Could you work from home for weeks at a time? How long could you hole up
without needing to go to the grocery or drugstore? Would you be willing to wear
a face mask and isolate yourself from others?
Harvard researchers are surveying Americans on questions like these as the
government wraps up work on a plan to use primitive infection-control measures
to deal with a killer flu outbreak until drugs and vaccine become available.
The federal Centers for Disease Control and Prevention is pitching the plan
at medical meetings and aims to send it out for review by the end of the year.
State and local governments have asked for unusually detailed and specific
advice on such matters as closing schools and canceling public events, one CDC
This week, CDC awarded $5.2 million in grants related to the plan, including
research on whether to recommend face masks to the public. CDC also asked the
Institute of Medicine, a group of scientific advisers, to meet on these measures
later this month.
"We can't afford to neglect some of the traditional approaches to contagion
control because we very well may find ourselves in a situation where that's all
we've got for a period of time," said CDC's quarantine chief, Dr. Marty
However, skeptics say parts of the plan amount to wishful thinking with
little evidence they would work.
"A lot of these things sound good but they lack practical application," said
Michael Osterholm, a University of Minnesota health expert involved in the
Advising people in big office buildings to avoid elevators and stay 6 feet
away from each other is impractical, and people can't stay in their homes for
weeks or months without needing insulin and other medications, he noted.
The nationwide survey by the Harvard School of Public Health is an attempt to
get a handle on how Americans would follow such advice.
As for hygiene tips like sneezing into your sleeve, "we have no data that that makes any difference" in controlling
a pandemic, Osterholm said.
The bird flu that has ravaged poultry in Asia and killed at least 140 people
is "still smoldering" as a human threat, showing no signs yet of morphing into
one that spreads easily among people, said Dr. Anthony Fauci, director of the
National Institute of Allergy and Infectious Diseases.
If it does, severe travel restrictions would delay its spread in the United
States by only a week or two and at extreme cost, the CDC's Dr. David Bell said
at a recent meeting of public health and disease experts in San Francisco.
Thermal scanning to try to detect people with fevers during the SARS outbreak
turned up no cases and caused many false alarms. But voluntary quarantine,
voluntary isolation of infected people and hygiene measures like hand washing,
"cough etiquette" and face masks did help and might for flu,
too, Bell said.
Dr. Frederick Hayden, a University of Virginia virologist currently working
on global flu planning for the World Health Organization, agreed.
"The classic public health measures did work in SARS," he said. They won't be
enough to stop a flu pandemic but could prolong and spread out its impact to
prevent hospitals from being swamped and running out of respirators to keep the
The CDC plan will list multiple scenarios for pandemics that range in
severity or attack certain age groups like children or college students, and
recommend corresponding control measures.
These will include voluntary isolation of sick people, voluntary quarantine
for those exposed to the germ but are not ill, and protective sequestration to
separate healthy people or communities from a source of infection.
"Quarantine has gotten a very bad name and for very good reason. It has been
abused in the past. It works best when we obtain and maintain the public trust,"
However, Osterholm said there's not enough science to recommend some
measures, like "keep your distance" campaigns. Scientists know flu spreads
through hand contact and big droplets when people cough or sneeze, but they
don't know how far tiny particles remain in the air, or how important that is
for spreading the germ.
In fact, experts know surprisingly little about what enables a flu germ to
Health officials need to give advice but should be honest about the limits of
what is known "and not oversell it, which there is a tendency to do in times of
crisis," Osterholm said.
If that happens, "we will lose credibility quickly," he said.