National Geographic : 2009 Dec
PHOTO: RAMZI HAIDAR, AFP/GETTY IMAGES HEALTH Fighting the Flu Last summer, public health experts warned that 2009 H1N1, aka swine flu, could afflict up to 50 percent of the U.S. population this flu season. To prepare, officials readied 50 million doses of initial vaccines for children, pregnant women, and health care workers. Though not likely, two other, older techniques--- isolation and quarantine---could also eventually be considered. Isolation separates sick people from well ones. Quarantine limits the movements of those who aren't ill but have been exposed. In lieu of a vaccine, these intrusive, oft-debated measures can curb disease spread, lower death rates, and lessen the toll on hospitals. Both are "social distancing" tacks. School closures are another. For all, coordination and timing are key. Act too soon, and the costs can outweigh the health benefits; one study says 26 weeks of shut- tered U.S. schools could mean lost wages equal to 6 percent of the GDP. Act too late, and more people can die as the virus's attack rate grows. Yet well-timed action can help. In the 1918 flu pandemic, the cities that fared the best---San Francisco, St. Louis, Kansas City, Milwaukee---acted fast and on many fronts. ---Melody Kramer A BRIEF GLOBAL HISTORY OF PUBLIC HEALTH CONFINEMENTS CIRCA 600 400 B.C. The Torah offers instructions on isolating lepers and disinfecting the home. A.D. 549 The emperor Justinian isolates travelers from disease-affected regions during a plague. 1374 In an era of plague, ships must lie at anchor for 40 days ("quaranta" in Italian, ergo "quarantine") prior to docking in Venice. 1892 After typhus fever strikes, Eastern European Jewish immigrants are sent to the same New York island that will later confine Typhoid Mary. 1893 The U.S. National Quarantine Act allows the federal government to enforce containments. 1900 San Francisco's quarantine of Chinatown is ruled discriminatory. 2009 Lacking an H1N1 vaccine, nations kill pigs, prohibit gatherings, and ban flights from Mexico. 1963 A smallpox carrier is quarantined, the last U.S confinement until a TB patient is isolated in 2007. 2003 SARS joins plague, smallpox, yellow fever, and tuberculosis on the U.S. quarantine list. Passengers are screened at a Beirut airport during the swine flu outbreak.