Swine flu ethics

Hong Kong says it will detain in hospital anyone arriving there who has a fever, at least until it can be proven that they don't have swine flu.

Hardly a surprising reaction by a place that was the epicentre of the SARS outbreak six years ago, but it raises interesting ethical questions about the needs of the many versus the rights of individuals.

Is it ethical to effectively jail someone merely on the suspicion of illness? On the other hand, with thousands, perhaps millions, of lives at stake if this thing becomes a pandemic, would it unethical not to detain people?

Tough questions, to be sure, but ones that I suspect we'll be hearing more about in the coming days as swine flu continues scaring people around the world.

Detention sounds like an easy answer, but it raises some practical problems. For one, will people avoid getting treatment for fear that doing so will get them detained? If even a handful of people react that way, the results could be catastrophic. On the other hand, can we count on people to do the right thing and get tested -- and stay indoors if diagnosed -- without strict controls?

Local health authorities are meeting around the world to discuss theses issues.

Another practical concern is deciding who will get vaccinated against this new flu. Health care workers will almost certainly be top of the list, but even the details of that could be up for debate. I wrote in the Toronto Star last fall about a study that argued that not all medical staff should get the flu shot during a pandemic. Why would a foot doctor be needed. it asked.

Better, it said to direct some of the vaccine to truckers and public works staff to ensure that food, water and electricity remain available through any health crisis.

"It takes a lot of people to keep society going," says Nancy Kass, a professor at the Johns Hopkins Berman Institute of Bioethics and lead author of the study in the most recent edition of the journal Biosecurity and Bioterrorism.

Traditional pandemic planning calls for giving first priority for medical treatment to hospital staff and "first responders" to a crisis, such as firefighters and ambulance workers, so that the immediate health crisis can be dealt with effectively.

But as Hurricane Katrina showed three years ago, the study argues, "the after-effects of a disaster can be as damaging as the precipitating event," as electricity and heat are cut off, clean water becomes scarce and sewage starts to back up.

"There could be widespread social chaos, significant outbreaks of other infectious diseases, and severe anxiety, with the possibility of social degeneration, looting, or even violence as people try to secure needed supplies," the study says.

Even people whose homes were not damaged by the hurricane had trouble getting food, electricity and gasoline, Kass says in an interview.

Up to 40 per cent of the workers whose job it is to keep the lights on and the water flowing could be absent from work after a pandemic, the study says. That's enough to cause a breakdown of such services.

I will be watching to see how the many ethical issues play themselves out with the swine flu story.

Meanwhile, blogger Janet D. Stemwedel (aka Dr. Free-Ride) has been keeping track of how various airlines and others are responding. From a Canadian perspective, both Air Canada and WestJet are waiving fees for changing Mexican travel plans.