There's a series of posts I've done for Daily Kos about how the Feds are preparing for an influenza pandemic, including disaster preparedness, and pandemic preparedness, as well as a review of the National Response Framework that the federal government uses to approach disasters and disaster management. A recent position paper by the ACLU has brought this back into the headlines. How far the Feds can and will go to contain a pandemic and protect your health is an important topic both to discuss and to track. The ACLU report provides an opportunity to review selected aspects of this topic.

Background

Flu pandemics are different than other disasters because they are extensive (they happen everywhere), significant (a quarter of the population might be affected, with a third of the population unable to report for work because of illness or health care obligations for dependents and others) and require careful planning to help prevent spread of disease as well as to mitigate the disruption a pandemic would bring to our worldwide just-in-time economic system. One aspect of this planning includes the use, and consideration of, isolation and quarantine at the beginning of a pandemic outbreak, when containment is still theoretically feasible (although many experts doubt if containment is indeed ever feasible). From Flu Wiki:

Isolation and quarantine are two public health strategies designed to protect the public by preventing exposure to infected or potentially infected persons. In general, isolation refers to the separation of persons who have a specific infectious illness from those who are healthy and the restriction of their movement to stop the spread of that illness. Isolation is a standard procedure used in hospitals today for patients with tuberculosis and certain other infectious diseases. Quarantine, in contrast, is very unusual and generally refers to the separation and restriction of movement of persons who, while not yet ill, have been exposed to an infectious agent and therefore may become infectious. Quarantine of exposed persons is a public health strategy that is intended to stop the spread of infectious disease. Both isolation and quarantine may be conducted on a voluntary basis, and this is usual, or compelled on a mandatory basis through legal authority.

Back in 2005, George Bush held a news conference in which he proposed military intervention.

The United States may need to quarantine regions of the country if localized outbreaks of a pandemic flu occur, US President George Bush said today during a press conference in Washington, DC. Bush suggested expanding presidential power over state-run National Guard operations to implement such quarantines in the event of a pandemic.

By executive order (April 1, 2005) pandemic influenza was added to the Public Health Service Act of 2003 as a quarantine disease. However, there was considerable push-back from the public health community at that time (link is to a Boston Globe op-ed from George Annas:

WHENEVER THE world is not to his liking, President Bush has a tendency to turn to the military to make it better. The most prominent example is the country's response to 9/11, complete with wars in Afghanistan and Iraq. After Hurricane Katrina, Bush belatedly called on the military to assist in securing New Orleans, and has since suggested that Congress should consider empowering the military to be the ''first responders" in any national disaster. On Tuesday, the president suggested that the United States should confront the risk of a bird flu pandemic by giving him the power to use the US military to quarantine ''part[s] of the country" experiencing an ''outbreak." So we have moved quickly in the past month, at least metaphorically, from the global war on terror to a proposed war on hurricanes, to a proposed war on the bird flu. Of all these proposals, the use of the military to attempt to contain a flu pandemic on US soil is the most dangerous... Planning makes sense. But planning for ''brutal" or ''extreme" quarantine of large numbers or areas of the United States would create many more problems than it could solve... Public health in the 21st century should be federally directed, but effective public health policy must be based on trust, not fear of the public.

Since then, and until recently, the voluntary nature of quarantine and containment has been stressed by CDC, HHS and federal disaster planners.

Contemporary Concerns

On Monday of this week, the ACLU issued a strongly-worded report entitled Pandemic Preparedness: The Need for a Public Health — Not a Law Enforcement/National Security — Approach, co-authored by George Annas, the same author of the Boston Globe editorial from 2005 (more after the flip).