Health officials along the West Coast are still working to slow the spread of novel coronavirus. One strategy they’re using is quarantine.
OPB Science Reporter Jes Burns has been delving into the subject. She spoke with JPR's Liam Moriarty.
We’ve been hearing that word tossed around quite a bit regionally, largely in the context of health care workers who have come in contact with the infection. But it's touching us all and officials are recommending that households prepare for the possibility of quarantine by stocking up on supplies.
What is quarantine?
Quarantine is used to separate people who’ve come in contact in some way with the infection – but aren’t showing any current symptoms. One thing to remember is that sick people aren’t quarantined.
For a little history, the word comes from Venice in the 1300s – it's derived from quaranta giorni, or "forty days – when ships were forced to anchor offshore for 40 days before unloading to keep plague out of the city. Now quarantine is usually used when diseases first break out – before vaccines and treatments have been developed.
What does quarantine look like?
There are different degrees of strictness that can be applied – quarantine can be mandatory or voluntary. You can be quarantined at home or at a facility. And the time spent in quarantine should track with the amount of time it takes for the infection to reveal itself.
Quarantine can also be applied to groups or even region – although maintaining the most restrictive definition on these larger scales is difficult unless mandatory quarantine is imposed and enforced. And at that point, at least in democratic, open societies, civil rights questions related to personal freedoms can really start to emerge.
If a person does develop the disease, they’re put into something called isolation, separating them from others until they’re no longer contagious.
Why are we hearing about quarantine now?
First the seriousness of the outbreak. The Centers for Disease Control and Prevention says the new coronavirus seems to be easily spread – in other words, highly contagious.
It’s also more severe than the flu. Oregon State University’s Chunhuei Chi, director of the Center for Global Health, has been observing the spread of coronavirus internationally. He equates the severity of this infection to pneumonia. He also says it’s different from other communicable diseases outbreaks we’ve seen globally in recent decades.
“This virus has the unique characteristic that few others had – that is it has the capability [to] collapse a country's health care system. And that's why we already observed in Wuhan and other parts of China. And that is about [to happen] in the South Korea … right now they have over 6,000 confirmed. They don't have places to put them,” Chi said. “And so South Korea's health care system is on the brink of collapse. And when that happened, what goes next is the collapse of the economy. So it presents a huge risk to the entire society, and that I think most Americans are not aware of.”
Consequently, there’s urgency both locally and nationally to slow the spread.
The other reason we’re hearing more about quarantine is that for the first time in more than 50 years, the United States is using mandatory quarantine to control coronavirus. About 200 U.S. citizens evacuated from China in late January were placed under mandatory quarantine at military bases. And more recently, more than 3,000 people on board the cruise ship Grand Princess were quarantined on board off the coast of California and then moved to other facilities on land.
The quarantine cases we’ve seen in Oregon so far have not been mandatory. They’re considered volunteer quarantine.
Is it effective?
Quarantine’s effectiveness depends on the nature of the disease and how the quarantine is handled.
“Quarantine has to be implemented appropriately if it's going to be effective. And you have to have an illness that is easily recognizable when a person becomes contagious in order for it to be effective,” said John Townes, the medical director of infection prevention and control at Oregon Health and Science University.
The new coronavirus gets low marks for this second criteria because its symptoms are similar to other colds and flus. But at this point in the pandemic, quarantining people that are known to have been exposed to the virus is the prudent move, according to the Oregon Health Authority.
In the broader sense, quarantine is not likely to halt the spread of a disease, but it has been demonstrated to slow down the transmission.
For example, back in 2009, when H1N1 flu was moving through China, there were mandatory quarantines put in place. Afterward, when researchersanalyzed the effects, they found the infection rates were about six times lower with quarantine than it would have been without. The spread of the disease was also delayed.
Dr. Laura Hawryluck, an intensive care physician at Toronto Western Hospital, studied Toronto’s quarantine of 15,000 people during the SARS outbreak in 2003. She said the ability of quarantine to delay the spread of a disease is key.
“The slowing of the pace … is still a very important thing for medicine. Because it gives medicine as a science more time to try and answer these questions: About, you know, what does an infection look like? What's the progression of that person who has that illness and how do we best help them?” she said.
Once a virus firmly established in the wider population, quarantine becomes far less effective at controlling the spread.
What do public health officials do at that point?
That’s when they start relying on a broader strategy called “social distancing” – this is telling people to stay away from large gatherings, cancelling events and that sort of thing.
We’re not yet moving away from quarantine in Oregon yet. But Washington is starting to put more and more of these social distancing measures in effect because community transmission is starting to rise. So it could be coming soon to Oregon.
How would someone know if they should be quarantined?
The Oregon Health Authority and local health agencies are in charge of managing quarantine. If you’ve been linked to someone with coronavirus, you would likely hear from your county health department. They’ll give you quarantine instructions.
So far they’re asking people to quarantine at home for 14 days, monitor your own health, and take protective measures to prevent exposure to others in your household.
What should someone expect if they are placed under quarantine?
Expect a lot of alone time. It’s recommended that you stock up on a couple weeks’ worth of food, personal items, prescriptions, and over the counter medicines in advance – just in case you’re asked to go into quarantine.
It also wouldn’t hurt to think about supplies for things you might want to do while on your own: spring cleaning, binge watching TV shows, craft projects, books, etc.
Also expect quarantine to be potentially challenging mental health-wise. For example, you know you’ve been exposed to the virus, but you don’t know if you’ll get sick. This can cause anxiety. Also you may be by yourself most of the time. Humans are social creatures and this extended alone time can be tough.
Just remember that if you are asked to go into quarantine, health officials are trying to keep coronavirus from spreading and people from dying. Apandemic influenza plan issued by the U.S. Department of Health and Human Services calls quarantine “collective action for the common good.”
Public health officials are in a really tough position right now and are having to make difficult choices when there's still so much unknown about the nature of the new coronavirus. If they impose restrictions too early, they'll be accused of being alarmist. If they act too late, then they're blamed for allowing the disease to spread.
Being asked to go into quarantine is essentially being asked to voluntarily give up a little bit of personal freedom to help your neighbors.
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