LEAD: Legal cases focusing on people ac-cused of knowingly exposing others to the AIDS virus are cropping up around the country, raising troubling issues for the courts, public health officials and the law-enforcement authorities.

Legal cases focusing on people ac-cused of knowingly exposing others to the AIDS virus are cropping up around the country, raising troubling issues for the courts, public health officials and the law-enforcement authorities.

About 30 criminal and civil cases have been filed accusing people of trying to transmit the virus by sexual acts, biting or spitting, according to public health experts and lawyers who follow AIDS litigation.

And while there is no evidence that the virus has been spread through biting or spitting, and while no one has yet been convicted or held liable in such cases, they have helped drive efforts to rewrite state public health statutes. Florida and Idaho have already made it a crime to wilfully or knowingly expose another person to the HIV virus, which causes AIDS.

Similar statutes are under consideration in several other states, along with legislation that would allow forcible isolation of infected people who are believed to pose a threat to public safety. Laws that would make it a crime to knowingly donate infected blood are also being considered.Some Say Moves Are Misguided 

To many public health specialists and advocates of gay rights, the movement to criminalize the transmission of AIDS reflects a misguided and politically motivated eagerness to be seen as doing something to combat the spread of AIDS. These experts contend that politicians have seized on a handful of peculiar and frivolous cases and have often relied on faulty medical assumptions to justify their call for legislation. They point out that recent studies suggest that the chance that the AIDS virus will spread in a single act of heterosexual intercourse is extremely low, perhaps 1 in 1,000.

''We've got a classic case of hard cases making bad law,'' said Lawrence O. Gostin, executive director of the Boston-based American Society of Law and Medicine. ''It's totally a symptom of the hysteria surrounding AIDS.''

These experts also contend that the possibility of civil or criminal penalties is likely to drive carriers of the virus underground. Leonard Graff, legal director of the National Gay Rights Advocates in San Francisco, said the trend would discourage people from seeking AIDS tests and counseling, thus contributing to the disease's spread.

But the cases now in the justice system have already raised legal questions about whether the HIV virus can be treated as a deadly weapon under law, and whether people who knowingly transmit it can and should be sued for damages or even prosecuted for assault or attempted murder.

In what legal experts believe to be the first case in which someone has been charged with a crime for exposing another person to the HIV virus during sexual activity, an Army private at Fort Huachuca in southern Arizona faces a court-martial next month on charges that include aggravated assault even though neither of his sex partners has been shown to be infected by the AIDS virus. The soldier, Pfc. Adrian Morris Jr., is accused of having had sexual relations twice with a female soldier and once with a male soldier without disclosing that a blood test had shown him to be infected.

In New York last week, prosecutors dropped efforts to seek a court-ordered test for the virus for a prostitute who was charged with biting a police officer and then telling him that she had AIDS.

And in Los Angeles, Marc Christian, who contends he was a lover of Rock Hudson, the actor who died of AIDS-related illness in 1985, has filed a civil suit seeking $10 million in damages from Mr. Hudson's estate. Mr. Christian's attorney, Marvin Mitchelson, has argued that his client ''lives in constant fear'' of getting the disease.

These and other cases have raised new legal issues concerning the limits of civil liability, the boundaries of negligence, the concept of criminal intent and the right to privacy. AIDS as Crime: Legal Hurdles 

Even if more states pass laws that criminalize the transmission of the HIV virus, legal experts said they believed that prosecutors seeking criminal convictions would face near impossible burdens of proof. First, the prosecutor would have to establish that the accused carried the virus, raising the question whether a person could be compelled to submit to an AIDS test. He would also have to show that the accused knew he was infected, and that he passed it to a particular ''victim.''

A charge of assault, which requires a showing that the victim was harmed, would raise additional difficulties, since many of those infected by the virus do not contract AIDS. In the case of sexual transmission of the virus, the prosecutor pressing an assault case would also have to show that any harm was caused deliberately or, in most states, by ''depraved indifference'' to the consequences.

Existing statutes in more than 25 states already make it a crime to knowingly transmit a veneral disease, according to Mr. Gostin, who is also a lecturer at the Harvard School of Public Health.

But very few cases have been tried under these laws, some of which are limited to identified diseases like syphillis and gonorrhea, and most states have thus far hesitated to classify AIDS as a venereal disease.Cases Are Dropped 

Several prosecutors have already dropped assault charges in cases where people are accused of deliberately transmitting the virus by biting or spitting because of the difficulty of finding positive medical evidence of transmission.

In the New York case, for example, the prostitute, 18-year-old Miriam Sanders, was originally charged with first-degree attempted assault and reckless endangerment. But the prosecutors reduced the charges to misdemeanors after consulting with medical experts and learning that there have been no documented cases of transmission of the virus by bites.

In a similar case in Flint, Mich., in January, a judge threw out charges against a man who was charged with attempted murder after he spit on two police officers. There are no documented cases of transmission of the virus through saliva, according to the Centers for Disease Control. The virus is spread through exchanges of bodily fluids, as in sexual intercourse or the sharing of hypodermic needles. It can cripple the body's immune system, leaving the victim susceptible to deadly infections and cancers. Nine out of 10 victims in the United States are homosexuals or intravenous drug users and their sex partners.

The problem of testing arose in a California case. A 29-year-old San Francisco man, Brian Barlow, was arrested last June after biting two police officers in a confrontation between marchers and demonstrators at a Gay Pride parade in San Diego.Problem of Testing 

After Mr. Barlow told officers he was homosexual and carried the HIV virus, the officers asked him to submit to a blood test but he declined. Several lower courts upheld the testing order but in April, a California appellate court held for Mr. Barlow, ruling that a 1985 state confidentiality law prevented authorities from testing him or using test results to prosecute him.

''While some cultures require a leper to ring a bell to warn the passerby, our Legislature has not so stigmatized the victims of AIDS,'' the court wrote.

Legal experts also said that prosecutors bringing such cases would have to prove that a defendant accused of transmitting the virus knew he was infected and gave no warning.

Such questions have already been raised in the case of Private Morris. Although the case will be tried in a military court and have no direct bearing on civilian cases, it will be watched intently.Question of Harm 

Edward G. Rheinheimer, an Arizona lawyer initially retained by Private Morris, said there could be no assault conviction because none of Private Morris's three sexual partners - all of whom are being tested monthly - have tested positive for the HIV virus.

Mr. Rheinheimer, who has since withdrawn in favor of military attorneys, compared the situation to a person who, knowingly intoxicated, gets behind the wheel of a car.

''If he drives from point A to point B and injures somebody, that's usually charged as aggravated assault,'' Mr. Rheinheimer said. ''If that same person gets in the car and successfully negotiates from point A to point B without injuring anybody, there's no aggravated assault.''Long Incubation Period 

Those familiar with AIDS litigation said prosecutors in criminal cases would also have to prove that a particular incident led to contraction of the virus, a tall order since the HIV virus may be present for may years before the onset of symptoms of AIDS.

''You would have to discount all of the other sexual encounters or intravenous drug experiences someone had during those five or more years,'' Mr. Gostin said.

According to Harlan L. Dalton, an associate professor of law at Yale University and co-editor of a forthcoming book on AIDS and the law, such obstacles made succcessful prosecution of such cases extremely doubtful.

Asked to sketch a possible scenario for a conviction, Mr. Dalton said, ''If you had a forcible rape in which the rapist was exposed to the virus and intended to transmit the virus, which I cannot imagine, that would be a situation that would give rise to a charge of both rape and attempted murder.'' Issue of Stress: The Civil Cases 

According to legal experts, the likelihood of winning a civil case may be greater than the chance of successful criminal prosecution.

The groundwork for such claims has been established by an increasing number of cases in which spouses and lovers have sued their partners for infecting them with genital herpes.

The right to bring such suits has been upheld by appellate courts in New York and Georgia and, in some cases, defendants have already won settlements in excess of $100,000. Because herpes has an incubation period of about two weeks, it has proved legally possible to pinpoint who passed the virus.

Experts believe that, as in the herpes cases, those involving carriers of the HIV virus will focus on a person's legal obligation, still uncertain under law, to inform others of the possibility that they risk contracting the virus.'Creative Lawyering' Expected 

Mr. Dalton, the Yale professor, said that even if a plaintiff does not test positive for the virus ''the floor is open for creative lawyering all around.''

''The plaintiff's lawyers will argue that the fear of contracting full-blown AIDS is something that ought to be paid for,'' he said. ''The trick will be to think of injuries that seem less speculative,'' such as difficulties in obtaining employment or insurance, he added.

In the San Diego case, for example, one of the police officers alleged to have been bitten is seeking $500,000 in a suit that names Mr. Barlow and the organizations that sponsored the parade.

Transmission of the HIV virus has also led to the challenging of wills, according to Gary Wood, a lawyer who is co-chairman of the San Francisco AIDS Legal Referral Panel.

In one such case, a 28-year-old Los Angeles man who was infected with the HIV virus left half his assets to a church run by his homosexual lover. His family has moved to set aside the will, claiming that the lover exposed the man to the AIDS virus.

Because most individuals suffering from AIDS are impoverished and unable to pay damages, Mr. Wood said, most of those seeking damages are likely to sue third parties like school districts, prisons or hospitals.

Last September, for example, a Chicago woman filed suit seeking $12 million in damages from American Airlines after she was allegedly bitten by a ticket agent after a scuffle. The agent later tested positive for the HIV virus.

The woman, whose identity has been kept secret, has tested negative for the virus, her lawyer, Ernest J. Mirabelli said. But she is seeking compensation for ''infliction of emotional damages'' and has charged American with ''negligent hiring.''

He said that the case, now in preliminary stages in Federal District Court in Chicago, would for the first time test whether a person can succeed in ''putting a price on the fear of AIDS.'' Climate of Fear: Cases Spread 

Experts attribute the recent proliferation of AIDS legislation and litigation to widespread fear of the disease bred in part by misperceptions about how it is spread.

Recent public opinion polls have found that more than half those questioned said they would support laws making it a criminal offense for a person infected with HIV to have sex with another person, and some state legislators have begun to look for ways to deal with people believed to present a danger to others.

Colorado and Indiana have passed laws that permit AIDS victims to be isolated, and the Nevada legislature approved a bill yesterday that includes 20-year prison sentences for prostitutes who sell sex knowing they are infected. Under the Colorado statute, health authorities may order testing for a person reasonably believed to be infected and may further order that person to desist from ''dangerous conduct.''

Mr. Wood of the San Francisco AIDS Referral Panel, who favors less emphasis on legal solutions and more on counseling and education, predicted that the trend toward legal action and legislation will grow. As public officials argue for widespread testing for the AIDS virus and gay rights groups insist that any mandatory testing amounts to a civil rights violation, he said, disputes over the response to the AIDS epidemic are certain to end up in court.

''Now that this issue is becoming more political, nobody is willing to draw that line,'' he said.

When a Boston man was recently told he was infected with the AIDS virus, he asked his doctor to keep the information confidential. The man said he planned to file for divorce and that if his wife were told, it would complicate matters.

The physician tried to persuade his patient to tell his wife so she would get tested. When he refused, the doctor personally informed the woman, risking substantial civil damages under Massachusetts' strict confidentiality law, which requires written consent from a patient to disclose AIDS test results.

The Massachusetts case, which doctors and those who study medical ethics say is only one of several similar incidents around the country, illustrates how many physicians and health authorities, struggling to prevent the spread of AIDS, are beginning to tip the delicate balance between the right to privacy and the right to know.

Like the Boston physician, who did not want to be identified, a growing number of doctors, ethicists and legislators argue that the sanctity of the doctor-patient relationship must give ground to society's need to protect itself, despite warnings that this could discourage people from seeking medical advice, thus hindering efforts to slow the disease's spread.

''The right to privacy is absolute until it infringes on other people's right to safety,'' said Dr. M. Roy Schwarz, assistant executive vice president for medical education and science at the American Medical Association. ''Physicians not only have a responsibility to treat but also a responsibility to prevent disease.''

Dr. Schwarz and many other physicians compare carriers of the AIDS virus who do not tell sexual partners or refuse to take precautions to a gunman who fires into a crowded area or a drunken driver. ''The fact is you get seriously sick and then you die,'' he said. ''That drives the consensus pretty quickly. Society has the right to protect itself.''

That has led dozens of states to consider laws to identify and track both victims of the disease and carriers of the virus, a step rejected by the Federal Centers of Disease Control as intrusive and costly. Most measures include some clauses to protect confidentiality. But they expand the number of people with access to the information, providing many more opportunities for intentional and unintentional disclosure. How to Battle Epidemic

''There's a move away from absolute privacy,'' said Richard Merritt, the director of the Intergovernmental Health Policy Project at George Washington University. He noted that a Wisconsin law, one of dozens of such measures passed last year, allows the results of tests for the AIDS virus to be disclosed to doctors, hospitals, employers, professional review groups and funeral directors, among others.

Arthur Caplan, the director of the Center for Biomedical Ethics at the University of Minnesota, said that even though there is a risk that increased disclosure will reduce the public's willingness to be tested, he supported doctors who break patient confidentiality to warn the spouses of victims of AIDS or carriers of the AIDS virus. ''The doctor's obligation to prevent harm is overriding,'' he said At stake, both proponents and oponents of increased disclosure say, is the country's ability to contain the AIDS epidemic. Many officials say that increased disclosure will be counterproductive, discouraging carriers of the virus from seeking help and accelerating the disease's spread. They say even the strictest privacy laws are often honored only in the breach.

''There's a belief that more disclosure solves the problem,'' said Janlori Goldman, the acting director of the American Civil Liberties Union's Project on Privacy and Technology. ''But disclosure won't cure AIDS. It may, in fact, further the disease. In the end, you are going to deter people from being tested. The benefits of confidentiality outweigh the possibility that somebody may be injured.''

Federal officials have estimated that 1.5 million Americans are already infected with the virus and are presumed capable of transmitting it through blood transfusions or in sexual intercourse.

Public health officials say that the best solution is through counseling to encourage infected people to inform their sexual partners themselves and that with counseling, most agree to do this. #38,000 AIDS Cases Reported So far, 38,000 cases of acquired immune deficiency syndrome have been reported to the Federal authorities, who predict 270,000 cases by the end of 1991. Although 9 out of 10 patients have been members of high risk groups, like homosexuals or intravenous drug users, health officials warn that without precautions, the disease may slowly spread among heterosexuals.

That has spurred wide-ranging efforts to protect the uninfected, often by overriding a patient's right to privacy. Several states have passed laws regarding the confidentiality of AIDS test results.

The California Medical Association voted in March to support a proposal that would allow doctors in that state, which has the strictest confidentialty laws in the country, to tell the spouses of carriers of the AIDS virus about their partners' affliction.

On the Federal level, a Washington aide to Senator Edward M. Kennedy said that the Massachusetts Democrat will introduce a bill today that would, among other things, free doctors from criminal and civil liability if they inform members of the family or known sexual partners of a patient infected by the AIDS virus. Defining a Doctor's Duty

''The confidentiality of the doctor-patient relationship is coming under increasing attack,'' said Lawrence Gostin, the executive director of the American Society of Law and Medicine, who is a lecturer at the Harvard School of Public Medicine. ''AIDS spears physicians on one of the greatest dilemmas, a torturous dilemma - the conflict between the duty to the patient and the duty to society.''

The conflict is as old as the medical profession. But the 100 percent fatality rate of AIDS patients has raised the stakes. So has the widespread discrimination faced by both victims of the disease and carriers of the virus. The results have included a legal conundrum and dozens of lawsuits: some charge physicians with breach of confidentiality; others contend they should have given out more information.

The American Medical Association passed a resolution at its annual meeting in Chicago last month that reaffirmed the vital importance of a confidential doctor-patient relationship, but noted that confidentiality was not absolute. Gauging a Specific Threat

Dr. Schwarz said the group was not backing away from confidentiality, but Mr. Gostin and other authorities said they interpreted the resolution as tilting the balance away from privacy.

The Hippocratic Oath, taken by all doctors before they may practice medicine, requires physicians to jealously guard patient confidentiality. In cases not involving AIDS, many courts have ruled that patient confidentiality is inviolable.

But in the last decade an increasing number of courts have concluded that health care professionals have an overriding duty to warn potential victims. A physician, these courts said, must disclose information if a patient poses a predictable risk to another person.

The question as defined by the courts is, how specific is the danger. In a case 10 years ago in California, when a mental patient told his psychologist that he planned to kill a friend, a court ruled the doctor should have warned the intended victim and was liable for damages after the patient carried out the threat. Several years ago, however, South Carolina courts ruled that the Army did not have to inform the local community of an outbreak of hepatitis because it was impossible to identify likely victims of the outbreak.

Mr. Gostin, counsel to the Senate Labor and Human Resources Committee, noted that the courts have strictly limited the circumstances under which confidentiality is superceded by the duty to prevent harm. In a recent article in The American Journal of Law and Medicine, he noted that courts have found there must be a specific threat to a specific individual and that the duty to protect ''is not owed to statistically probable victims.'' 'It's Our Own Responsibility'

Alice Philipson, a lawyer who is co-chairman of the AIDS Legal Referral Panel in San Francisco, a group of lawyers that specialize in law involving AIDS, denounced any breaches of patient confidentiality as unethical and said it will ultimately accelerate the spread of the disease. ''We can't presume people with the virus are irresponsible, stupid and out to harm the people they love,'' she said. ''Ultimately, it's our own responsibility to stay healthy.''

But state legislatures have increasingly started to disagree. In what many medical and legal authorities consider the most intrusive package of laws, the Illinois Legislature this year passed 17 AIDS-related measures, including several that require physicians, hospitals, laboratories, blood centers and other health care facilities to report the names of all carriers and to provide their names to school officials and employers.

The Illinois Department of Public Health opposes the most intrusive sections of these bills. Gov. James R. Thompson has not said which measures, if any, he will sign. But Dr. Schwarz and other health officials noted that similar laws have been introduced in state legislatures around the country and predicted that it is only a matter of time until even more intrusive measures are passed.

Nan D. Hunter, a staff attorney for the American Civil Liberties Union who is coordinator of AIDS-related issues for the group, noted that patient confidentiality is often breached. Even in California, with has the strictest confidentiality laws in the country, she said, the authorities have steadfastly declined to prosecute health care officials who violate the sanctity of the patient-doctor relationship.

''Confidentiality really isn't a reality,'' Ms. Hunter said. ''It quickly becomes an illusion.''

• Clinical Management :   An estimated 80% of Zika infections are asymptomatic, and most of the remainder are self-limited. No specific antiviral treatment is available and care is supportive, with symptoms usually resolving within 7 days.1 Severe GBS cases can require intensive care, including mechanical ventilation.OnJanuary 19, the CDC issued new guidelines for pregnant women with suspected or proven Zika virus infection, including an algorithm for offering laboratory testing. (Diagnostic testing is not optimal because antibody tests could cross-react, giving false-positive results due to other flavivirus infections.)Commercial tests are unavailable, but the CDC and several state laboratories have testing capability. Pregnant women with laboratory evidence of Zika virus in serum or amniotic fluid should consider serial fetal ultrasounds every 3 to 4weeks.

• Accelerated Research and Development. When Zika infection was seen as usually asymptomatic and self-limited, researchers had little incentive to develop reliable countermeasures. The emerging data on fetal complications,4 however, have altered this equation, with research on new vaccines becoming urgent. Similarly, understanding which individuals are at increased risk of GBS could allow specific antiviral treatment. A safe and effective Zika virus vaccine is probably 3 to 10 years away even with accelerated research.The National Institutes of Health launched a Zika vaccine initiative in late 2015, and Brazil has expedited vaccine development. Vaccines against yellow fever and Japanese B encephalitis have been licensed for decades, and Brazil, Mexico, and the Philippines approved the first dengue vaccine in 2015.

• Public Health Emergency Declarations. A national declaration of a public health emergency can focus political attention, while financing a surge in resources. Public health agencies also have increased authority during public health emergencies. Brazil, for example, proactively declared a public health emergency in November 2015.4 Countries experiencing major Zika virus outbreaks with possible neurological, autoimmun and congenital malformation associations could invoke heightened emergency powers.

World Health Organization Leadership :

• The World Health Organization (WHO) Ebola Panel in July 2015 said that urgent warnings “either did not reach senior leaders or senior leaders did not recognise their significance.”

• By many accounts the agency’s failure to act decisively cost thousands of lives.7 Despite internal reforms, however,WHO is still not taking a leadership role in the Zika pandemic. On January 18, WHO said it is “supporting countries to control Zika,” citing the need for surveillance, laboratories, vector control, and clinical care. Yet, the global dimensions of Zika are quite clear, with fresh urgency as the 2016 Olympics in Rio de Janeiro loom.

• Despite the global threat, the WHO director-general has not convened an IHR Emergency Committee to advise countries on critical issues such as vector control, health system preparedness, travel advisories, and avoiding punitive measures. An emergency committee should be convened immediately to advise the director-general about the conditions necessary to declare a Public Health Emergency of International Concern (PHEIC). The very process of convening the committee would catalyze international attention, funding, and research. While Brazil, PAHO, and the CDC have acted rapidly, WHO headquarters has thus far not been proactive, given potentially serious ramifications.

• Convening an emergency committee does not mean that the director-general should declare a PHEIC. WHO, for example, convened an emergency committee on 10 occasions to review global data on the Middle East respiratory syndrome (MERS). Yet the emergency committee has not advised to declare a PHEIC for MERS but has offered detailed recommendations to guide member states. The director-general has the sole authority under the IHR to convene an emergency committee, and she is uniquely empowered to declare a PHEIC subject to the committee’s advice.

• The director-general was widely criticized for waiting 4 months after the first cross-border transmission of Ebola before declaring a PHEIC.8,9 A key lesson learned from that searing experience was the need for an intermediate-level response to emerging crises, thus avoiding overreaction while still galvanizing global action. Functionally, the director-general could achieve a similar result by convening an emergency committee on Zika virus. The international community cannot afford to wait for WHO to act.

On December 31, 2019, China reported to the World Health Organization (WHO) cases of pneumonia in Wuhan, Hubei Province, China, caused by a novel coronavirus, currently designated 2019-nCoV. Mounting cases and deaths pose major public health and governance challenges. China’s imposition of an unprecedented cordon sanitaire (a guarded area preventing anyone from leaving) in Hubei Province has also sparked controversy concerning its implementation and effectiveness. Cases have now spread to at least 4 continents. As of January 28, there are more than 4500 confirmed cases (98% in China) and more than 100 deaths.1 In this Viewpoint, we describe the current status of 2019- nCoV, assess the response, and offer proposals for strategies to bring the outbreak under control.

Current Status

China rapidly isolated the novel coronavirus on January 7 and shared viral genome data with the international community 3 days later. Since that time, China has reported increasing numbers of cases and deaths, partly attributable to wider diagnostic testing as awareness of the outbreak grows. Health officials have identified evidence of transmission along a chain of 4 “generations” (a person who originally contracted the virus from a nonhuman source infected someone else, who infected another individual, who then infected another individual),suggesting sustained human-to-human transmission. Current estimates are that2019-nCoV has an incubation period of 2 to 14 days, with potential asymptomatic transmission.1,2

Multiple countries have confirmed travel-associated cases, including Australia, Cambodia, Canada, France, Germany, Japan, Nepal, Singapore, SouthKorea,Taiwan, Thailand, United Arab Emirates, United States, and Vietnam. Vietnam identified the first human-to-human transmission outside China. Yet fundamental knowledge gaps exist on how to accurately characterize the risk, including confirmation of the zoonotic source, efficiency of transmission, precise clinical symptoms, and the range of disease severity and case fatalities.

Control Measures in China

The Chinese Lunar New Year is the largest annual mass travel event worldwide, risking amplification of the spread of 2019-nCoV. In response, China severely restricted movement across Hubei Province in 16 cities, affecting more than 50 million people.3 Authorities have closed public transit and canceled outbound transportation (air, train, and long-haul buses). Vehicular traffic in Wuhan was banned. China also imposed a ban on overseas travel with tour groups and suspended sale of flight and hotel packages. Authorities canceledLunarNewYear gatherings in Beijing as well as intra-province bus service into the nation’s capital. China's Finance Ministry announced ¥1 billion (US $145 million) to fund the response as well as the rapid construction of 2 hospitals inWuhan to treat those affected.

The Hong Kong Special Administrative Region declared its highest-tier emergency, curtailed public events, and barred travelers from Hubei Province. Travelers from mainland China must complete health declarations. Hong Kong has also closed schools and universities at least until mid-February.4

Control Measures by Governments Worldwide

As travel-associated cases of 2019-nCoV escalate, countries have implemented border screening. China itself sharply curtailed travel to and from Hubei Province. Consequently, governments have not yet felt the need to ban travel from China, with2exceptions:NorthKorea has prohibited entry of all Chinese travelers and Kyrgyzstan has closed its border with China. During previous outbreaks like SARS (severe acute respiratory syndrome) and Ebola, governments curtailed travel and trade, so future directives seem reasonably foreseeable.

Multiple countries (eg, Australia, Thailand, South Korea, Japan, India, Italy, Singapore, Malaysia, and Nigeria) have commenced temperature screening, symptom screening, and/or questionnaires for arriving passengers from China. The US Centers for Disease Control and Prevention launched enhanced, noninvasive screening of travelers from Wuhan at 20 major airports, while theUSState Department issued its highest-level travel advisory for Hubei Province: level 4, “do not travel.” The State Department now advises that people should “reconsider travel” for all of mainland China.

Non-pharmaceutical Interventions

The sheer scale of China’s cordon sanitaire across Hubei Province is unprecedented. Health authorities quarantined major cities during the 1918-1919 influenza pandemic, but with little lasting effect on the epidemic’s spread.5 The Ebola epidemic inWest Africa (2013-2016) spurred quarantines, such as the Liberian government’s unsuccessful and heavily criticized cordon sanitaire of 60000 to 120000 people inWest Point, Monrovia. The order led to violence and public mistrust that risked amplifying the spread of Ebola.

Gaining the public’s trust is critical to any public health strategy.The health system should facilitate and encourage individuals to promptly seek testing and treatment, as well as to cooperate with containment measures such as isolation and contact investigations. According to Wuhan officials, by the time China implemented the cordon sanitaire, up to 5 million individuals had already traveled fromWuhan for Lunar New Year.6 While social distancing measures can delay viral spread, involuntary restrictions of movement within Hubei are likely to erode community trust and undermine cooperation with health authorities. Within the cordon sanitaire, logistical issues are evident, already resulting in shortages of pharmaceuticals and medical equipment. With hospitals and clinics overcrowded and public transport limited, symptomatic individuals may delay access to treatment. There is also the possibility that congregating people in congested cities may still lead to infection, albeit in divergent ways.

Beyond the public health effects, enforcing cordons sanitaires can violate human rights, including the rights to dignity, privacy, and freedom of movement. The International Health Regulations (IHR) proscribe unnecessary interference with international travel and trade, while also requiring respect for the human rights of travelers. States must impose the “least restrictive” measures necessary to safeguard public health.7 While border screening has had questionable efficacy for detecting cases in past disease outbreaks, the enhanced noninvasive screening implemented by US officials appears consistent with IHR requirements, provided it is conducted in a manner that treats travelers with respect for their dignity, human rights, and fundamental freedoms.7

Role of the WHO

The IHR grants the WHO director-general power to declare a public health emergency of international concern (PHEIC) for an extraordinary event that poses a public health risk to other states through international spread and requires a coordinated international response. It is clear that the 2019-nCoV outbreak fully meets these legal criteria for a PHEIC. The director-general announced that on January 30 the Emergency Committee will reconvene to consider if the coronavirus outbreak constitutes a global health emergency. The escalating 2019-nCoV outbreak poses a significant risk to human health, international spread, and interference with international traffic.

WHO has declared 5 PHEICs: H1N1 (2009), polio (2014), Ebola in West Africa (2014), Zika (2016), and Ebola in the Democratic Republic of Congo (2019). The IHR does not grant WHO special powers or financing in the event of a PHEIC, suggesting an imperative to reform the regulations to give traction to an emergency declaration.8 Still, declaring a PHEIC is a powerful signal to the international community to launch a surge public health response, galvanizing political action and mobilizing funding. When declaring a PHEIC, the director-general can make influential, albeit legally non-binding, recommendations. Declaring a health emergency would be a critical opportunity for WHO leadership to set norms, devise a global strategy, and uphold principles meticulously articulated by 196states party to the IHR.

Bringing 2019-nCoV Under Control

The 2019-nCoV outbreak is currently not under control, with a high risk of spread in China and globally. Managing the outbreak requires international cooperation using traditional public health strategies that ultimately succeeded with SARS. The scientific community must fully characterize 2019-nCoV; epidemiologists must conduct intensive contact investigations; researchers should move rapidly toward development of medical countermeasures; and supply chains must mobilize to meet human needs for food, water, and medicine.

While China has considerable resources and technical competence, containment of 2019-nCoV requires a coordinated international response. WHO should exercise leadership, urgently convening a multidisciplinary committee to devise a global action plan for novel outbreaks, including surveillance, contact investigations, testing, and treatment; fostering public trust and cooperation; transparently sharing scientific information; and incentivizing academia and industry to develop vaccines and antiviral medications.

It is too early to predict how widespread and pathogenic 2019-nCov will become. It is better to act decisively now rather than wait to see how the outbreak unfolds globally. Beyond all, this global health threat teaches, once again, that it is far better to invest in preparedness to prevent, rapidly identify, and contain outbreaks at their source. Reacting after a novel infection has spread widely (perhaps overreacting with travel bans and quarantines) costs lives, economic resources, and the well-being of millions of people currently cordoned off in a zone of contagion.

• ARTICLE INFORMATION :Published Online: January 30, 2020.  doi:10.1001/jama.2020.1097
• Conflict of Interest Disclosures: Mr Gostin is the director of theWorld Health Organization Collaborating Center on National and Global Health Law. No other disclosures were reported.
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    6. Shih G, Denyer S.Wuhan mayor says 5 million people left city in recent days.Washington Post. https://www.washingtonpost.com/world/coronavirus-china-latest-updates/2020/01/27/3634db9a-40a7-11ea-aa6a-083d01b3ed18_story.html. January 27, 2020.
    7. World Health Organization. International Health Regulations. 2nd ed. https://www.who.int/ihr/publications/9789241596664/en/ . Published 2008. Accessed January 27, 2020.
    8. Gostin LO, DeBartolo MC, Katz R. The global health law trilogy: towards a safer, healthier, and fairer world. Lancet. 2017;390(10105):1918-1926.

EMPLOYMENT

• University Professor (Georgetown University’s highest academic rank conferred by the University President)
• Linda D. and Timothy J. O’Neill Professor of Global Health Law, Georgetown University Law Center (2007-2012)
• Faculty Director, Linda D. and Timothy J. O’Neill Institute for National and Global Health Law
• Director, World Health Organization Collaborating Center on National and Global Health Law (the health and human rights global database is illustrative of the projects launched by the WHO Collaborating Center)
• National Cancer Advisory Board (Presidential Appointment)
• Co-Principal Investigator, FDA Center of Excellence in Regulatory Science and Innovation (CERSI), 2014-17.
• Professor, Department of Microbiology and Immunology, Georgetown University School of Medicine
• Associate Dean (Research and Academic Programs) Georgetown University Law Center (Responsible for faculty research and scholarship), 2005-2008
• John Carroll Research Professor (2004/05) Georgetown University Law Center
• Director, Center for Law & the Public’s Health at Georgetown and Johns Hopkins Universities (CDC Collaborating Center) (1995-2010).
• Global Health Editor & Legal Correspondent, Journal of the American Medical Association
• Professor of Global Health Law in the Faculty of Law, University of Sydney
• Visiting Professor and the Claude Leon Foundation Distinguished Scholar, The University of the Witwatersrand, Johannesburg, South Africa (2011/12) (Academic Honor: Nobel Laureate Selection Criteria)
• Professor of Law & Public Health, The Johns Hopkins University, Bloomberg School of Public Health, 1997-2013
• Faculty Director, LL.M Program in Global Health Law, Georgetown University
• Faculty Director, LL.M Program in Global Health Law and International Institutions, Georgetown Law and The Graduate Institute of Geneva
• Faculty Affiliate, Kennedy Institute of Ethics, Georgetown University
• Research Fellow, Centre for Socio-Legal Studies, Faculty of Law, University of Oxford
• Visiting Professor of Public Health Faculty of Medical Sciences, Oxford University (July 1, 2005 – June 30, 2013)
• Visiting Professor of Global Health and International Visiting Fellow, University of Sydney, 2009
• Miegunyah Distinguished Visiting Fellow, University of Melbourne and Senior Fellow, Melbourne Law School, 2009 – 2022.
• University of Manchester (Institute for Science, Ethics and Innovation), Visiting Professorial Fellow, 2011

EDUCATION

• 1971 :   STATE UNIVERSITY OF NEW YORK AT BROCKPORT B.A. (Psychology, Summa Cum Laude)
• 1974 :   DUKE UNIVERSITY SCHOOL OF LAW J.D.
• 1974-75 :   OXFORD UNIVERSITY AND THE SOCIAL RESEARCH UNIT, UNIVERSITY OF LONDON Fulbright Fellow, United Kingdom, in Psychiatry and Law
• 1994 :   STATE UNIVERSITY OF NEW YORK (system-wide), Doctor of Laws (Honoris Causa)
• 2006 :   CARDIFF UNIVERSITY,WALES Honorary Fellow (University’s highest honor for “international distinction and scholarship in law and public health”)
• 2007 :   FELLOW OF THE ROYAL SOCIETY FOR PUBLIC HEALTH (FSPH)
• 2012 :   THE UNIVERSITY OF SYDNEY Doctor of Laws (Honoris Causa)
  • • Delivered Commencement Address to the Sydney Law Class of 2012

PAST POSITIONS

• Visiting Professor, Di Tella School of Law, Buenos Aires (2017)
• Visiting Scholar, Centre for Socio-Legal Studies Oxford University (2002)
• Member, President’s Task Force on National Health Care Reform Chair, Health Information Privacy Chair, Public Health (1993-94)
• Executive Director, American Society of Law, Medicine & Ethics (1986-1994)
• Adjunct Professor of Law & Public Health In the faculty of Public Health, Harvard University formerly Senior Fellow, Lecturer, and Adjunct Associate Professor (1985-94)
• Associate Director, International Collaborating Center on Health Legislation Harvard University/World Health Organization (1988-94)
• Lecturer on Law In the Faculty of Law, Harvard Law School (1989-93)
• Vice Chair, Committee on the Use of Human Subjects in Research Harvard School of Public Health (1991-93)
• Visiting Fellow, Centre for Socio-Legal Studies Wolfson College, Oxford University (Summer, 1989)
• Legislative Counsel, Labor and Human Resources Committee, Edward Kennedy, Chairman United States Senate (1987-88)
• General Secretary (Chief Executive), National Council for Civil Liberties (U.K.) (1983-85)
• Fellow in Psychiatry and Law, Centre for Criminological Research, Oxford University (1982-83) Associate (1983-85)
• Legal Director, MIND (National Association for Mental Health) (U.K.) (1975-82)

PROFESSIONAL AND BAR ASSOCIATIONS

• Member New York State Bar Association (1981-present)
• Member Bar of the Council of Europe (European Commission and European Court of Human Rights) (1977-present)

HONORS/RECOGNITIONS

• Rosemary Delbridge Memorial Award from the National Consumer Council (U.K.) for the person “who has most influenced Parliament and government to act for the welfare of society” (1983).
• Lifetime Elected Member, National Academy of Medicine, of the National Academies of Sciences, Engineering, and Medicine (formerly Institute of Medicine).
• Lifetime Elected Fellow, The Hastings Center: “For individuals who have made distinguished contributions to the field of bioethics.”
• Lifetime Elected Member, Council on Foreign Relations (to provide independent advice to governments on foreign policy).
• Lifetime Achievement Award by the American Public Health Association (APHA) for a career devoted to Public Health Law (2015).
• Distinguished Lifetime Achievement Award, Public Health Association of New York City, for extraordinary service to improve the public’s health (2014).
• Dr. Mary Ann Quaranta Distinguished Public Health Law Scholar Award, Bestowed by the Collaborative for Palliative Care (2018).
• Who’s Who in the World, since 1984.
• Albert Nelson Marquis Lifetime Achievement Award, Who’s Who highest honor (2018).
• Homeland Security: 100 Key Government Officials and Experts, National Journal, Feb. 2004.
• The Adam Yarmolinsky Medal conferred by the National Academy of Sciences for “distinguished service by a Member who, over a significant period of time, has contributed in multiple ways to the mission of the Institute of Medicine.” (2006).
• Distinguished Lifetime Achievement Award from the Public Health Law Association presented at the National CDC Public Health Law Conference: “in recognition of a career devoted to using law to improve the public’s health” (2006).
• Key to Tohoko University, Japan, for distinguished contributions to human rights in mental health (January 1987).
• Public Service Award from the State University of New York for distinguished public service and professional accomplishment (1991).
• State University of New York, Hall of Heritage (2005) a for “most outstanding success in his/her profession and significant contribution to higher education or public service.”
• Jay Healy Health Law Teacher of the Year, conferred by the American Society of Law, Medicine & Ethics (2002).
• 150 most influential AIDS advocates, International Association of Providers of AIDS Care (IAPAC) (2016).

EDITORIAL POSITIONS

• Editor-in-Chief, Laws: An Open Access International Journal (2010 – 2016)
• Legal Correspondent and Contributing Writer, Journal of the American Medical Association (JAMA) (1992 – 2017)
• Global Health Editor & Legal Correspondent, JAMA (2017- present)
• Editorial Board, Journal of Law & Biosciences (Peer reviewed journal from Harvard, Stanford, and Duke Universities) (2012 – present)
• Editorial Board, Journal of Health Economics, Policy and Law (2010-2014)
• Editorial Board, International Journal of Health Policy and Management (2016 – present)
• Associate Editor, American Journal of Tropical Medicine & Public Health (2011–present)
• Honorary Editorial Board, Medicolegal and Bioethics (2010 – present)
• International Editorial Board, Public Health: Journal of the Royal Society of Public Health (2012 – present)
• Editorial Board, Public Health Ethics (2007-present)
• Editorial Board and Contributing Writer, The Milbank Quarterly (2000-present)
• Board of Editors, Journal of Law, Medicine & Ethics (2002-present)
• Editorial Board, American Journal of Bioethics (2002-present)
• Editorial Board, The Cambridge Dictionary of Bioethics (2001-present)
• Editorial Advisory Board, Yale Journal of Health Policy, Law, & Ethics (2000-present)
• Editorial Advisory Board, Yale Journal on Regulation (Yale University School of Law) (1991-present)
• Editorial Board, Journal of Medical Practice and the Law (1991-present)
• Editorial Board, Journal of Law & Medicine (2003-present)
• International Editorial Board, Medical Law Review (Oxford University Press) (1992-present)
• Editorial Board, Medical Law International (1993-present)
• Editorial Board, Health and Human Rights: An International Journal (Harvard University, Francois-Xavier Bagnoud Center for Health and Human Rights) (1993-present)
• Editorial Board, Organizational Ethics: Healthcare, Business, and Policy (2003 – present)
• Editorial Board, Global Health Governance: The Scholarly Journal for the New Health Security Paradigm (2008 – present)
• Editorial Board, Current Issues in Public Health (1993 – 2000)
• Editorial Board, International Journal of Environmental Research and Public Health (2009-present)
• International Editorial, Board British Journal of Holistic Medicine (1985-present)
• Editorial Board, AIDS Law & Policy Journal (1985-present)
• Editorial Board, HIV/AIDS Policy & Law Review (2005-present)
• Editorial Board, Journal of Forensic Psychiatry (1989-present)
• Editorial Advisory Board, Journal of American Health Policy (1991-present)
• Editorial Advisory Board, AIDS Reference Guide (1989-2000)
• Editorial Board, International Journal of Bioethics (1990-present)
• Editor-in-Chief, Journal of Law, Medicine & Ethics (formerly Law, Medicine & Health Care) (1986-1995)
• Executive Editor, American Journal of Law & Medicine (1986-1995)
• Associate Editor, ATIN: AIDS Targeted Information: Abstracts and Critical Comments from Current AIDS Literature (American Foundation for AIDS Research, distributed by WHO) (1986-1992)
• Western European and United Kingdom Editor, International Journal of Law & Psychiatry (1978-81)

GUEST SYMPOSIUM EDITOR