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 medical care providers and members of
the general community. These cases might have been prevented with the
effective use of isolation. [CDC. Outbreak of multidrug- resistant tuberculosis—
Texas, California, and Pennsylvania. MMWR. 1990;39:369.]
The transmittal of drug-resistant tuberculosis to medical care workers remains
a serious problem. [TB not limited to AIDS patients, can affect workers.
Alert. 1991;6:9.] About 10% 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. 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
medical care providers, continue to be exposed to carriers of easily
communicated, deadly diseases such as drug-resistant tuberculosis.