Americans for quarantine not forced compliance

SARS-hit countries more likely support enforcement

If faced with the threat of SARS, avian flu or another epidemic, most Americans would consider quarantine a good idea — but they wouldn’t approve of strong enforcement. That is one American attitude toward quarantine described by Harvard public health researchers who studied U.S. attitudes about quarantine.

The study also indicates weak faith in the government’s ability to manage an epidemic, according to study author Robert Blendon, MD, professor of health policy and management at the Harvard School of Public Health. Blendon says in light of his findings that only 40% of Americans trust the government to cope with a disease outbreak so how officials manage future emergencies will be crucial.

The Harvard study compared U.S. attitudes to those of people in Hong Kong, Singapore, and Taiwan, where quarantine was used during SARS outbreaks in 2003. While residents of SARS-hit countries support arrest for those who violate quarantine, Americans surveyed say they strongly support quarantine as a preventive measure; however that support falls when asked if they would support arresting people who did not comply with the quarantines.

Respondents who opposed quarantine were concerned about overcrowding, infection, and inability to communicate with family members while quarantined.

The survey asked about support for three measures that public health officials could take to protect the health of the public and prevent the spread of a contagious disease: masks, required temperature-taking, and quarantine.

In areas of Asia where most respondents had worn a mask in public, there was a higher level of support for requiring everyone to wear one. In Hong Kong and Taiwan, approximately 90% of the public reported wearing a mask in public in the past two years to protect themselves against becoming ill. Support for requiring masks ranged from a high of 96% in Taiwan to a low of 53% in the United States. However, when people were told that they could be arrested for noncompliance, support for this measure in Hong Kong fell to a level similar to that of the United States and Singapore.

There was a high level of support (99%-84%) in Taiwan, Singapore, and Hong Kong for requiring everyone to have their temperature taken to screen for illness before entering public places during an epidemic. But again, when told that people who refused could be arrested, support for this measure declined.

Strong majorities in each of the countries favored quarantining people suspected of having been exposed to a contagious disease. In the United States, compulsory quarantine, under which those who refuse to comply could be arrested, was supported by 42% of the public across all demographic groups. African-Americans were significantly more likely than whites or Hispanics to move from initially favoring the measure to no longer favoring it when told they could be arrested for noncompliance. This difference across racial groups held after age, sex, income, education, and urbanity were adjusted for.

The findings from the Harvard study are available on-line at http://content.healthaffairs.org/cgi/content/abstract/hlthaff.25.w15.