Monday 24 May 2010

Quarantine and the State

Gordon Tullock always chided the anarchists in his public choice classes because of two matters he figured were impossible to handle absent the State. The first: interconnection of roading networks. He didn't think private road owners would make it easy for commuters to move from one owner's roads to the other, or that they'd make it easy for roads to cross each other. The second: quarantine. If a deadly epidemic were to break out, private institutions couldn't use force to implement necessary quarantine.

Turns out that the State can't handle the second one either. Writes MacDoctor of the recent H1N1 flu scare:
The Herald reports that a report by Martin Dawe of the first two weeks of the Swine Flu epidemic is intensely critical of the lack of planning and poor coordination of data resources. This was the MacDoctor’s impression of the entire debacle. I knew of a potentially deadly strain of Mexican flu three days before NZ1 landed with what was to be “ground Zero” of the Swine Flu epidemic. At that time the data looked extremely alarming. Nothing short of a full epidemic response would have been appropriate. Yet people were allowed to walk off that plane and mingle with the population for nearly a day before anyone reacted with any sort of real response. I blogged on how, nearly 3 days after NZ1 landed, a patient who was on that flight wandered into the A&M, in which I was working, with flu-like symptoms, because Healthline had sent them there. That particular lady was not seen by a public health nurse until nearly 24 hours later, when she was promptly given Tamiflu.
So the country with the best chance of anywhere in the world of implementing effective quarantine [we're a very long flight from everywhere except Australia], with public institutions generally regarded as being among the most competent in the world, couldn't handle quarantine. But, at least if they didn't ramp up, that made sense because swine flu turned out to be not all that bad, right? Well...
At the other end of the crisis – when it turned out that it wasn’t really a crisis after all – it took weeks for the public health guys to stop sending me updates and even longer before we were asked not to notify the disease. This is exactly the reverse of what should have happened. When we have data that suggests there may be a dangerous virus on our way, there should be a prompt response to try and limit the spread of the disease. This response should be swift and sharp. It is better to be completely over-the-top about such a thing than dangerously blase. As soon as the data tells us that there is no crisis, or that further intervention is pointless, there should be an equally rapid (or, at least, staged) stand-down. Otherwise massive medical resources are being wasted in a futile effort to stem either a minor disease, or a severe one that is already epidemic.
None of this should really come as much surprise.


  1. The state hasn't effectively used quarantine in years. And interconnectedness of roads could be handled by a voluntary non-governmental standards body the same way the interconnectedness of the internet is.

  2. @Doc: Road interconnection always seemed a weak argument. I could buy quarantine though.

  3. If you throw bureaucrats at any problem they will find a reason to vacillate until it is impossible to do otherwise. I can imagine with H1N1 that they were faced with the choice of either:
    a) doing nothing and risking a chance of some people getting sick (and annoyed by lack of response), or
    b) quarantining folk arriving from Mexico/US with 100% certainty people getting pissed off.
    From a bureaucratic mindset it seems a pretty easy choice, always go with the option that results in less immediate consequences, or where the decision can be fobbed off to someone else.
    Hindsight suggests that a more rigorous approach may have been appropriate, but it seems perhaps issues of public health took a back seat to more personal concerns...?

  4. @Lats: Quarantine only works if it's done very quickly; initial reports out of Mexico were very scary. I can buy that we do better by having an agency that underreacts rather than overreacts since most scares are just scares, but the telling bit in MacDoctor's report is how things ramped up only AFTER we saw it wasn't going to be a really big deal.

  5. @Eric I agree entirely, I wasn't suggesting that health officials acted correctly. I confess to not taking H1N1 terribly seriously either at the time, it was after all just another flu, and there seemed to be a bit of paranoia and wolf-crying going on. Much like I imagine the health ministry did, I assumed the deaths in Mexico were due to overcrowding, poor nutrition and otherwise compromised immune systems among the slum dwellers. Luckily for us the virus seemed to lose a lot of its vigour by the time it got here. It was still highly contagious, but caused relatively few deaths.