Quarantine;, the physical separation and geographic restriction of groups of uninfected individuals potentially exposed to a communicable illness, has been variably considered to be a management strategy following bioterrorism. The potential effectiveness, feasibility, legality and consequences of quarantine were reviewed following the USA anthrax attacks.40 The logistics of this approach are complex and impractical and it can be associated with adverse consequences such as increased risk of disease transmission among a quarantined group or public unrest. It seems clear that there are only limited scenarios in which the potential public health benefits of the imposition of quarantine may outweigh the potential problems it engenders; these scenarios involve highly transmissible, lethal agents. In most situations a disease-specific containment strategy, based on transmission epidemiology and disease prevention tenets, is preferable.
Quarantine The term and the concept of quarantine are profoundly rooted in culture and world health procedures, and have periodically recalled peak interest in the course of epidemics. In the past the concept of quarantine was used to refer to the period of isolation of people alone,
Principles of Modern Quarantine
Quarantine as it is now practiced is a public health tool and a collective action for the common good. Today’s quarantines are more likely to involve a few people exposed to contagion in a small area, such as on an airplane or at a public gathering, and only rarely are applied to entire cities or communities. The main goal of modern quarantine is to reduce transmission by increasing the “social distance” between persons; that is, reducing the number of people with whom each person comes into contact (see Figure 1-2).
Effectiveness of vaccination and quarantine to contain a smallpox outbreak after the release of bioengineered, aerosolized smallpox in an airplane carrying 500 people.
If quarantine is to be used, the basic needs of those infected and exposed must be met. The following key principles of modern quarantine ensure that it strikes the appropriate balance between individual liberties and the public good:
Quarantine is used when persons are exposed to a disease that is highly dangerous and contagious.
Exposed well persons are separated from those who are ill.
Care and essential services are provided to all people under quarantine.
The “due process” rights of those restricted to quarantine are protected.
Quarantine lasts no longer than is necessary to ensure that quarantined persons do not become ill. Its maximum duration would be one incubation period from the last known exposure, but it could be shortened if an effective vaccination or prophylactic treatment is available and can be delivered in a timely fashion.
Quarantine is used in conjunction with other interventions, including—
Disease surveillance and monitoring for symptoms in persons quarantined.
Rapid diagnosis and timely referral to care for those who become ill.
The provision of preventive interventions, including vaccination or prophylactic antibiotics.
Quarantine encompasses a range of strategies that can be used to detain, isolate, or conditionally release individuals or populations infected or exposed to contagious diseases, and should be tailored to particular circumstances. Quarantine activities can range from only passive or active symptom monitoring or short-term voluntary home curfew, all the way to cancellation of public gatherings, closing public transportation, or, under extreme circumstances, to a cordon sanitaire: a barrier erected around a geographic area, with strict enforcement prohibiting movement in or out. In a “snow day” or “sheltering in place” scenario, schools may be closed, work sites may be closed or access to them restricted, large public gatherings may be cancelled, and public transportation may be halted or restricted. People who become ill under these conditions would need specific instructions for seeking evaluation and care; they would only expose others in their households—or perhaps no one at all, if precautions are taken as soon as symptoms develop. The fact that most people understand the concept of sheltering at home during inclement weather, regarding home in these circumstances as the safest and most sensible place to be, increases the likelihood that similar conditions of quarantine will be accepted. “Snow day” measures can be implemented instantaneously, and most essential services can be met without inordinate additional resources, especially if the quarantine lasts only a few days.
Another important feature of quarantine is that it need not be absolute to be effective. Even a partial or “leaky” quarantine, such as occurs with voluntary compliance, can reduce the transmission of disease. Voluntary measures, which rely on the public’s cooperation, reduce or remove the need for legal enforcement and leverage the public’s instinct to remain safely sheltered. In contrast, compulsory confinement may precipitate the instinct to “escape.” If an effective vaccine is available, partial quarantine can be an effective supplement to vaccination, further reducing transmission of disease. For example, Figure 1-3 shows a model illustrating various outcomes of a hypothetical scenario of 500 people, all of whom are vaccinated against smallpox, exposed to an intentional aerosol release of that contagion on an airplane. In the model, all 500 people are offered postexposure smallpox vaccine; the model assumes that the vaccine is 95 percent effective. Even under these unlikely and theoretical circumstances, the addition of even partial (50 percent to 90 percent) quarantine to vaccination can have a profound effect on reducing the number of eventual cases in the community. This trend remains significant even at low rates of transmission (“reproductive rates”).
Impact of varying Ro and percent quarantined on total smallpox cases. Even with 100 percent vaccination against smallpox, quarantine effectively reduces the spread of disease in the community. This effect remains significant even at lower reproductive (more...)
In order to implement modern quarantine effectively, there must be a clear understanding of the roles of public health staff at federal, state, and local levels, and each group should know their legal authorities. Effective implementation also requires identifying appropriate partners, including transportation authorities and law enforcement officials, and engaging them in coordinated planning. Finally, quarantine can be most successful if the public has advance knowledge of the disease threat and understands the role of quarantine in containing an epidemic. People who are actually quarantined need to believe that their sacrifice is justified and that they will be supported during the period of quarantine. (not a chance say's I)
Quarantine and the Response to SARS
Containment strategies employed during the recent SARS epidemic included case and contact management, infection control in hospitals and other facilities, community-wide temperature screening, mask use, isolation and quarantine, and the monitoring of travelers and response at national borders. Various combinations of these strategies were applied in different places, depending on factors such as the magnitude and scope of the local outbreak, the availability of resources to support containment, and the level of public cooperation and trust. In the United States, where only eight laboratory-confirmed cases of SARS and no community transmission occurred (see Figure 1-4), the principal strategies of containment were education of high-risk populations (e.g., international travelers and health-care workers); early detection of suspected and probable cases; and rapid implementation of isolation and other infection control tools. Additional measures such as quarantine were used in other countries where SARS presented a greater threat.
2017, Pages 477-480
Severe Acute Respiratory Syndrome (SARS)
Abstract
Severe acute respiratory syndrome (SARS) is caused by a novel coronavirus (SARS-CoV), spread largely via droplets (Not bats, fish or crows DL). Patients present with rapidly progressive pneumonia and respiratory failure. Diagnosis requires the demonstration of epidemiological linkage, clinical profiles, and virological evidence of SARS-CoV infection. Treatment of SARS is largely anecdotal. High-dose corticosteroid therapy might be useful for critically ill patients, but previous use of ribavirin (a broad-spectrum antiviral agent) was probably not efficacious. Some survivors of SARS suffer from avascular necrosis of hip and knee joints. Poor prognostic factors include advanced age, comorbidities, and high serum lactate dehydrogenase and neutrophil levels.
Keywords
Acute respiratory distress syndrome
Coronavirus
Corticosteroid
Immunoglobulin
Immunomodulation
Infection control
Interferons
Noninvasive positive pressure ventilation
Pneumonia
Prognosis
Ribavirin
Ritonavir/lopinavir
SARS
Severe acute respiratory syndrome
Viruses and Bioterrorism☆
Refers to
R.F. Meyer, S.A. MorseViruses and Bioterrorism
Encyclopedia of Virology, 2008, Pages 406-411Purchase PDF
Abstract
The target for a terrorist attack with a viral agent can range from humans to animals and plants. However, the use of a viral agent may pose a challenge due to problems associated with acquisition, cultivation, and dissemination. Agricultural targets are of concern as they would require relatively little specialized expertise and technology and can have large economic consequences. Viral agents are prone to genetic variation and mutation, and can be manipulated or created in the laboratory. Unlike bacterial diseases, many of which are treatable with antimicrobials, there are fewer medical countermeasures to employ when dealing with viral infections.
Keywords
Biocrimes
Biological warfare
Biotechnology
Bioterrorism
Deterrence
Ebola
H5N1
Marburg
Recognition
Response
Smallpox
Viruses
Bioterrorism is not only a reality of the times in which we live but bioweapons have been used for centuries. Critical care physicians play a major role in the recognition of and response to a bioterrorism attack. Critical care clinicians must be familiar with the diagnosis and management of the most likely bioterrorism agents, and also be adequately prepared to manage a mass casualty situation. This article reviews the epidemiology, diagnosis, and treatment of the most likely agents of biowarfare and bioterrorism.
Conclusion
Modern quarantine represents a wide range of scalable interventions to separate or restrict movement (e.g. detain, isolate, or conditionally release) of individuals or populations infected by or exposed to highly dangerous contagions. These strategies can be an important part of the public health toolbox for suppressing transmission and stopping epidemics such as SARS. However, the ethical implementation of modern quarantine can be resource and labor intensive. Quarantine is most effective when it is tailored to specific circumstances and used in conjunction with other containment measures; people affected by quarantine must be ensured appropriate support services. The effectiveness of quarantine is further improved by comprehensive preparedness planning. Effective communication and public trust are quintessential components; consequently, the public must receive clear messages about the role and importance of quarantine as a means of containing certain infectious disease in advance of, as well as during, the epidemic.
If a future epidemic affects the United States as SARS did other countries in 2003, it may be necessary to recommend quarantine, among other containment measures, in this country. Thus, it is essential that planning for the effective implementation of quarantine and other containment measures be undertaken at every level of government, and well in advance of the need. Strategic and operative plans should be exercised at all levels to expose and rectify gaps and pitfalls in nonurgent settings to ensure our readiness in an emergency.