Quarantine Following Biological Terrorism in the United States </TD></TR><TR id=journalPan><TD vAlign=top align=right width="20%">Journal: </TD><TD width="80%">Journal of the American Medical Association Volume:286 Issue:21 Dated December 5, 2001 Pages:2711 to 2717

</TD></TR><TR id=authorPan><TD vAlign=top align=right width="20%">Author(s): </TD><TD width="80%">Joseph Barbera M.D. ; Anthony Macintyre M.D. ; Larry Gostin Ph.D. ; Tom Inglesby M.D. ; Tara O'Toole M.D. ; Craig DeAtley PA-C ; Kevin Tonat MPH ; Marci Layton M.D. </TD></TR><TR id=urlPan><TD vAlign=top align=right width="20%">Document Url: </TD><TD width="80%">PDF </TD></TR><TR id=pubDatePan><TD vAlign=top align=right width="20%">Publication Date: </TD><TD width="80%">12/05/2001</TD></TR><TR id=pagePan><TD vAlign=top align=right width="20%">Pages: </TD><TD width="80%">7</TD></TR><TR id=typePan><TD vAlign=top align=right width="20%">Type: </TD><TD width="80%">Legislation/policy analysis</TD></TR><TR id=originPan><TD vAlign=top align=right width="20%">Origin: </TD><TD width="80%">United States</TD></TR><TR id=langPan><TD vAlign=top align=right width="20%">Language: </TD><TD width="80%">English</TD></TR><TR id=notePan><TD vAlign=top align=right width="20%">Note: </TD><TD width="80%">Downloaded December 28, 2001</TD></TR><TR id=annotPan><TD vAlign=top align=right width="20%">Annotation: </TD><TD width="80%">This article reviews the principles that are relevant to the likely effectiveness of a large-scale quarantine following biological terrorism.</TD></TR><TR id=abstractPan><TD vAlign=top align=right width="20%">Abstract: </TD><TD width="80%">In the event of a large bioterrorist attack with a communicable disease, the potential for person-to-person transmission of the disease would create serious health care and emergency management problems at the local and Federal levels. One of the first challenges to address is the lack of a precise definition of quarantine. It is most appropriate to use quarantine to refer to compulsory physical separation, including restriction of movement, of populations or groups of healthy people who have been potentially exposed to a contagious disease, or to efforts to segregate these persons within specified geographic areas. When an infectious disease is confined to a specific locale, the authority for quarantine usually rests with local or State public health officials. The Federal Government has the authority to enact quarantine when presented with the risk of transmission of infectious disease across State lines. For travelers seeking to enter the United States, the Centers for Disease Control has the authority to enact quarantine. U.S. history has demonstrated that quarantine actions themselves may cause harm. Some unintended consequences of quarantine implementation have been increased risk of disease transmission in the quarantined population; mistrust in government recommendations leading to violence; and ethnic bias adversely altering public health decision making. Decisions to invoke quarantine should take three questions into consideration. Do public health and medical analyses warrant the imposition of large-scale quarantine? Are the implementation and maintenance of large-scale quarantine feasible? Do the potential benefits outweigh the possible adverse consequences? Alternative disease control methods include investing new information tools and emergency management systems that would improve awareness during disease outbreaks; and providing incentives to foster specific public actions. Also suggested is devoting resources to developing robust public communication strategy commensurate with the critical importance of this action. 60 references</TD></TR><TR id=mainTermPan><TD vAlign=top align=right width="20%">Main Term(s): </TD><TD width="80%">Biological weapons ; Domestic Preparedness</TD></TR><TR id=indexPan><TD vAlign=top align=right width="20%">Index Term(s): </TD><TD width="80%">Emergency procedures ; Medical and dental services ; Weapons ; Subversive activities ; Terrorist weapons ; Communicable diseases ; Mandatory reporting of diseases</TD></TR><TR><TD></TD><TD class=text width="100%">
To cite this abstract, use the following link:
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[gsgs]

Re: isolating cities

in medieval Eurasia, they could just close the city-gates in the city-wall.
I think, some did it when there was plague.

We could do it today too (fences instead of walls), but it's expensive
and would prabaly only be done in a very severe pandemic.
But are there plans ? Estimates of costs ?

 

[tropical]

Re: isolating cities

It's necessary quarantining inside the city walls also.

http://www.haverford.edu/biology/edwards/disease/viral_essays/cummingsvirus.htm

Spanish Influenza Outbreak, 1918 by Sarah Cummings

...
Quarantines were also imposed in other areas. Washington D.C. enacted a law that made it illegal to appear out of doors and out of one's home. The quarantine infringed upon the personal rights of the townspeople to attempt to benefit the greater population. Again, if the outbreak had been small and easily contained, the quarantine may have been necessary and effective, but attempts to stop the greater outbreak and spread of influenza by quarantine were not necessarily useful.
...
___
As a result of an poultry bf outbreak 2004 (China):

http://www.chinaconsulatechicago.org/eng/xw/t67420.htm

<TABLE cellSpacing=0 cellPadding=0 width="98%" border=0><TBODY><TR><TD vAlign=center align=middle width="100%" height=30>Isolation Ends in China's 1st Bird Flu-hit Town </TD></TR><TR><TD align=middle width="100%" height=1>23-02-2004 </TD></TR></TBODY></TABLE>

Tang Bowen, magistrate of Long 'an County in south China's Guangxi Zhuang Autonomous Region, announced Sunday morning the ending of isolation imposed on the county's Dingdang Town, which had been stricken by the deadly H5N1 strain of avian flu late last month.
It is the first bird flu-affected area in China relieved of isolation. The move was based on the official prescription on lifting isolation imposed on highly pathogenic avian flu-afflicted areas after thorough examinations from Chinese agricultural experts.
Since the bird flu broke out on Jan. 23, governments at all levels took resolute control measures, paving way for the day to lift the isolation, said, Bi Qiang, a regional government official in charge of bird flu control.
It had been confirmed that ducks dying in a farm in Dingdang Town, Long'an County, were caused by the deadly H5N1 strain of bird flu virus. The local governments slaughtered 14,000 poultry within a three km radius of the duck farm, and vaccinated all poultry within five km of the duck farm.
The area had been closed off in accordance with China's Law on Animal Epidemic Prevention.
The Chinese Ministry of Agriculture received a report from Guangxi that no new bird flu cases had been discovered or confirmed for a succession of over 21 days since the last poultry in the affected area of the town was slaughtered as stipulated.
"We are told that emergent quarantine measures such as isolation, culling of poultry confirmed of bird flu, disinfection of poultry farms, as well as inoculation of poultry being threatened by bird flu were carried out around Dingdang Town, and the local quarantine officers of Guangxi supervised the quarantine efforts at the area," said the bird flu control spokesman with the Ministry of Agriculture.
Experts who were sent to assess the result of the bird flu control efforts concluded that the outbreak of the deadly H5N1 strain of bird flu found in Dingdang Town had been uprooted and the area met the requirements for being lifting out of isolation as stipulated in the Emergent Countermeasures Against Bird Flu of China and Technical Standards Regarding Fight Against Bird Flu.
In the meantime, the Ministry of Agriculture urged local organizations for supervision over animal quarantine to tighten the monitoring of bird flu in Dingdang and to prevent the occurrence of new bird flu cases. <META name=TRSWCM.ContEnd>

 

[Sunshine123]

Re: isolating cities

GSGS, yes there are plans and civilians are not privy to them. Isolation (after the virus is released in w/ the population or individual and symptoms are present; quarantine when the virus is being kept away from the household with no symptoms or population).

 

[Giuseppe]

Re: isolating cities

To fence partially a town may be costly but in the past several exercise were done to test this way of containment (both for riots and other mass gathering events with terrorist potential threat).

One of the prototypical example was the Genoa 2001 G8 Summit, when hundreds of thousands contestants met in the town amidst the big nation leaders meeting.

Italian interior ministry deployed a massive amount of policemen, soldiers and iron fences were placed to close the most part of downtown streets.

Containers walls were placed around the seaside motorways and citizens were ordered to stay at home, commercials and shop centres closed as well as anyother public and private halls.

Hospitals were put on alert and communication partially interrupted.

This is an example for other states for the rapid containment of a unknown number of people threatening public (and health) safety.

Extensive footage archives exist, mainly produced by contestants and represents one of the large multimedia account of a single historical event (with 9/11 WTC attack as the maximum example) built by non-professional people.

 

[gsgs]

Re: isolating cities

my idea was a fence to prevent others from entering, not people
from the town escaping.
Some small city please test it for seasonal flu, so we can see
whether/how it works.
Can they keep the flu out of the city for one season ?

 

[Giuseppe]

Re: isolating cities

my idea was a fence to prevent others from entering, not people
from the town escaping.
Some small city please test it for seasonal flu, so we can see
whether/how it works.
Can they keep the flu out of the city for one season ?

The iron fences closed the downtown Genoa streets for avoid people to enter into the RED ZONE.

Borders with France were sealed and all ground trasportation interrupted.

 

[gsgs]

Re: isolating cities

in a pandemic all these people could be infectious,

 

[mixin]

Re: isolating cities

GSGS, yes there are plans and civilians are not privy to them.

After a little Google search of "protective sequestration", I belive you are exactly correct. This article from Michigan University explains how the study of 7 towns came about. Have we seen the big study of the 45 cities?
-----------------------------------------------------------------------
http://www.medicineatmichigan.org/magazine/2007/spring/teamflu/default.asp

Team Flu Answers the Call
[snips]
But one call late on a Friday afternoon before the July 4 weekend in 2005 surprised even Markel ? it was from the Pentagon.

At the other end of the line was Cleto DiGiovanni Jr., M.D., of the Department of Defense?s Defense Threat Reduction Agency (DTRA).

DiGiovanni needed medical historians who understood the social, scientific, as well as epidemiological contexts of pandemics. The staff of the U-M Center for the History of Medicine fit the bill precisely.

The agency was looking for evidence of the effectiveness of so-called non-pharmaceutical interventions (NPI) in slowing the spread and mitigating the damage of a devastating outbreak of infectious disease. These interventions included quarantine of those exposed to the illness; isolation of the infected; social distancing (i.e. closing schools and prohibiting public gatherings); wearing masks in public; frequent hand washing; and educating the public. Until adequate supplies of vaccine and antivirals became available, they would be the only arrows in the public health quiver.

DiGiovanni consulted with senior public health officials around the country who would ultimately use this kind of information, as well as key people in the disease containment areas at the U.S. Centers for Disease Control and Prevention (CDC).

As it turned out, the study DiGiovanni had in mind ? to define and identify provisional escape communities and document what they did ? required a team of historians.

Nevertheless, the concept of protective sequestration has caught on among many policy makers as a possible tool in the containment of a worst-case scenario pandemic of 1918-like proportions until enough vaccine could be produced and distributed to immunize a susceptible population.

The story of Team Flu hardly ends here. In June 2006, Markel received a call from Atlanta. This time it was Martin Cetron, M.D., director of the CDC Quarantine and Global Migration Division.

As a result, CDC hired Team Flu for a far more comprehensive project. ?They said, in effect, ?We really liked your methods, we really liked your results and conclusions, let?s do an even bigger study,?? says Stern, whose specialty is the development of local public health agencies. ?They wanted us to look at 45 of the most populous U.S. cities for which the data exist, in order to see what public health measures they implemented, the timing of those measures, who implemented them, and what compliance was.?
It was a good thing Team Flu already had a steep learning curve behind it ? the CDC wanted a preliminary report by December 2006 and a final report by July 2007.
?In my career, this is the project that has entailed detailed analysis of the largest amount of paper, with the most manpower and the shortest turnaround time,? Markel says.

Typically, historians work alone, but this project is so mammoth that the center has become ?almost like a history laboratory,? says Stern.

?It?s collaboration in the truest sense of the word,? says Navarro, who is the project manager for the CDC study. ?We each have certain areas that we?ve become mini-experts on, so it?s doubly important that we?re able to pop into each other?s offices here at the center or discuss issues with our partners at the CDC.?

By December 2006, Team Flu had collected and processed data on all the communities in the study in consultation with a team of statisticians and epidemiologists at the CDC.

?But if you look at them (the cities) individually with very fine-grained statistical and qualitative analysis,? he quickly adds, ?you find that every city had a very different experience and not a few did surprisingly better than most of the others.?

Although data analysis is ongoing, the preliminary conclusions Team Flu is making on the utility of non-pharmaceutical interventions are striking. To begin, cities that applied NPIs earlier in the pandemic wave appeared to have lowered and delayed peak excess death rates; moreover, earlier non-pharmaceutical interventions implementation was associated with proportionately lower death rates than expected.

That this research is of such pressing interest to policy makers lends what Stern calls a frisson to the enterprise. It could have ramifications for how communities think about the implementation of public health strategies. ?There really is a sense of urgency that something needs to be generated so that Americans can be prepared,? she says.

Says Markel, ?Here you have the confluence of a group of scholars who are adept in studying the history of epidemics, the potential threat of a devastating flu pandemic, an extraordinary archive of NPI data from the last, most serious influenza pandemic (1918), and the need to come up with a policy of how to comfort such contagious challenges. This marriage of federal governmental agencies, policymakers, and the U-M Center for the History of Medicine has catapulted us to places we never expected to go. Perhaps this has become the greatest adventure of my career at Michigan because our work has proven to be of such critical importance to the nation?s health.?

 

[tropical]

Re: isolating cities

#13:
...
?Such conclusions are easier to describe than to implement,? Markel says. ?If you are a small town nestled in the Rockies, or an island in the middle of San Francisco harbor, where you could protectively sequester yourself before the advent of the flu in 1918, you had a fighting chance. Unfortunately, that?s not necessarily a useful strategy for most people living in today?s world.?

Nevertheless, the concept of protective sequestration has caught on among many policy makers as a possible tool in the containment of a worst-case scenario pandemic of 1918-like proportions until enough vaccine could be produced and distributed to immunize a susceptible population.

The report, published in abbreviated form in Emerging Infectious Diseases, the journal of the CDC, can be accessed at www.med.umich.edu/medschool/chm/ influenza/assets/dtra_final_influenza_report.pdf.
The project?s fruits included a boon to future researchers ? the digitization of all the archives that were analyzed, available at www.med.umich.edu/medschool/ chm/influenza/.
...
?The conventional wisdom of the sweeping history of flu in America in 1918, is that every American city was decimated by the pandemic. Indeed, nearly three-quarters of a million Americans died during the event and millions more became critically ill. The conclusion of such a story might be that none of the NPI measures taken back then had any impact at all on the containment or mitigation of influenza,? Markel says. ?But if you look at them individually with very fine-grained statistical and qualitative analysis,? he quickly adds, ?you find that every city had a very different experience and not a few did surprisingly better than most of the others.?
...

 

[tropical]

Re: isolating cities

...
Can they keep the flu out of the city for one season ?

If flu propagate by air currents with infected exhaled breeding particles enaugh distant (fog/...) from town to town, than it's impossible to stop no matter the isolation.

 

[mixin]

Re: isolating cities

If flu propagate by air currents with infected exhaled breeding particles enaugh distant (fog/...) from town to town, than it's impossible to stop no matter the isolation.

Do you really believe that's possible?

Most studies indicate short term transmission = 3 or 4 feet; possibly expanded to 6 feet.

 

[Amish Country]

Re: isolating cities

I seem to remember a city in Germany by the name of Berlin. That city proved at least to me that if the people in it do not voluntarily chose to stay in it and are determined to leave, they will find a way out of the city despite what ever actions the government or military may choose to take. It may not be many that choose to leave on any given day but with a quarantine situation it may not take that many in proportion to the population of a major city to render a quarantine ineffectual.

Granted surveillance systems and technology may have had significant improvements since the cold war era but I'd not be surprised if human determination, persistence and ingenuity will eventually defeat it.

 

[gsgs]

Re: isolating cities

the main mode of transmission is presumably short range, by droplets.
But the foggy thing could also be possible, yet it had never been observed/proved,
so how likely is it ?
Why can't they test it ?



In one city for one season everyone reports his/her ILI and where he/she maybe
got it from.

 

[gsgs]

Re: isolating cities

Berlin was not isolated, people came in by airplane, later by streets.

GDR did a good job to build walls,fences and prevent the people
from crossing borders. Most borders are still well controlled
in Europe, hard to cross them undetected.
This is mainly to prevent people from entering illegally for
economical reasons.
You have the wall in San Diego and controls along the Mexican border,
Israel has a wall to prevent people from Palestina entering.

Does a wall stop or delay flu ? Old sequences from GDR, or new ones from San Diego
may show.

 

[Amish Country]

Re: isolating cities

Does a wall stop or delay flu ?

That is my point. A wall may slow the flu down but not stop it as long as the "wall" is somewhat porus. It also IMHO would depend on the effectiveness and application of quarantine/health check procedures incoming or out going populations were subjected to. Everyone would have to be checked to help ensure the safety of the whole population, none could be allowed to "slip" in or out without proper monitoring.

The problems inherent to the logistics of putting together such a system for a large city on the fly could be formidable. Much may depend on the discipline and willingness of the population to cooperate.