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Using Isolation and Quarantine

When it became clear that AIDS was a communicable disease, there was discussion of quarantining persons with AIDS to prevent the spread of disease. Although this was never seriously considered, the resulting outcry made public health authorities reluctant to use or discuss quarantine and isolation in any circumstances. Some states even rewrote their disease control laws to make it difficult to restrict disease carriers. The repercussions of these policies are evident in the growing number of reports of the spread of tuberculosis and other diseases from known carriers to health care providers and members of the general community. These cases might have been prevented with the effective use of isolation.[130]

The transmittal of drug-resistant tuberculosis to health care workers is increasing.[131] About 10 percent of otherwise healthy people who are infected develop acute disease, which is often impossible to cure and difficult to render noninfectious. A person with infectious tuberculosis must be put in respiratory isolation. This isolation lasts a short time for drug-sensitive tuberculosis, but it may last until the end of the patient's life for drug-resistant tuberculosis.

The biggest problem with quarantine and isolation is not the patient's civil rights but the logistics. Few city or county governments want to pay for feeding, housing, and caring for patients placed under isolation. The public health nurse may not consider doing grocery shopping and laundry for a quarantined patient as a proper part of nursing duties. Hospitals do not like to take in infectious patients who require extensive isolation precautions. The cost of these precautions is seldom reimbursed fully, and the patient cannot be discharged until noninfectious. Controlling the spread of disease is particularly difficult in jails. This reticence to bear the responsibility of quarantine and isolation is often concealed behind a facade of concern for the individual's civil rights. The result in some jurisdictions is that people, including health care providers, continue to be exposed to carriers of easily communicated, deadly diseases such as pan-drug-resistant tuberculosis.

[130]CDC: Outbreak of multidrug-resistant tuberculosis--Texas, California, and Pennsylvania. MMWR 1990 39 (22):369.

[131]TB not limited to AIDS patients, can affect workers. AIDS Alert 1991 Jan; 6(1):9.

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