Cetron

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

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First Indian SARS patient, Punde,Goa NYT April 2003

Contagion Epidemic ModelingGoal: 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)

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Quarantine A collective action for the common good Public good Individual liberties Paramount to meet needs of individuals infected and exposed

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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

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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

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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”

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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 Airplane3. Disembarkation Notices: 

Airport Measures: 1. Pre-departure Screening 2. Suspected SARS Aboard Airplane 3. Disembarkation Notices

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1. Pre-departure Screening

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Disinfecting Guangzhou City Streets, NYTimes April 2003

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Constructing a SARS Hospital in Beijing