By Seth Borenstein
Knight Ridder Newspapers

WASHINGTON — In the event of a bioterrorist attack using a deadly and contagious disease such as smallpox, public-health officials want to be able to close roads and airports, herd people into stadiums, and, if necessary, quarantine entire infected cities.

To make that possible, 50 governors this week will receive copies of a proposed law, drafted at the behest of the Centers for Disease Control and Prevention in Atlanta, that could give states immense new power to control their populations.

The proposed "model state emergency health powers act" may be months or years away from enactment by state legislatures. It may be amended beyond recognition. But health officials say major new public-health legislation is crucial to keep smallpox, plague or hemorrhagic fevers (such as Ebola) from spreading in the event of a terror attack. Unlike anthrax, they are highly contagious.

As a general principle, the draft law says authorities could "require isolation or quarantine of any person by the least restrictive means necessary to protect the public health."

Broad quarantines envisioned in the draft have never been invoked in the United States. They raise all sorts of logistical, political and ethical questions in a mobile society, public-health experts concede. But they also may save lives.

"If we don't do it, what would happen? I don't think we've got any choice but to quarantine," said Dr. Lew Stringer, medical director of North Carolina's special operations response team that handles disasters and bioterror.

"The first thing you do is shut down the roads," he said. "Then you shut down the interstates, you shut down the schools, you shut down the businesses. You're shutting down essential services, not just nonessential ones."

Communities not only need to plan for quarantines but also to practice them so they work in an emergency, said Dr. Scott Lillibridge, the special bioterrorism assistant to Health and Human Services Secretary Tommy Thompson.

CDC authorities and a state's governor would exercise their authority using mobilized National Guard units, said former Federal Emergency Management Agency Director James Lee Witt.

Lawyers and public-health professors at Georgetown University and Johns Hopkins University, in Washington, D.C., and Baltimore respectively, drafted the 40-page model law, in collaboration with associations representing governors, state and local health officials, and state attorneys general.

Many states already have quarantine laws, but they are antiquated and may not be constitutional, said the proposal's chief author, Lawrence Gostin, professor and director at the two universities' Center for Law and the Public's Health in Washington.

He said his proposal would probably pass constitutional muster because it gives detainees the ability to ask a judicial-medical board to get them out of quarantine.

The proposal also would give officials authority to seize control of hospitals or even stadiums to house quarantined people.

The United States has a long and checkered history with quarantines, starting with a federal law passed in 1878 to cope with yellow-fever outbreaks.

In the early 1900s, local public-health authorities carried out quarantines. They rarely isolated more than a few people and never did so effectively in a large city. In that era, San Francisco tried to quarantine Chinese-Americans during a tuberculosis epidemic, but the tactic did not stop the disease's spread, Gostin said.

The CDC still has a quarantine division with 81 staffers and field offices in Miami, San Francisco, New York, Atlanta, Chicago, Los Angeles, Seattle and Honolulu. The division deals with health-hazardous individuals and products entering the country.

In the event of a quarantine, it's likely that people would evade restrictions and spread the infection elsewhere, experts said.

In one simulation, involving a fake plague that struck at a rock concert in Chicago, questions arose about what to do with people who insisted on breaking the quarantine, said Randy Larsen, director of the Anser Institute of Homeland Defense, an Arlington, Va., security and science think-tank.

"What are your rules of engagement?" asked Larsen, who also teaches military strategy at the National War College.

Would a National Guardsman, he asked, shoot a grandmother trying to evade quarantine?

Maybe, said Gostin. "You have to use all reasonable force to exercise that power." Sometimes, he added, that could mean lethal force.

The proposed emergency health powers law:

www.publichealthlaw.net/MSEHPA/MSEHPA.pdf

The Center for Law and the Public's Health: www.publichealthlaw.net/

The Centers for Disease Control and Prevention's quarantine division: www.cdc.gov/ncidod/dq/