Restricting Movement During Epidemics

Epidemic (also known as pandemic) disease is one of the more likely larger-scale disasters we might have to deal with. One common aspect of such outbreaks is the erection of barriers to free movement during epidemics. How well do these barriers work? Should we push for them in our own communities? If so, how should they be set up?

These last few weeks I’ve been doing an online course developed by the Harvard Global Health Initiative on lessons we can learn from the most recent Ebola epidemic. (1)

There have been a couple of other posts about particular aspects (you can find them here and here). This is the last of the series.

Let’s examine how well barriers to movement served to contain the epidemic; what worked and what didn’t. There may come a time when we in our own communities have to make such decisions, and we want to avoid repeating failures.

Barring movement from infected regions

The Ebola epidemic started in Guinea and spread west through Sierra Leone and Liberia. 

If outlawing travel between nations was really effective, there wouldn’t have been any cases in Sierra Leone or Liberia. Travel across those borders was prevented as well as the governments could manage — which clearly was not enough.

Here’s a podcast that we did on this subject:

Did restricting movement help reduce the spread? Almost certainly so. The rise of rapid air travel is considered one of the biggest promoters of pandemic disease in general.

Stopping people from infected areas from entering your community might work. It worked for a few towns in the U.S. during the Spanish Flu epidemic of 1914/1915. I’d say it’s definitely worth doing if the infection’s really dangerous and your community is still clear. Here’s a key takeaway though: You can’t trust that one approach to protect you. The same approach that kept some U.S. towns flu free failed for many other towns. People find a way.

Blocking movement can be overdone

During the Ebola epidemic, many airlines simply stopped service into and out of affected areas. That approach might have reduced the spread of the disease, but it definitely made the situation worse in other ways. Health care workers couldn’t get in; necessary supplies couldn’t get in. 

You might consider that regrettable but necessary if you were on the clean side of the border; you’ve got to take care of your own community, right? But there’s a stinger hidden in the tail of that tactic. No health care workers and supplies means many more cases of disease. Many more disease cases mean more desperate and sick people. Some of them will try to flee; and some will be successful.

The global health administrators trying to contain the Ebola epidemic were convinced that halting flights did more harm than good, on balance. They supported tight controls on people moving out, based on potential exposure; but thought the disease overall would have been better contained without the complete flight bans.

Blocking movement of the sick within the community: Infection Control Centers

So when someone in the community does show signs of this nasty infection, what do you do? Keep them from wandering around and spreading it! Makes sense, yes?

In these dangerous epidemics, health control workers usually open special treatment centers to both corral the afflicted and give them care. Please note there were two parts to that: *corral the afflicted* AND *give them care*. If you don’t actually give care, the corralling ends up being far less effective.

By lack of resources rather than will, the early Ebola Treatment Centers set up in the affected regions did a good job of keeping in all who arrived, and a lousy job of caring for them. Do you think it doesn’t much matter, since the mortality rate was so high anyway? After all, if you probably can’t save them anyway, would it be a waste of resources to really try?

Let’s set aside the ethics of that  – yours are your own business – and look at the practical side. People soon figured out there was very little actual treatment going on in the centers. It was a bunch of miserably ill people with little but beds, food, and the company of other miserably ill and dying people.

Why did Infection Control Centers often fail?

Would you want to go to such a ‘disease prison’ it were you? Can you imagine dropping off your beloved at such a place? Well, the West Africans weren’t interested. They avoided seeing health care professionals, they hid, they fled rather than being locked up in a treatment center. 

Instead, they were cared for by their families — who often caught the disease. Sometimes they fled to other communities (violating the barriers meant to stop them) and brought the disease with them.

When enough resources were in place to offer a decent standard of care, the story changed. People would come, knowing they’d be confined but they’d be cared for without putting their families at risk. Even when the care offered could not save the individual (and it often could not), it helped save the community by being a more effective way to stop movement of people carrying the disease.

My takeaways on preventing movement during epidemics

Discouraging the possibly infected from coming into the community can be a real help. I’m still liking the ‘Hang out by ourselves at The Place’ approach for Salty and myself, for example

Being too heavy handed about blocking movement can backfire. Decisions based on real risk assessment worked better than blanket bans out of fear.

Infection control centers that don’t offer meaningful care fail to control the spread of disease. People work very hard to avoid being locked up in them.

Here is another post about what we can learn from the West African ebola epidemic.

1) Jha, Ashish. 2015. Lessons from Ebola: Preventing the next pandemic. Harvard Global Health Institute course, as distributed by EdX.

2) CDC Global [CC BY 2.0 (https://creativecommons.org/licenses/by/2.0)], via Wikimedia Commons. I did not modify the image.