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Monday, February 10, 2020

An American coronavirus quarantine would look less like the movies and more like watching movies on Netflix - cleveland.com

CLEVELAND, Ohio – Chinese authorities have taken drastic action in an attempt to contain the spread of the new coronavirus, placing at least 15 cities and more than 50 million people under quarantine.

The U.S. government also took an unprecedented step by ordering a 14-day quarantine for 195 people evacuated from mainland China. They are being held at a California military base until the Centers for Disease Control and Prevention can confirm they are not infected.

In Northeast Ohio, a confirmed case of coronavirus could also lead to isolation or quarantine procedures, but they may not bear much resemblance to those in China or even California, according to local experts and federal guidelines.

U.S. officials will avoid place-based or mass quarantine procedures, said Dr. Elie Saade, an infectious disease specialist at University Hospitals. He called blocking off a city a “nightmare scenario,” similar to something you’d see on “American Horror Story” or “The Walking Dead.”

Local public health officials would rely on CDC guidelines, which recommend monitoring an infected person at their home or keeping them isolated in a healthcare facility.

"The reality is that people can stay at home and sit in their rooms and watch Netflix," Saade said.

Quarantine refers to separating seemingly healthy people who have been exposed to virus from the public. Isolation, a commonly accepted measure for halting communicable diseases, is for people who are already sick.

Most public health experts describe mass quarantines, like the one in China, as an ineffective solution. The practice could make healthy people sick and comes with significant psychological and economic costs.

“There’s just no good evidence, at least in modern times, that (a mass quarantine) has made a big difference,” said Dr. James Kazura, the director of Case Western Reserve University’s Center for Global Health and Diseases.

What might a quarantine order look like in a major U.S. city?

It’s difficult to say, because quarantine orders are exceedingly rare. The U.S. government’s decision to quarantine 194 people in California is the first federal quarantine order since a 1960s effort to evaluate a suspected case of smallpox, the CDC said. The CDC did not release any more information about the effort; the last case of smallpox in the U.S. came in 1949, and the disease was declared eradicated worldwide in 1980, according to NBC News.

The U.S. federal government did not impose quarantine orders during recent global health scares such as the SARS outbreak in 2003 and the Ebola outbreak in 2014.

The CDC has the authority to detain and examine people at quarantine stations located at ports-of-entry in 20 U.S. states and territories. Diseases including infectious tuberculosis, cholera and smallpox are subject to the federal order that governs isolation and quarantine.

Several U.S. states were criticized for imposing mandatory, 21-day quarantines for medical workers returning from Africa amid the Ebola outbreak. A 2015 report by the American Civil Liberties Union and the Yale Global Health Justice Partnership called them medically-unjustified and unconstitutional, and argued they discouraged other doctors and nurses from traveling to Africa to help contain the epidemic.

It’s almost impossible to imagine a U.S. city or state trying anything akin to the mass quarantine in China, Kazura said.

“It’s really in more authoritarian countries than the United States, you could perhaps have an enforced quarantine. But in the United States, I don’t think it’s feasible,” he said. “I think it would be very hard to do something like that in this country.”

Are mass quarantines even a good idea?

Public health experts questioned the efficacy of large-scale quarantines in a 2001 report in the Journal of the American Medical Association, saying they might lead to unintended consequences, including the infection of healthy people.

“If you put people who are quarantined together in close quarters, if there’s two people infected, and the other 1,000 aren’t, then it puts those people at risk,” Kazura said.

Such quarantines might also result in violence. Authorities in Muncie, Indiana struggled to convince the public of the need for a mass quarantine amid an 1893 smallpox outbreak. The public’s anger led to the shooting of several government officials.

Mandatory quarantines also raise ethical concerns. During the Ebola outbreak, the ACLU said government officials should not overreact and issue medically-unnecessary quarantines. The organization has reiterated that stance amid fears of the coronavirus.

“The public health community has learned over time that treating sick people like potential enemies only spurs them to ‘go underground’ and avoid the authorities, which exacerbates the spread of disease,” the organization wrote in a Jan. 28 blog post.

Even if a U.S. city imposed a mass quarantine, it’s highly likely people would simply find a way to leave, Saade said. They may also lie about their symptoms in order to escape, he said.

“For big areas I would never underestimate peoples' ability to find what's best for them. Traveling by land or traveling otherwise,” Saade said. “There are reports coming from Wuhan of people being able to get out of the city in different ways.”

Are local hospitals prepared to isolate patients infected with coronavirus?

Summit County released a plan this week which largely pulls from CDC guidelines for isolation and quarantine. Cuyahoga County has not released a similar plan, but would follow the same state and federal procedures, county Board of Health spokesman Kevin Brennan said.

Local hospitals are under no order to keep a patient exhibiting coronavirus symptoms from leaving. Public health officials would need to issue such an order, Saade said.

If a patient walks into MetroHealth exhibiting mild coronavirus symptoms, doctors might send them home under the supervision of public health agencies, hospital spokesman Mike Tobin said.

“Obviously, what you don’t want to do is hospitalize someone who doesn’t need to be hospitalized, and expose more people to the virus,” he said.

If a patient is exhibiting more serious symptoms, they may be isolated in the hospital. MetroHealth has a protocol that designates an isolation space for patients, and the hospital has protective gear for healthcare workers, Tobin said.

Hospitals are taking guidance from a CDC risk-assessment guide covering isolation and quarantine procedures. It includes four risk levels: high, medium, low and no known risk for contracting the new coronavirus.

The highest risk level includes people with lab-confirmed cases of coronavirus; people showing symptoms; people who live with or had intimate contact with confirmed case; or people who’ve recently traveled to Hubei Province. High-risk people may be isolated at home or in a healthcare facility, or quarantined in a location determined by public health authorities.

What might happen if coronavirus was detected at a local school or airport?

If there are no guidelines issued by public health officials, schools would decide whether or not to close to close entire schools.

In Northeast Ohio, Bay Village closed Westerly Elementary School on Jan. 30 and 31, an example of what a school district can do for communicable diseases. There was no suspected coronavirus there; students were experiencing a variety of symptoms and illnesses.

The superintendent made the decision to close Westerly, district spokeswoman Karen Derby-Lovell said.

The district added in extra cleaning to try to get ahead of the various sicknesses affecting students, but call-ins reached about 35 percent of the total student population on Jan. 29.

The district hired a professional cleaning service, which cleaned every surface in the school with a disinfectant, then fogged all the rooms with a food-safe, EPA-approved sanitizing treatment. The district began to see call-ins decrease right after the weekend, Linda Gandee reported for cleveland.com.

Cleveland Hopkins International Airport is not an international port-of-entry, so it’s unlikely the airport will encounter a passenger exhibiting symptoms, said airport spokeswoman Michele Dynia.

The airport is following guidelines issued by public health agencies and taking precautions such as additional cleaning and sanitizing of surfaces, she said.

What's happening in California?

The mandatory 14-day quarantine in California is an order from the federal government, and a prime example of how federal government can intervene in quarantine procedures. It is within the typical purview of the federal government as it relates to hundreds of travelers coming into the country.

As more planes arrive from China with evacuees, they are housed at federal facilities for 14 days. These homes can include hotels or military bases, according to multiple reports. These evacuees are not showing symptoms, but each person's health and temperature is monitored by staff. While those under quarantine can go on walks and participate in activities, it's recommended that people keep a 6-foot distance, reports NPR. Meals are catered three times a day.

By catching coronavirus at travel hubs, the CDC hopes there won't have to mandate isolation or quarantine at a local level.

“Within my career 25-year career at CDC, there have been situations where this has come up and what was different about this one is that the outbreak was caught so early before it really got to the United States,” Dr. Nancy Messonnier, director of CDC’s National Center for Immunization and Respiratory Diseases, said in a Wednesday press briefing.

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An American coronavirus quarantine would look less like the movies and more like watching movies on Netflix - cleveland.com
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