Update

Note: This is the concluding entry in a series of posts related to my experiences in quarantine. Remember the mumps outbreak? King County Public Health was concerned that I was a vector, but...

The PCR was negative,
So I am back at the lab.
Instructed to keep a distance,
And avoid crowded spaces.

They drew some more blood yesterday.
Called "convalescent serum."
What? Convalescent? I feel fine!
Parotid stone passed Monday.

So much for mumps quarantine poems.

Check out MJ's comment on "the role of quarantine." It makes good points about the differences between H5N1 and SARS in terms of incubation time and the usefulness of quarantine. With mumps' 12-25 day period, I suppose it is more like SARS than bird flu!

It looks like public health is overcoming the mumps outbreak in Iowa:
Check this Chicago Tribune article.

Deconstructing Pandora's Quarantine

The myth of Pandora seems to me a useful metaphor for understanding the kinds of issues I hope to discuss on this blog. My current experience with quarantine is a good first exercise. Using the Pandora's Box story as a guide, I will try to name the evil spirits of a given situation and identify the hope that can reconcile them. Why not just call them plusses and minuses? I guess that just doesn't seem as interesting to me.

Quarantine

Evil

• Endangered Individual Liberties
• Lost Productivity
• Economic Hardship

Hope

• Public Safety
• Time to Recover from Illness
• Increased Personal Time

In reality, this demarcation is oversimplified. If one is genuinely infected with a dangerous disease, most people would agree that public safety and the need to recover from the illness would trump any of the negatives of quarantine. What I would really need to do is categorize my thoughts not for quarantine in general, but for quarantine in the context of an otherwise healthy and functioning individual experiencing one nuisance sign of a potentially dangerous disease that surfaced in a rare outbreak that had a few cases in a state where he recently traveled.

Day 3 (Economics)

Day three of the waiting game feels much as the first. The weekend is not sush a bad time to be forced apart from society. My wife and I typically spend the time with each other, and if we leave the house, it is for a hike or such. We each typically go into lab for a good chunk of one day, and that is where she is right now. Now facing Monday, I have realized the challenge this will be if this goes on for another week (the nine day period expires Friday.)

This brings me to another point: economic productivity. I wonder what the effects of a widespread quarantine for H5N1 avian flu would have on the economy. I'm no economist, but I would imagine that any effects from lost work would hit the poor first and hardest. Do employers make any allowance for workers on quarantine? Is that something the government is prepared for in the reports recently issued about the possible pandemic? Who's responsibility is it to keep food on the table when the breadwinner is quarantined?

The Role of Quarantine

So I'm Quarantined...

Institute of Medicine member Marty Cetron opens a published discussion about quarantine as follows: "By utilizing quarantine and isolation as public health tools we are in many ways battling twenty-first century pathogens with a fourteenth century toolbox." The public control of disease is not new. A sizeable number of empirical prescriptions exist in the book of Leviticus that control and reduce the spread of disease. Individual and community health still play a very important role in contemporary Jewish culture. Quarantine as first applied in bubonic plague infested Europe referred to a forty day isolation period.

Having been under quarantine for about 24 hours of an expected 9 day period, I am glad that the Washington and King County health boards no longer stick to that duration. I am already feeling the tension between individual liberty and the public good. This manifests in its own disease: cabin fever. I have repeated to many that, "I believe in public health," and still stand by that statement. In my opinion, public health departments should have even greater reign over the health risks that we confront daily. I would like to see some public authority take more control of school food, for example. (Hooray for the curb on sweet drinks at school!) My condition however falls within the imminent threat category of public health. Perhaps it will help me better think about the real and potential quarantines issued in response to SARS or H5N1 bird flu.

Let me clarify my situation with mumps, in case any of you are worried about me or about yourselves! The public health officials I have spoken with report that a significant number of the mumps cases in Iowa occurred in individuals who had received two MMR vaccines. The MMR vaccine is not without controversy. A report by Dr. Andrew Wakefield published in Lancet in 1998 documented increased numbers of kids with Crohn's disease and autism. Even though this article was retracted, numerous parents - particularly in Great Britain - refused to immunize their children with MMR. This episode is a particularly good one illustrating a dysfunctional relationship between biomedical science and the public, but that is for another entry... Regarding the vaccine's efficiency, the common report is that the MMR is 90-95% effective at producing protective antibodies. Let's say I received 2 MMRs as a child (the standard regimen, confirmed by my mom), a booster shot before high school at age 13, and a booster at age 22 before medical school. By my calculations, that would put my chances of seroconversion between 99.99% and 99.9994%. This is not even close to the risk of infection we would see with a SARS or bird flu outbreak. That puts my experience in quarantine in a different category than its infectious colleagues, but does not refute the legitimacy of my experience.

I believe I am serving what is called a voluntary quarantine. I do not believe I am under any legal obligation to stay home. My doctor says it is okay to go jogging and biking, as long as I do not engage in close contact with others. My wife has already been exposed, so it is okay for me to live in the same place as her – thank goodness! From the statistical data above, I am very inclined to believe that I neither infected or infectious. I wonder what percentage of quarantined individuals in a SARS or H5N1 will actually be sick, and how many will endure the quarantine unaffected (& bored). Another aspect of an epidemic outbreak would be fear of infection. Perhaps if I was really afraid of getting sick, I would not mind as much a forced absence from work and play. If I could telecommute to do experiments, I guess this situation would be very different. Until I figure that out, I will have to put off my studies for a week.


For members of the academic community, see the full transcript of the discussion these quotes are extracted from in the Journal of Law, Medicine & Ethics, Winter 2004 v32 i4 pS83(4). This proceedings includes a number of important topics ranging from the need for quarantine, how it should be enforced, and the mechanism by which state legislators put quarantine laws in place.

Do the Mumpty-Mump

So, maybe you are wondering why I am posting so much the first day after going live. The hidden motivation for this blog is THE MUMPS. Don't worry - I am sure that I do not have the mumps. Three MMR vaccines should account for that. I do have a very swollon parotid gland. I think it is due to a salivary stone. Anyway, the CDC has suggested that the states take conservative measures to contain subsequent outbreaks. So here I am at home until further notice - notably a PCR for viral load and IgM measurements. If they are clear, I could be back in circulation by Tuesday or so, but maybe not until Friday. Which sucks.

While writing this I was contacted by the Public Health folks - the PCR machine crashed. I wonder what that means. Did the thermal cycler fall off the table? I told the person that called that I was willing to give the reaction a go. Just send the primers over. I could go into lab after hours to run it, in case I really do have the paaramyxovirus. Are you allowed to run diagnostics on yourself, anyway? What are the ethical implications of that decision? I guess that means the first tests won't get done until Monday, which means they will want me to stay home longer... In the meantime, I am supposed to look out for orchitis.