Are quarantines back?

For five passengers aboard an American Airlines flight from Tokyo earlier this month, it was a dilemma worthy of reality television: Go with Santa Clara County health authorities and risk being held in quarantine for hours -- maybe days -- for no good reason. Or go home, make the next connection or get to that business meeting, and risk spreading a potentially deadly new disease to family, fellow passengers and business associates.

Emergency vehicles had the aircraft surrounded, and across the nation, Americans watching on live TV got a new look at an old weapon in the fight to protect the public's health: the quarantine.

Dating back to the days of bubonic plague, the quarantine is a notion that had fallen on hard times in the turn-of-the-millennium United States: a government detaining and holding apparently healthy American citizens, potentially against their will, because they might be carriers of a contagious disease.

But in an age of mysterious diseases like Severe Acute Respiratory Syndrome, or SARS, and of bioterrorism threats like smallpox, the quarantine is staging a comeback.

Aboard American Airlines Flight 128, the five passengers who suffered flu-like symptoms on April 1 stepped aboard waiting ambulances and went willingly to a nearby hospital to be screened for the SARS virus. Another two chose the "every man for himself" route: They refused to go with authorities and went on their way, with a promise to call if they became ill. In the end, none of the five actually had SARS, and all survived.

By April 4, President Bush signed an unusual executive order that would add SARS to a list of diseases for which federal health officials may quarantine U.S. citizens against their will. It was the first such action since 1983, when the dreaded Ebola virus was added to a pantheon of epidemics that includes tuberculosis, leprosy, smallpox and cholera.

The president's action came after Santa Clara County health officials complained they lacked the authority to order the detaining or confinement of possible SARS patients. Though the president's executive order doesn't give county health officers that right, it does allow the U.S. Centers for Disease Control and Prevention, backed by federal law enforcement personnel, to do it instead.

Experts warn that the president's action might set up a legal tussle over who -- state officials or the federal government -- should be in charge in a public health emergency. And that, they say, is only one of many problems that could paralyze the system at a time when decisive action might be needed to stop a disease from spreading like wildfire.