SARS Containment Strategies : Detect, Isolate, Quarantine : SARS Containment Strategies : Detect, Isolate, Quarantine Martin Cetron, M.D. SARS III Broadcast May 20, 2003
Public Health Tools: Definitions: Public Health Tools: Definitions Isolation*
Restriction of movement / separation of sick infected person(s) with contagious disease;
usually in a hospital setting, but can also be at home or in a dedicated isolation facility
Quarantine*
Restriction of movement / separation of well person(s) presumed exposed to a contagious disease;
usually at home, but can also be in a dedicated quarantine facility
individual(s) or community/population level
* Measures usually voluntary, but can be mandatory; legal quarantine authority covers “isolation” and “quarantine” tools
International SARS Containment:: International SARS Containment: Isolate symptomatic individuals (communicable phase)
SARS Hospitals
Home
Recovery during period of communicability
Quarantine 10 asymptomatic contacts (pre-communicable phase)?
Home vs. Residential facility
Fever surveillance of close contacts
Community Measures: decrease social contacts
Cancel public gatherings e.g. schools, workplace, sporting
Limit translocation, restrict travel
Slide4: First Indian SARS patient, Punde,Goa NYT April 2003
Contagion Epidemic Modeling Goal: R< 1, Extinction or Quenching: Contact tracing Public health notified 2º case ascertainment Period of communicability
Contagion Epidemic Modeling Goal: R< 1, Extinction or Quenching Encounter Recognition Isolation initiated Isolation
ended ? Asymptomatic shedding? Incubation
2-10 Period of risk for epidemic propagation Time (days) 2º contacts exposed and infected Time (days)
Slide7: Quarantine A collective action for the common good Public good Individual liberties Paramount to meet needs of individuals infected and exposed
Slide8: EXECUTIVE ORDER 13295: REVISED LIST OF QUARANTINABLE COMMUNICABLE DISEASES Cholera; Diphtheria; infectious Tuberculosis; Plague; Smallpox; Yellow Fever; and Viral Hemorrhagic Fevers
(Lassa, Marburg, Ebola, Crimean-Congo, South American,
and others not yet isolated or named).
(b) Severe Acute Respiratory Syndrome (SARS), which is a disease associated with fever and signs and symptoms of pneumonia or other respiratory illness, is transmitted from person to person predominantly by the aerosolized or droplet route, and, if spread in the population, would have severe public health consequences. President George W. Bush
April 4, 2003
Slide9: Framework for Isolation and Quarantine Measures in a SARS Outbreak Known or Presumed Infected Individuals
Isolation: Type C (Contagious) Facility Asymptomatic Contacts
Surveillance/Isolation: Type R (Residential) Facility Determinants of Public Health Threshold for Community Response
Number of cases/exposed
Morbidity and mortality
Ease/ rapidity of spread
Movement in /out of community
Resources
Need urgent public health action
Risk for public panic Level 1
Travel alerts and information
Press releases
Interagency partner notifications Level 2
Level 1 activities
Travel advisories
Suspension of public gatherings
Closing of public places Level 3
Level 2 activities
Restriction of travel (air, rail, water, motor, and pedestrian) Level 4
Level 3 activities
“Cordon sanitaire”
Community-wide interventions (e.g. mass isolation and quarantine ) Individual Case Response Community Response Febrile Respiratory Contacts
Isolation: Type C (Contagious) or Type X Facility
Slide10: Interim Travel Advisory: Mainland China (Updated May 8, 2003; Released March 13, 2003) Interim Travel Advisory: Hong Kong (Updated May 8, 2003; Released March 13, 2003) Interim Travel Advisory: Singapore (Updated May 6, 2003; Released March 13, 2003) Interim Travel Advisory: Hanoi, Vietnam (Updated April 29, 2003; Released March 13, 2003) Interim Travel Advisory: Taiwan (Updated May 11, 2003; Released May 1, 2003) Travel Advisory = “Defer Non-Essential”
Slide11: Interim Travel Alert: Singapore (Updated May 6, 2003; Released March 13, 2003) Interim Travel Alert: Hanoi, Vietnam (Updated May 15, 2003; Released April 29, 2003) Interim Travel Alert: Toronto, Ontario, Canada (Updated May 20, 2003; Released April 23, 2003) Travel Alerts = “Head’s Up”
Slide12: Empty jewelry showcases from Hong Kong and Singapore
Zurich Trade Fair
Airport Measures: 1. Pre-departure Screening 2. Suspected SARS Aboard Airplane 3. Disembarkation Notices: Airport Measures: 1. Pre-departure Screening 2. Suspected SARS Aboard Airplane 3. Disembarkation Notices
Slide14: 1. Pre-departure Screening
Slide22: Disinfecting Guangzhou City Streets, NYTimes April 2003
Slide23: Constructing a SARS Hospital in Beijing