文章基本信息

标题：Encouraging Compliance With Quarantine: A Proposal to Provide Job Security and Income Replacement
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作者：Mark A. Rothstein ; Meghan K. Talbott
期刊名称：American journal of public health
印刷版ISSN：0090-0036
出版年度：2007
卷号：97
期号：Suppl 1
页码：S49-S56
DOI：10.2105/AJPH.2006.097303
语种：English
出版社：American Public Health Association
摘要：A human influenza virus is considered the most likely source of a pandemic in the near future. Quarantine has the potential to be the most effective measure for limiting the spread of infection. The major obstacles to compliance for those asked to enter quarantine include loss of income during quarantine and loss of employment after quarantine. We discuss current antidiscrimination and compensation laws, as well as options to expand coverage for quarantined individuals to encourage public cooperation by guaranteeing job security and providing income replacement. IN NOVEMBER 2005, OUT OF concern over the possible spread of avian flu in humans, President George W. Bush released the National Strategy for Pandemic Flu. The plan, which outlined measures to prepare, identify, detect, and respond to a pandemic disease threat, is intended to “provide guidance to all levels of government on the range of options for infection control and containment.” 1 The strategy lists social distancing measures for controlling and containing the spread of disease, including restrictions on large gatherings, “snow days,” and quarantine and isolation, but it does not provide details about how these measures should be implemented. Quarantine, the most restrictive measure, has the potential to be the most effective at limiting the spread of infection. 2 Its effectiveness depends on public cooperation and compliance, but there are major impediments to compliance for those asked or ordered to enter quarantine, including the loss of income during quarantine and loss of employment after quarantine. Unfortunately, the National Strategy for Pandemic Flu makes no mention of these potentially serious obstacles to voluntary compliance. 1 In the United States, authority to quarantine is vested primarily in state governments. Federal authority to order a quarantine is reserved for containment at the national borders and preventing the spread of infection between states, 3 but the federal government can be expected to take the lead in setting policy for the states in the event of a pandemic. Quarantine can take place in various locations, including homes, workplaces, schools, hospitals, and other settings, and compliance may be voluntary or pursuant to a governmental order. 4 Individuals subjected to quarantine may be reluctant to adhere to government directives to limit their movement, because of the disruption that it creates in their daily lives. 5 When individuals are quarantined in their own homes, they are effectively isolated from the outside world, and their livelihoods may be jeopardized. 5 Quarantined individuals not only risk the loss of income if they become infected and miss work, they also risk losing their employment entirely because of absence or stigma related to the disease, regardless of whether they become infected. Loss of income heads the list of most frequently cited major obstacles to compliance with quarantine. 6 ^, 7 Because quarantine reaches its peak of effectiveness at 90% compliance, 6 ^, 8 public cooperation with quarantine is critical in containing the spread of disease. Countries affected by severe acute respiratory syndrome (SARS) in 2003 recognized the importance of legal protections for job security and income replacement caused by quarantine and moved quickly to enact the needed legislation. It is not clear that similar legislation could be enacted so rapidly in the United States, and even if it could, having laws in place before a pandemic strikes is a much better approach. Unfortunately, there are few laws in the United States to replace the lost income of individuals during quarantine 9 and to provide job security after quarantine. Furthermore, no federal legislation is pending or is a part of the National Strategy for Pandemic Flu. In this article, we discuss current job security and income replacement laws, as well as options to expand coverage for quarantined individuals. We propose measures to provide job security and income replacement to meet the basic needs of individuals in quarantine. Although many details of the income replacement program need to be developed, the purpose of the article is to raise awareness of this issue and to stimulate public health officials and policymakers to include these matters in public health emergency plans.