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.