Trips to Asia trigger SARS jitters: Travelers find co-workers, friends edgy

Co-workers and friends didn't tell Alan Lowe directly they were worried about his return to work as mayor of Victoria, B.C., after his two-week trip to China.

But when his family landed in Vancouver a week ago, and best friends showed up wearing surgical masks, he said, that was a clue.

The Lowes' friends had planned to drive their car and the Lowes' to the airport and then use both to help the family and all its luggage get home. Instead, the friends parked the Lowes' car, tossed in the keys and waved hello/goodbye to the Lowes from their own car — with the windows rolled up.

Around the Northwest, some workers have let it be known they're dreading the return of colleagues traveling from Asia, the epicenter of severe acute respiratory syndrome, or SARS. It's a tricky question: Should returning travelers put themselves into self-imposed quarantine — not because they're required to by law or even good health practices but out of courtesy to nervous colleagues?

Last week, as deaths from SARS mounted worldwide, government and public-health authorities dusted off the notion of "quarantine," giving health officials more powers to involuntarily detain people possibly exposed to SARS.

Friday, President Bush added SARS to the list of diseases for which federal officials can impose involuntary quarantine. It's the first time in two decades a disease has been added to a list of the world's most-feared diseases; that list includes plague, smallpox, viral hemorrhagic fevers and active tuberculosis.

At the same time, local and national officials tried to reassure everyone that ordering involuntary quarantine or isolation would be a step taken only after all other possibilities had been exhausted.

So far, 2,416 people around the world are believed to have had SARS, and 90 have died. In the United States, 115 suspected cases are under investigation, and no one has died. Canada has a total of 201 probable or suspected cases and eight deaths (and one under investigation) — most in Toronto, which has a large number of travelers to Asia.

Worry and questions

No one has been placed in involuntary quarantine or isolation in the United States. Dr. Alonzo Plough, head of Public Health — Seattle & King County, said the agency is not advising any restrictions on returning travelers without symptoms.

But that doesn't mean co-workers, friends or relatives of those coming from affected areas aren't worried.

Around Puget Sound, schools and businesses have fielded questions from parents and workers, and some companies have called health authorities for advice.

Students in the Federal Way School District went home Friday with a letter asking families to help prevent the spread of SARS by keeping sick children home and reminding them to wash hands frequently and cover their mouths when coughing.

At Boeing, spokesman Bob Saling said some employees have expressed some nervousness about co-workers coming back from Asia. "I don't think anybody's frantic about it," he said.

Some work groups with many traveling members have met with company doctors to have questions answered, he said.

So far, officials in the United States have taken a voluntary approach, requesting that people believed to have been exposed to a case of SARS and have a fever or respiratory symptoms to go home and quarantine themselves for 10 days, believed to be the limit of the disease's incubation period.

For the most part, voluntary measures have been the rule in Canada, as well.

In British Columbia, about 50 people have been asked to voluntarily quarantine themselves because they were exposed to someone who may have SARS, said Clay Adams, of the Vancouver Coastal Health Authority.

Health workers check in daily on the quarantined people, Adams said. During the 10-day quarantine period, people are asked not to leave their houses. If they must, they're asked to wear a mask. "Our approach has been, unless you have direct contact with a probable case, there is no need to quarantine people," Adams said.

But officials found the voluntary approach doesn't always work.

In Toronto, seven people violated orders to stay home after possible exposure, forcing authorities to take other measures. In one case, they sought and were granted a court order for police to arrest and quarantine a man who refused to isolate himself. The order allows police to forcibly escort the man to mandatory quarantine in a secure hospital.

In Edmonton, Alberta, last week, echoing a similar incident in San Jose, Calif., an airplane with two ill passengers was held on the tarmac for nearly three hours while officials contacted the appropriate agencies, sorted out jurisdiction and arranged to take the ill passengers to a hospital. The plane came from Vancouver, but the sick women had begun their travels in China, said Dr. Gerry Predy, medical health officer for the region.

In what is becoming standard operating procedure in most cases in the United States and Canada, passengers were allowed to leave after giving officials their names and contact information. The two women were later determined not to have SARS.

New state rules

In Washington state, regulations adopted in December give health officials the power to order people believed to be exposed to dangerous infectious disease into quarantine — or, if the person is actually sick, into involuntary isolation.

No court order is needed. And police must back up health officials.

The new regulations modify laws that worried civil-rights advocates and public-health authorities because they were crafted when there was little worry about "due process" or civil rights of patients. The new rules contain civil-rights protections, including the right of appeal.

Ordering involuntary quarantine or isolation would always be a last resort, Plough said.

The last time state authorities invoked such powers was in 2001, when they sought a court order to force a tuberculosis patient to complete the drug regimen that would render his disease harmless to others. He was detained at Western State Hospital until treatment was complete, said James Apa, spokesman for the health department.

"You have to be very, very judicious, very science-based, in an instance when an individual's behavior or a disease warrants this response," Plough said. "If quarantine and isolation authority is misused, you run into legitimate legal issues."

Jurisdictions that have misused such authority have found regulations dismantled by lawmakers, he added.

Newspaper headlines from 1946, when a smallpox outbreak threatened Seattle residents, seem unthinkable today: "Tenants, quarantined in Hotel, on Verge of Revolt in Food Crisis."

The building was guarded by police 24 hours a day, and no one could enter or leave. One resident said they couldn't get food because local grocers refused to take their money. "We have sterilized it," she said, "but they still won't take it."

But to compare the contagiousness of SARS to smallpox gives the wrong impression, Plough said. So far, no one in the U.S. has caught the disease without close contact with an actively ill patient, he noted.

In Victoria, Mayor Lowe recalled, the region's health officer assured him that without symptoms, "you can carry on a normal course of activities." He wasn't sure about that. "Nobody told me flat out not to be (at work)," he said.

"But you get hints, especially when your best friends come to the airport and don't even want to be in contact with you. You know very well you could cause a lot of anxiety."

Lowe said his wife, a nurse at a local hospital, was told not to come back to work for 10 days. And as children returned to schools after spring-break travels to Asia, parents of other children threatened to keep their kids home unless the traveling children stayed home.

He thought about his co-workers: one is pregnant, another fighting cancer.

The city manager told him, "If you were thinking about staying home for a while, it might not be a bad idea," he recalled.

Lowe decided to stay home for the week, along with his wife and two children. "It wasn't fair for me to put everyone else in a very difficult position, so I decided to stay home for the week and do work at home," he said.

Carol M. Ostrom: 206-464-2249 or costrom@seattletimes.com

Seattle Times staff reporters Julia Sommerfeld and Sandi Doughton contributed to this story.