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BL Fisher Note: The problem with the "common good" argument being made by elitists like Gostin is that they want to be the ones in charge of defining the "common good" and taking away the civil liberties of others who don't agree with their definition.

FROM THE NEW YORK TIMES

Aggressive Steps Help U.S. Avoid SARS Brunt

May 5, 2003

By JOHN M. BRODER

Severe acute respiratory syndrome arrived in Gainesville,

Fla., by airplane from Asia and was spread with a cough.

A 60-year-old Gainesville woman, whom the authorities

declined to name, returned to Gainesville in late March

after a visit to Beijing. She had a slight cough, but did

not seek medical treatment until after she had coughed on

and infected a co-worker, a 47-year-old woman.

Both women were hospitalized in early April but have since fully recovered, said Thomas Belcuore, health director for Alachua County. Neither showed signs of pneumonia and both are therefore still classified as suspect, rather than probable, SARS cases. They remain friends, Mr. Belcuore added.

In Massachusetts, the first of the state's 19 reported SARS cases was a 54-year-old Cambridge man who returned to the state on March 3 from a trip to Vietnam and Singapore. His symptoms were relatively mild, and he was never hospitalized. But a little more than two weeks later, a Springfield, Mass., woman brought home an adopted one-year-old girl from China who showed much more severe signs of respiratory distress. The girl was admitted to the Bay State Medical Center, where she spent four days in a negative-pressure isolation room. The child's aunt, who traveled to China with the adoptive mother, also came down with a suspected case of SARS.

A Santa Clara, Calif., man, who stayed in the now-infamous Metropole Hotel in Hong Kong was hospitalized on March 17 shortly after his return to the United States with symptoms of pneumonia. Later tests showed he had developed antibodies against a strain of coronavirus, thought to be the family of diseases at the root of SARS. His case was one of the most serious of the 58 known and suspected cases in California, which has more travelers from Asia - and more reported SARS cases - than any other state.

But federal health authorities and infectious disease

experts say that the United States has escaped the full

fury of the SARS epidemic, in part because of aggressive

public health measures and in part because of sheer luck.

The 291 people across the country who are classified as possible or likely victims of the respiratory virus have been anything but lucky.

"I would call it a measure of unluck for those individuals

who got those incident cases, certainly those that happened

to stay in the Metropole Hotel in Hong Kong," said Alonzo Plough, director of public health for Seattle-King County, Wash., which is a gateway to Asia and home of 14 suspected SARS patients. "I think the United States, by adopting a very conservative case definition, allowed for early isolation of individuals and played a role, certainly, in containment. But we were lucky in that we did not have an individual who came with the kind of infection that characterized what happened in Toronto."

At the end of last week, SARS had appeared in 38 states,

from New Hampshire, with one suspect case, to California,

with 37 suspect cases and 21 probable cases, according to

the latest tally from the federal Centers for Disease

Control and Prevention.

Alabama, Arizona, Arkansas, Indiana, New Mexico, Oregon,

Rhode Island and South Dakota each had one case. In

addition to California, eight states had more than 10 cases

- Colorado, Florida, Illinois, Massachusetts, New York,

Ohio, Pennsylvania and Washington.

Worldwide, officials have reported 6,234 cases from more

than two dozen countries, with 435 deaths. No SARS patient

in the United States has died, although four patients with

the most severe cases required ventilators to assist their breathing.

Of the 54 probable SARS cases in the United States - those showing signs of pneumonia or other serious respiratory distress - people in all but 2 had traveled to areas where the outbreak has been most severe, including mainland China, Hong Kong, Singapore, Hanoi or Toronto, according to the C.D.C.

The two people who came down with the syndrome by contact

were a health care worker and a member of a household of a

SARS patient.

Public health officials from coast to coast have cited good planning and timely communication between federal and local officials as part of the reason the disease has not hit harder in the United States.

On March 15, the day the World Health Organization issued a global alert warning of a new and as-yet-unnamed virus spreading through Asia, Jonathan E. Fielding, director of the Los Angeles County Health Department, convened a conference call of his top deputies.

The health department immediately issued a notice to 81 receiving hospitals in the county, detailing the symptoms of the new virus and asking for immediate notification of suspect cases. The first report came in that same day. Ultimately the county found five probable SARS cases and four suspected cases, all of whom had recently traveled to infected areas.

"We're back where we were a century ago in dealing with an emerging infectious disease," Dr. Fielding said in an interview last week. "We don't have a definitive diagnostic test, we don't have a vaccine and we don't have a specific treatment. We're left with good public health measures as a bulwark against the spread of this disease."

He said that planning and new federal domestic security

funds had helped the county prepare for the outbreak of the disease. He acknowledged that given the risk of infection - roughly one in a million in a county of 10 million residents - officials might have overreacted. But he said he would respond the same way if another health scare struck.

"I'd prefer to see us overprepare and overreact in

retrospect than not to do enough," Dr. Fielding said.

In Minnesota, officials diagnosed two new cases late last month. The first was a 2-year-old from St. Paul who returned from a visit to Toronto with relatively mild symptoms. The other, classified as a probable SARS case, was a 14-month-old, also from the Twin Cities area, who had spent a month in China and returned with X-ray evidence of pneumonia. The state is awaiting laboratory tests on both children to determine whether they contracted the coronavirus that is believed to cause SARS.

One of the children may have spread the disease to a third child by contact in a doctor's office waiting room, according to Richard Danila, assistant state epidemiologist.

"We have notified everyone who was in the waiting area with this child," Dr. Danila said. "Unfortunately, one of them has shown respiratory symptoms, so we are following up."

New York has 45 possible and probable cases of SARS as of Friday, including 8 children adopted from China, according to state health officials. Twenty of those are in New York City and all of the cases involve people who traveled to affected areas of Asia or to Toronto, officials said. There have been no cases of secondary infection in the state, even among health care workers.

"Considering we have 19 million people, the fact that we

have only 45 cases is almost good news," said Dr. Antonia

C. Novello, New York's state health commissioner. "The

threat of bioterrorism after Sept. 11 and dealing with the

West Nile virus have really strengthened the public health system and helped us prepare for this naturally occurring virus."

A 30-year-old Chicago-area man who returned from China in

April infected four members of his household with the

virus, apparently the worst case of secondary infection in

this country. Illinois health officials said that after

contact with the man, a 76-year-old woman, a 75-year-old

man, a 30-year-old woman and a 3-year-old child all came

down with SARS symptoms. The older man was hospitalized,

but all have since recovered, officials said.

But as state health officials around the country express

relief that the outbreak was not worse and congratulate themselves on an effective response, some say the virus exposed weaknesses in the public health system.

Senator Edward M. Kennedy, Democrat of Massachusetts, said

last week that SARS revealed how thinly stretched health

care resources were in city after city. Mr. Kennedy said

that the C.D.C. had responded effectively, but that many

city health departments were forced to divert resources

from other important health programs to address the threat

of SARS.

"From Boston to Los Angeles, and from Seattle to Miami, the story is the same," Mr. Kennedy said at a hearing on SARS by the Senate Heath, Education, Labor and Pensions Committee. "Budgets have been cut to the bone and there is no excess capacity to meet new challenges like SARS."

He cited a study by the American Public Health Laboratory Association that found that financing for 30 state health laboratories would be reduced this year. The senator's staff found that few cities had enough hospital space to quarantine patients in the event of a large-scale outbreak of an infectious disease like SARS.

Lawrence O. Gostin, director of the Center for Law and the Public's Health at Georgetown University Law Center, said that public health laws date back to the 19th century and were wholly inadequate to deal with an emergency.

"The need for public health law reform is urgent," Mr.

Gostin said. "It should have provisions for surveillance, vaccination, treatment, isolation and quarantine in a way that gives decisive powers to health authorities while respecting the Constitution."

Mr. Gostin, who wrote a model Emergency Health Powers Act

that has been adopted by 22 states, said he was gratified

that virtually everyone suspected of having SARS had

submitted to voluntary isolation. The one exception, a New

York man, was involuntarily confined until his symptoms

passed. Federal quarantine law now includes SARS among its disease guidelines.

He said that the question of quarantine revealed the

tensions between individual freedom and the public welfare,

and that he came down on the side of public safety.

"If a person had SARS and wanted to go to school or work against public health advice, it seems to me that the need for effective state compulsory power is beyond doubt," Mr. Gostin said. "But that's not a given in our country, which is now so tied to the rhetoric of individual rights. It seems we've lost the tradition of the common good."

http://www.nytimes.com/2003/05/05/national/05SARS.html?ex=1053242782&ei=1&en

=cd9e68e047db5448

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