Unprepared for a SARS quarantine. (Guest Editorial).

The Centers for Disease Control and Prevention has performed admirably to stem a severe acute respiratory syndrome (SAPS) epidemic in the United States. Despite the strong federal response, the United States is ill prepared to cope with emerging infectious diseases and bioterrorism.

The lack of preparedness is underscored by the fact' that the public health system is chronically underfunded, public health laws are antiquated and ineffective, and political leaders have given scant attention to the logistics and ethics of the exercise of public health powers.

The CDC and the Institute of Medicine have drawn attention to the lack of preparedness of public health agencies. Although the federal government has invested in bioterrorism, the majority of public health agencies in a recent survey said that bioterrorism preparedness and smallpox vaccination are diverting resources from SAPS and other naturally occuring infectious diseases. The current state budget crisis will only put greater strain on existing capabilities. As a result, public health agencies lack adequate surveillance capacities, sophisticated laboratories, well-paid and trained workforces, and modern data systems.

The vast majority of federal and state health spending-more than 95%-is directed toward personal health care and biomedical research; only 1%-2% is directed toward prevention. This history of investment skewed toward biotechnology offers a limited vision that is unlikely to safeguard the public's health and security.

Political leaders have not carefully considered the logistics and ethics of quarantine, the only known response to SARS. A quarantine order, in effect, asks people to sacrifice their liberty for the common good. In exchange, the state owes them a safe, humane place where they can receive food and medical and nursing care and. where they will have a means of communication. If people are quarantined in their homes, their family and friends may be exposed to infection.

Vulnerable people such as the elderly or disabled may be especially at risk from being isolated. Hospitals lack sufficient space and personnel to ensure safety and humane treatment for a mass quarantine. Few modern hospitals, for example, have facilities for isolation of more than a few patients. It is important to consider ...