Effects of Quarantine on the Military

Effects of Quarantine on the Military
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Abstract
This article explores ways by which policies relating to public health, quarantine in specific, were legislated in the United States of America and their implications for the military. Additionally, it explains biological attack as the most lethal terror attack, the challenges military commanders have faced in the past, maintaining order and civilian operability in times of bioterrorism through quarantine, and the complexity in determining the agent of the infection. Further, the history of quarantine is discussed, changes in legislation relating to quarantine, aimed toward understanding how these changes have affected the military. Isolation and quarantine as a means of preventing the spread of illness during an outbreak are compared and contrasted. Vital to this understanding is to help military commanders understand the most appropriate prevention method to apply during an epidemic that would not violate individual rights. Also, explained, are the recommended approaches employed by the commanders during outbreaks. Military heads are to plan for a worst-case situation when handling disasters. Demonstrated is the importance of taking caution when dealing with healthcare personnel since they have the highest possibilities of contracting the infection, and the need to notify international health bodies such as the WHO. Furthermore, this paper explains the primary challenge military heads face when making emergency announcements on community health, providing the solution.

Keywords: Quarantine, isolation, military, legislation

Effects of Quarantine on the Military
According to the Outbreak, a hit movie by Warner Brothers, the only significant menace to the continued governance of the universe by man is a virus. The film depicts the struggles of the Department of Defense to prevent the spread of a lethal biological agent, providing a perfect illustration of how panic and terror can result if quarantine is executed improperly, whether caused by a deed of bioterrorism or a naturally happening infection spread by chance as illustrated in the movie (Lynteris, 2016, 53). Though armies are well trained to handle threats, the threat that attacks microscopically and one that cannot be hindered by a perimeter wall is tricky and requires a vigorous and time-sensitive approach. Pathogens pose the worst case kind of enemy because they transmitted faster, are extremely lethal, and remain invisible until a substantial number of infections occurs. In addition, they also possess a quality that conventional enemies lack, the ability to burgeon and spread beyond the battle Frontline. With the recent speed of advancement in biotechnology, biological threats become real each day and getting ready for the possibility of an attack is not only a sagacious idea but a mandatory precaution. This paper seeks to explore the development of quarantine as a strategy used in biological terrorism, duties of a commander in case of an imminent biological threat and the impact of quarantine in the military.
This literature also aims to ultimately define the function of quarantine as a battle-tested strategy for public health and its possible effect on military procedures in the US Air Force. The primary emphasis will be on ways a commander can run efficient processes while observing the requirements of isolation during the preceding 72-hour period after the discovery of an outbreak. Seclusion may not be suitable in all situations until a diagnosis is made, which takes longer.
The 72-hour window was selected to create a window for intervention following latest bioterrorism exercises. The assessment will take place before the arrival of extra support and the official identification of the causative agent, particularly in a foreign setting up. Most of the commendations relating to the timing of isolation and sustainment will be valid irrespective of the cause of nuclear threat, location, or facility.
Literature Review
Bioterrorism was used as a war strategy since medieval times. In ancient times, both human and animal cadavers served as vehicles for the transmittance of disease across enemy lines. According to Cenciarelli et al., dead bodies would be dropped in communal wells or catapulted over the castle walls to cause widespread disease (2013, 110), and these would end up determining the outcome of the wars. The recent use of biological weapons has been closely linked to terror attacks, which introduces a new dynamic in the ensuring the safety of Americans. It is cheaper today to produce biological weapons than it was some decades ago, and it has even been proven that this method is the most cost-effective method compared to chemical, nuclear, and conventional warfare (Cenciarelli, 2013, 112). Due to this, even paramilitary and terrorists have easy access bioweapons.
The fear of bioweapons is not unfounded though, in 1942 the Japanese army unleashed infected fleas on their Chinese enemies and ended up with similar casualties in their camp (Miller, 2005, 20). In 2001, the menace of anthrax letters hit the United States almost immediately after the 9/11 (Miller, 2005, 21).
Isolation on itself has been existent for several millennia because even in biblical times, those who caught leprosy would be kept out of the camp. The first recognizable act of quarantine dates back to the 14th century in Italy when ships boarding Venice showed from the infected regions were forced to anchor for almost forty days until landing to shield the cities along the coast from the disease outbreak. The history of the US regarding quarantine was irregular, and enactment took place in 1878 after the passage of legislation on Federal quarantine following Yellow Fever outbreaks, even though the state community representatives remained in control. The law was then reinterpreted in 1892 on the arrival of Cholera, giving federal officials more power in imposing confinement, which led to the dubious aiming of some given ethnic individuals as occurred within New York with Jewish Settlers. Legislation surrounding the subject took several twists and turns, at times being left to the state law, then other times becoming the jurisdiction of the federal government. The first federal legislation on quarantine happened in 1796, prompted by a yellow fever outbreak and since before then the subject was the preserve of the states. Three years later, another law that only allowed the federal government to assist the states in the implementation of quarantine law, and so it remained in the century that followed. Military involvement in quarantine law, albeit minimal, came in 1870, when an Army Medical officer was tasked with surveying major port cities in the US and it is his recommendation that preceded a gradual increase in the involvement of the federal government in matters quarantine. When the influenza pandemic hit in 1918, it is the federal government that imposed the biggest quarantine in the US history. The Public Health Services Act of 1944 gave the power of apprehending and detaining individuals suspected to be health risks to the federal government (Greene, 2015, 73). Seclusions were also placed around residents belonging to Chinese businesses after the realization of the plague in San Francisco (McDonald, 1951, 22).
Without proper preparation, enforcing quarantine can have dire consequences, especially when dealing with uninformed civilians. With the outbreak of Ebola in the West African country of Liberia, angry citizens lashed out at military personnel enforcing quarantine and casualties resulted (Greene, 2015, 60). Back at home, when smallpox broke out in Indiana, entire neighborhoods were barricaded to the much disquietude of the residents, and some lives were lost. This only shows how the necessary proper institution of quarantine is. In 2005, President Bush proposed executive orders that allowed the federal government to authorize the enforcing of a quarantine should there be a pandemic requiring such an action (Greene, 2015, 61). A quandary exists, however, because the military is trained to use force on enemy combatants and not on subjects whose only crime is their health status, but not their conduct. As a consequence, the distinction should be made crystal clear between people under quarantine and common rebels.
Apart from quarantine, isolation is also a method for restricting movement. Isolation is the act of separating individuals suffering specific communicable diseases from healthy individuals to prevent the spread of the disease. In dissimilarity, quarantine is the separation and prevention of movement of individuals who even though not ill, have been exposed to the cause of the infection and therefore may turn up to be infectious. Quarantine may be compulsory or voluntary, and while it is done for the good of the public, it does infringe on some individual freedoms. Although the requirements for isolation are usually frank and recognized by the society in the presence of plagues, opposing views exist concerning the appropriate application of quarantine subordinate to fears over the loss of domestic rights. Quarantine of persons is only operational for sicknesses that are communicable for instance, smallpox, plague, SARS, and influenza (Binns et al., 2010, 15).
CDC approximations are that between 75000 and 422000 American lives could be lost if a new pandemic virus struck today (Greene, 2015, 66). This is because modern medicine is not yet able to prevent health emergency pandemics and since immunization and chemoprophylaxis only work if the causative agent is identified early and there are treatment options for it.
Discussion
In major disease situations of catastrophic magnitudes, such as the ones posed by bioterrorism and or virus pandemics, the deployment of the military is inevitable even though some have questioned the effectiveness of such mass quarantine. The role of the military in such situations is intended to be supportive, though the differentiation of supporting and enforcing roles may overlap in cases where force must be used. Human beings do not like confinement. Moreover, in during outbreaks, there is always widespread panic during which people behave irrationally. Although there has been a tremendous development of procedures of involving the military during pandemics, there are still gaping loopholes that have not been adequately addressed, leaving a burden to the commander in charge when judgment calls should be made. Usually, when the military imposes a complete quarantine, the institutions mandated to regulate legislation like courts might not be working and a strict chain of command has to be followed in the army ranks.
Army commanders have several key points to learn from international studies on SARS and quarantine. Most importantly, is the comprehension that the worst natural occurrence a commander may come across is a formerly unknown infection with no person-to-person transmission, mainly relating to the respiratory system. Even though agents such as Smallpox would also have dangerous effects, response methods have already been created and treatment methods established. A new infection like the genetically-modified agent or SARS that terrorists may use demands additional planning for this worst-case situation.
Enforcement of a military quarantine comes with its own fair share of criticism, as many feel that civil liberties are undermined during such periods. The famous question of whether the law should be an impediment to itself, never fails to come up. Its effectiveness also is questioned, considering mass transportation means there is today. Even though the information is easily transmitted today through various media, could it be true that the same media would be the greatest undoing in the pursuit of safe containment of an outbreak? With the advent of instant messaging and social media platforms, there is no telling how much panic can be generated within a few minutes of posting an inflammatory message on Twitter. This adds to the challenges that could be encountered in case there is a need for military intervention during outbreaks. The state legislation regarding the issue of quarantine is not standard, and this poses a challenge because in each state the commander has to use a different approach. While time is of so much value during outbreaks and terror attacks, this is an unnecessary formality. And what of pathogens that are not transmitted via contact to contact and proximity to the source is not a factor?
Terrorism fails to adequately fill the traditional definition of war in how it is propagated, in that most terrorists who succeed in launching an attack are usually unknown until they cause the damage. Therefore, inasmuch as it is hard to prevent such sporadic attacks, response preparedness becomes the major weapon in fighting the vice, which becomes compounded if the attack turns out to be biological. With the increasing use of biohazards, quarantine protocols are therefore not a luxury, but a necessity.
Second, postponement in conducting quarantine can be devastating and may lead to complete loss of control of a situation as it happened in China. Critical actions must be synchronized in the sequence of command before the commander is served with all the answers. Also involves notifying bodies such as WHO or the CDC. The challenge of when to announce a health emergency to the public after a number of patients seek medical help still exists. It is recommended that the suspected level of risk is a determining factor in initiating preemptive action. The safest approach is to assume the worst outcome even before definitive results are available. Once the threat dissipates the restrictions can be called off. In initiating quarantine, however, there must be an adequate legal consultation as other factors should be considered. For instance, amenities like lodging and food should be handled by services staff, mortuary services should there be death need to be planned for and channels of disseminating information need to be established. Besides, an alternative medical center needs to be established for the treatment of the infected.
Third, medical care personnel have the highest chances of being exposed preceding to proof of identity of the outbreak, which may call for the closing of whole medical structures. Also, each infection is unique and requires knowledge of its epidemiology to come up with a strategy for treatment ultimately. The preliminary response should be broad-based and apply a worst-case setup (Lehnert et al., 2011, 68). It is the CDC that determines how risky a threat is and that allowing people of a particular area to scatter would lead to spreading of the threat. Upon this determination, thus, a quarantine can be legally enforced.
Recommendation
When fighting bioterrorism, it is crucial that a commander understands he is fighting two enemies, the biological agent, and the terrorist (Miller, 2005, 31). The biological agent is the most lethal due to its extensive infiltration before it is detected. Even though sensors have been developed to identify the agents, a commander will most likely first discover an outbreak is when patients are brought to the medical structure for treatment. The result is the initial challenge most commanders face, deciding the right moment to announce the community health emergency and deciding whether quarantine is needed. Commanders are recommended to induce a “pre-emptive” action depending on the observed risk level (Prelas, 2009, 89). For effective containment of exposed individuals, their compliance is paramount to the success of the operation is not just in preventing the escape of confined persons but also their safety from military force. A lot can happen if traveling is allowed for people who have not been screened and from history, it is clear that one passenger can cause massive damage. The safety of persons under quarantine should be taken for granted because not all are infected, and panic is an understandable reaction to being isolated and confined. The use of force should therefore not be allowed unless absolutely necessary, and the fundamental rights of the individual should never be violated. However, nobody should be left to pose a threat to others and balance should be struck. It worth noting that if citizens are involved in the quarantine process by first explaining the type of threat they are faced with, they are more likely to comply with the curfews.
Conclusion
Quarantine, as a health measure, is a best and the final option for containment of a disease outbreak, especially in the situation that the diagnosis is not known and no existing medication plan for the given infection. The decision procedure taken by an installation commander need be dissimilar to the one made in a civilian situation if maintaining operability is the goal. The method should focus on the initial seventy-two hours since delay may result in implications that could devastate the successful accomplishment of the mission and may lead to an unintended spread of the illness globally. The role of health care providers during health emergency times is indispensable since they are involved in the triage of the infected, in the identification of the causative agent, and treating supporting the patients who depend on them (Miller, 2005, 33). They, therefore, should be treated with dignity.
During desperate times, desperate measures can be excused and times of bioterrorism, disease outbreaks, or anything that may result in a pandemic are such times. If isolating people who may die all the same to die alone will save many others, then that is the right choice. It may not be a kind decision to make, especially if the person dying is someone close, but maybe that’s why the military is needed. The right decision is not always an easy one to make.

References
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Greene, J. T. (2015). Federal Enforcement of Mass Involuntary Quarantines: Toward a Specialized Standing Rules for the Use of Force. Harv. Nat’l Sec. J., 6, 58.
Lehnert, T., Heider, D., Leicht, H., Heinrich, S., Corrieri, S., Luppa, M., … & König, H. H. (2011). Health Care Utilization and Costs of Elderly Persons with Multiple Chronic Conditions. Medical Care Research and Review, 68(4), 387-420.
Lynteris, C. (2016). “The Epidemiologist as Culture Hero: Visualizing Humanity in the Age of “the Next Pandemic”.Visual Anthropology, 29(1), 36-53.
McDonald, J. C. (1951). The History of Quarantine in Britain During the 19th Century. Bulletin of the History of Medicine, 25, 22.
Miller, R. I. (2005). The Impact of Quarantine on Military Operations. AIR UNIV MAXWELL AFB AL.
Prelas, M. A. (2009). Biological Terrorism: Weaponization and Delivery Systems. Science and Technology of Terrorism and Counterterrorism, 89.