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http://www.nytimes.com/2003/04/10/health/10CND-QUAR.html?ex=1051502400&en=979541a9b903a1db&ei=5070

Hong Kong Balks at Wide Quarantines for Mystery Illness

By KEITH BRADSHER

ONG KONG, April 10 — Despite growing international pressure to halt the spread of a new respiratory disease here, Hong Kong officials are strongly resisting the kind of broad quarantines that some countries have imposed, taking only another modest step today to control the movements of potentially infected people.

This city has reported far more probable cases of SARS in the last two weeks — 628 — than the rest of the world combined, although there have been accusations from doctors in mainland China that the authorities there have been undercounting cases.

China has been fighting the disease with quarantines for months, while Vietnam swiftly quarantined its outbreak at the French Hospital in Hanoi on March 11. Canada, Taiwan and Singapore have quarantined thousands of people in their homes in the last two weeks for coming anywhere near SARS patients or for visiting a hospital where such patients were treated.

Singapore, a country with a reputation for Orwellian approaches to public policy, announced this evening that it would install closed-circuit televisions outside the doors of quarantined residents to make sure they stayed home. Security officials will call residents at random intervals each day and ask them to show themselves in front of the camera outside; any resident who is away from home and unable to do so will be required to wear an electronic tag that will automatically notify the authorities if the wearer leaves home.

But Hong Kong officials have been skeptical that quarantines are effective.

Two weeks ago, Hong Kong ordered only people sharing households with SARS patients to stay home for 10 days, and to report daily to clinics for medical evaluations.

After Malaysia today barred most citizens of Hong Kong and China from visiting while Singapore imposed a quarantine on lower-income workers arriving from SARS-affected countries, Hong Kong's top health officials held a news conference to announce what they initially described as some of the toughest quarantine rules anywhere in the world.

But when asked about the details, Dr. Margaret Chan, Hong Kong's health director, acknowledged that the new rules would still only affect "a few hundred" people who lived in the same households as people who have been admitted to a hospital in the last 10 days with SARS, or severe acute respiratory syndrome.

The main changes will be that the police will make unannounced visits to the homes of these family members to make sure that they do not go out, and health workers will visit the quarantined families at their homes instead of asking them to come to clinics.

The debate here over how far to go in restricting the movements of people who might be infected has echoes of similar debates over quarantines that have lasted for many years in the United States, including questions over whether to restrict the movements of patients with tuberculosis and H.I.V., the virus that causes AIDS.

Dr. Yeoh Eng-kiong, Hong Kong's secretary of health, welfare and food, said that just as quarantining people with H.I.V. might discourage people from seeking treatment, broad restrictions on people with SARS and their families might also lead to infected people avoiding hospitals.

"We were very concerned with the effect it would have on individuals' seeking help," he said.

City officials have also been leery of seeming to tread on people's civil liberties, Dr. Yeoh said, adding that, "An isolation order would restrict people's freedom, and that is not something people in Hong Kong are used to."

Yet calls for tighter restrictions have been growing here, even from politicians like Emily Lau, the leader of one of the largest pro-democracy political parties here and a member of the Legislative Council.

Ms. Lau frequently leads marches and demonstrations in favor of greater civil liberties, but now she has a new cause: she wants the government to round up all close family members of SARS patients and quarantine them in remote camps in the territory's northern hills.

"It is important to protect the whole community, and I hope these people will understand," she said; all seven political parties in Hong Kong have endorsed the same position.

Dr. Yeoh said this evening that household members could move into the camps if they wished, but would not be compelled to do so. Over the last 10 days, the government used the so-called holiday camps for the internment of 240 people from a housing complex where nearly 300 other people fell sick, but the 240 people were allowed to go home this morning.

The government here and many governments overseas are setting 10 days as the interval for quarantines because most infected people fall ill during that time. But Hong Kong doctors have reported a few cases involving people who fell sick as long as 16 days after exposure to the virus.

The reluctance to quarantine large numbers of people also reflects the growing view among many doctors here that a quarantine will not work.

"You have to have very good reasons for depriving people of their liberty," said Dr. Anthony Hedley, a professor and former chairman of the department of community medicine at Hong Kong University. "I don't think it would be easy to put together a good case medically for putting another 1,000 people in quarantine."

Most of the initial success stories of quarantines now seem to be running into trouble. Chinese officials admitted on Tuesday that the disease was still spreading on the mainland, although they insisted that it was not spreading as fast as it was two months ago. Vietnam and Singapore acknowledged on Monday that each had a cluster of new cases that appeared to have escaped the quarantine.

Canada appears to have slowed the spread of new cases, but has still been reporting a few new ones each day.

President Bush added SARS last week to the list of diseases for which people can be quarantined in the United States, but did not lay out the mechanics of how this might be done. Dr. Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases, said on the ABC program "Good Morning America" on Wednesday morning that he did not anticipate an immediate need to impose such a quarantine, however.

SARS patients are easily misdiagnosed as suffering from influenza or some other ailment. This problem was brought home for Hong Kong doctors when a top Hospital Authority administrator here, Dr. Fung Hong, was hospitalized in late March with the suspicion that he had SARS.

He was then misdiagnosed as not having the disease and later released, only to be readmitted last Sunday when he developed pneumonia and turned out to have SARS after all. Dr. Yeoh said this evening that some people could contract the virus that causes SARS and spread it to others without exhibiting the full list of symptoms that the World Health Organization has warned doctors to look for, notably a high fever.

Such disease characteristics can undermine the effectiveness of a quarantine by making it hard to identify everyone who has the disease, said Dr. Malik Peiris, the microbiologist leading SARS investigators at Hong Kong University. "It becomes difficult if there are a significant number of asymptomatic infections," he said.

With nearly 1,000 cases here now, and more than 1,000 more cases over the winter in cities just across the border in mainland China, there are also too many people to quarantine now who might have been in contact with SARS patients, said Dr. Leung Ka-lau, the president of the Public Doctors Association here.

According to the World Health Organization, a few so-called superspreaders can become extremely infectious and spread the disease to many people — Singapore has already traced 91 cases there to one infected woman. That raises the additional tricky question of whether to quarantine large numbers of people with no apparent illnesses in the hope of restricting the movements of a few superspreaders.

"Until we know more about who is a superspreaders, you're probably going to overstep in terms of how many people you quarantine," said Howard Markel, a professor of the history of medicine at the University of Michigan.

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