Interim Report of the 

Defense Science Board Task Force 

on 

SARS Quarantine 

December 2004 

Office of the Under Secretary of Defense 

For Acquisition, Technology, and Logistics 

Washington, D.C. 20301-3140
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Interim Report of the Defense Science Board Task Force on SARS 

Quarantine

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This report is a product of the Defense Science Board (DSB). The DSB is a Federal 

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concept of operations plan, Department Directives, and Center for Disease Control and 

Prevention (CDC) guidelines provides the necessary framework. Commanders are 

responding in a reasonably effective manner to implement the principles outlined in the 

Department Directive regarding emergency health powers, including quarantine. Plans 

are reportedly underway to further detail the Departmental plans dealing with public 

health emergencies and disease outbreaks. However, given the complexities involved in 

executing an effective and measured response, it would be prudent for the Task Force to 

provide oversight of the Department's progress over the next several months. 

The following findings and recommendations are provided: 

(a) Appropriate quarantine and isolation procedures occur within a spectrum and 

need not be perfect to have a salutary effect on an epidemic. While the military 

should be particularly vigilant not to be in fact or by allegation the vehicles of 

pandemic spread, the costs of extensive quarantine are very high, and provisions 

would be needed for welfare of those immobilized by quarantine restrictions. The 

transmissibility and virulence of the SARS-CoV, as we know it today is relatively 

low by the standards of other pathogens, but this may not be the case if the virus 

mutates or for future emerging pathogens. 

(b) A level of uncertainty should be expected when constructing a reliable 

quarantine model, particularly during the early states of the outbreak. Working in 

close concert with civilian authorities, and heeding considered advice from CDC 

expertise as primary fiduciaries of US public health are essential to quarantine 

execution within DoD. Many policies and procedures will have to be improvised 

in light of current and local circumstances. While functional interfaces between 

civilian and military public health agencies exist at the very lowest and highest 

levels within DoD, efforts aimed at strengthening lines of communication among 

local military and civilian decision makers at the community level would pay 

dividends in outbreak response. 

(c) A comprehensive exercise program that addresses the seams in the larger 

system of civilian and military, both within and outside the United States may 

prove helpful. Military commanders should actively participate with the civilian 

leaders of their communities in addressing trans-jurisdictional quarantine issues, 

in developing mutually agreed upon protocols, and in testing these plans through 

tabletop and actual exercises to demonstrate their need and identify their 

weaknesses. Systems and tools for collecting, organizing, and real-time tracking 

outbreak will be important and helpful to decision makers dealing with 

uncertainty. 

(d) The protection of the force strengthens the civilian defense and response to an 

outbreak. The Department's capability to perform its mission could be limited if 

there is no plan for immediate protection of the force. While DoD has cautiously 

adopted a supporting role in response to an outbreak and related consequence 

management, this deferral may result in delayed action when immediate action is 
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demanded. Establishing training programs for Public Health Emergency Officers 

and criteria upon which to base recommendations advocating specific public 

health powers should help to reduce delays. 

(e) The availability of isolation facilities in the event of a large outbreak could be 

a limiting factor. The Department should consider new technologies and 

alternative approaches to isolation. Since fecal contamination is a concern given 

persistence of SARS-CoV in stool, DoD may wish to review the empirical 

evidence on the efficacy of personal hygiene measures, including hand washing 

and use of masks in preventing SARS transmission and more generally in 

preventing infectious disease transmission. Regardless of whether additional 

SARS outbreaks are on the horizon, DoD should introduce signage similar to that 

posted in restaurant washrooms. 

 (f) Recommendations to enhance the Department Directive, Emergency Health 

Powers on Military Installations and the National SARS CONPLAN are included 

in Appendix B. 

 

Enclosures: 

1. Appendix A: Terms of Reference 

2. Appendix B: References 

3. Appendix C: A Review of Reference Documents by Dr. Thomas Inglesby, Center for 

Biodefense Strategy 
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Appendix A: Terms of Reference 
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Appendix B: Defense Science Board Task Force on SARS Quarantine Interim Report–– 

 References 

1. Terms of Reference--Defense Science Board Task Force on Quarantining Guidance for 

Severe Acute Respiratory Syndrome Epidemic, July 11, 2003 

2. DoD Directive 6200.3, Emergency Health Powers on Military Installations, 5/12/2003 

3. United States Government Severe Acute Respiratory Syndrome (SARS) Concept of 

Operations Plan (CONPLAN), January 8, 2004 

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Appendix C: Defense Science Board Task Force on SARS Quarantine Interim Report–– 

A Review of Reference Documents by Dr. Thomas Inglesby, 

Center for Biodefense Strategy 

Document: DoD Directive “Emergency Health Powers on Military Installations” 

May 12, 2003 

This Directive would be useful in a commander’s response to SARS or other disease outbreaks 

that were natural or caused by bioterrorism. It instructs military commanders to designate Public 

Health Emergency Officers (PHEO) who would counsel the commander on disease containment 

decisions in the event of public health emergencies like SARS or bioattacks, and it outlines the 

types of actions that might be deemed necessary. But I do have a number of concerns and some 

recommendations for change/amendment: 

Section 4.1: Recommend expanding possible scope of necessary response beyond 

specific Military Installations. 

The Directive focuses on military installations, property and personnel. It may be that 

disease containment measures would be necessary only within a specific military 

installation, but SARS cases may not be discovered until they are scattered 

geographically. A plan must be outlined for organizing a Command-wide or DoD-wide 

disease containment strategy in the event of widespread SARS cases. 

Section 4.4: Highlight importance of systems for Real-Time Tracking Scope of 

Outbreak and prepare decision-makers for much uncertainty. 

The Directive instructs the PHEO to ascertain the scope of the outbreak and the 

distribution of illness. Unfortunately, there will be a great deal of uncertainty. In all 

probability, we will not have rapid diagnostic tests available to confirm or exclude all 

cases. There will be many suspect cases, waiting for days to get final diagnosis. Tools 

for collecting and organizing the information on cases, their locations, etc. will be crucial 

as decision-makers try to decide what public health disease containment actions to take. 

These information technology tools should be established ahead of time. Even with such 

tools, decision-makers should understand that there will be much irreducible uncertainty 

regarding the extent of the outbreak and the location of cases. A military commander 

who is accustomed to a great deal of “situational awareness” on the battlefield may be 

surprised at how poor the situational awareness is with regard to the extent of a disease 

outbreak. In the military and civilian communities, there has been much focus on 

surveillance systems for “detecting an outbreak”, but in general, far too little attention has 

been given to surveillance systems for managing an outbreak. 

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Section 4.6: Recommend clear articulation of the process by which Decisions would 

be made to take these Special Public Health Powers. 

The powers being considered may be deemed necessary to control an outbreak. But they 

could at the same time have serious negative consequences. For example, stopping all 

ingress and egress of major military installation could: 

 affect supplies of commodities and medicines within the installation; 

 increase level of public anxiety within and outside of the base; 

 keep civilians from leaving the base: and 

 convince persons to hide their own illnesses to avoid detection and isolation, 

etc. 

It is also not clear from this Directive that the Public Health Emergency Officer (PHEO) 

would have had any professional experience in disease containment response. It would be 

ill-advised to have a PHEO with no past experience in disease outbreaks be the sole lead 

advisor to the Military Commander on these decisions. A system should be arranged so 

that Military Commanders facing serious disease containment decisions (e.g. the possible 

need to use serious public health powers) could receive the counsel/expertise of public 

health experts at CDC (who have made such decisions in the past) and the counsel of 

DoD health leaders at a minimum. The Directive as written notes that military 

commanders simply need to inform the appropriate service Surgeon General and the ASD 

for Health Affairs of their major disease containment decisions. I would suggest turning 

that around so that these decisions are at least informed by the counsel of these DoD 

health leaders unless logistics make that impossible. 

Section 4.6: Recommend establishment of criteria upon which a PHEO could base 

recommendations advocating for specific public health powers. 

Even with an experienced PHEO (and even if the PHEO had substantial counsel from 

CDC experts at the time), it would be useful to agree in advance on the types of grave 

outbreak conditions that would necessitate complete closure of a base, or the quarantine 

of individuals or the “controlling of evacuation routes”. Again, these are potentially very 

serious actions. The DSB Task Force was briefed about a Commander’s experience last 

year when he had considered such actions during SARS outbreaks in Asia. The 

Commander noted that he did not feel like he had sufficient counsel to make good 

decisions on these matters. Advanced discussion and planning on these issues may help 

commanders make better choices. Prototype scenarios with different types and extent of 

disease outbreaks may be helpful for PHEO and military commanders as they plan for 

possible responses. 

Section 4.6: Recommend that military commanders make advanced plans to 

harmonize their disease containment decisions with appropriate civilian leaders. 

If a military installation is within or adjacent to a city that also has cases of the disease, a 

military commander should be encouraged to try to harmonize decisions and actions with 

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the civilian leaders of the surrounding areas. For example, actions taken by the 

Commander of Andrews AFB responding to SARS on his base should be aware of 

actions being taken by elected officials in Washington, DC and State of Maryland. Such 

cooperation would best be established by advanced planning. The DSB Task Force was 

briefed on a number of military/community efforts that had attempted to forge such 

cooperative efforts, but it sounded like not a great deal of progress had been made. I 

would explicitly direct the PHEO to immediately initiate such cooperative planning 

efforts as a part of his or her responsibilities. 

Document: US Government Interagency SARS Concept of Operations Plan

I recognize this is meant to be a summary document, but found it was theoretical and vague to 

the point of not being particularly useful to those who would find themselves in the midst of 

decision-making or public health operations during a large SARS outbreak. 

Specific comments: By design or neglect, DoD’s responsibilities are vague in this 

CONOPS. It would seem reasonable to assume that a large multi-city outbreak of SARS 

would create tremendous burden on the US health care and public health systems. There 

are certainly thresholds beyond which hospitals would have difficulty functioning (as 

point of reference, look at what happened to major Canadian hospitals with single digit 

numbers of SARS cases – whole sections of their hospitals became dysfunctional or nonfunctional). Therefore, the DoD may be asked to provide logistical and/or personnel 

and/or health care facility and/or transport support during such a crisis. Presumably 

requests for such DoD help would be made through NORTHCOM now, but the 

mechanisms by which such requests would happen, how decisions would be made 

(especially if military units were also deployed overseas in Iraq) remain unclear and are 

not articulated in this document. 

The charts on page 15, 16, 20, 24 illustrate DoD responsibilities. Included in these 

responsibilities on page 24 is “support DHHS quarantine and isolation”: 

 What does “support DHHS quarantine and isolation” mean? 

 Does it mean that DoD can enforce DHHS quarantine decisions with force? 

 Does it give DHHS all the logistical support and material resources it needs 

for implementing voluntary home stays? 

In the area of quarantine and isolation in particular, more clear articulation to the DoD of the 

actions that DHHS might take and how it would plan to implement them is warranted. 

Expectations should be clarified now, in advance of a crisis, not during a crisis. 

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