Evidence-Based Practice for Public Health Emergency Preparedness and Response (2020) / Chapter Skim
Currently Skimming:
7 Implementing Quarantine to Reduce or Stop the Spread of a Contagious Disease
7 Implementing Quarantine to Reduce or Stop the Spread of a Contagious Disease
Pages 180-204
The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
From page 180... ...
can o reduce depression and anxiety symptoms in quar 7 antined individuals ; While adherence to quarantine measures can vary by culture, disease, and socioeconomic status, use ; of various strategies, including risk communication and messaging and access to employment leave can ; improve adherence ; 180
|
From page 181... ...
Quarantine may be more effective for a pathogen with moderate R0, or for a pathogen with a higher R0 that has previously produced durable immunity in a population Population ; When quarantine can reliably separate identified individuals Populations reflected from the general population for durations commensurate with in this evidence review the expected duration of asymptomatic infectiousness were primarily general ; When the asymptomatic infectious period is short or there is public and health care no asymptomatic infectious period workers. Some studies examined quarantine ; When exposed individuals can be identified reliably and quickly and at-risk population ; When isolation of individuals once they become symptomatic is groups.
|
From page 182... ...
Public Health Emergency Preparedness and Response Capabilities: National Standards for State, Local, Tribal, and Territorial Public Health (CDC PHEPR Capabilities)
|
From page 183... ...
. NPIs have played important roles in notable contagious disease emergencies, most notably in the 1918 pandemic influenza and the 2003 severe acute respiratory syndrome (SARS)
|
From page 184... ...
, and there is a potential hypothetical social value associated with the practice as a means of calming public fears during an epidemic. On the other hand, there can be pressure not to quarantine, and implementing quarantine may also contribute to public fears during an epidemic.
|
From page 185... ...
OVERVIEW OF THE KEY REVIEW QUESTIONS AND ANALYTIC FRAMEWORK Defining the Key Review Questions Theoretically, the benefit of quarantine is effective curbing of the spread of contagious diseases by preventing person-to-person transmission. Therefore, the primary question posed by the committee in this review is: "In what circumstances (e.g., based on biologic factors, risks, resource availability, legal authorities, social context)
|
From page 186... ...
. As a practical matter, implementing quarantine entails determining which people are at higher risk of having been infected because of exposure but are not yet showing signs or symptoms of illness and are therefore presumed not yet to be contagious, and then physically segregating these people from others for a defined period of time, usually intended to exceed the incubation period of the illness (WHO, 2019)
|
From page 187... ...
Reduced morbidity and/or social harms and mortality » Inability of quarantined individuals to meet social and economic demands » Increased risk of infection » Increased disparities » Missed work, personal financial loss, lost economic productivity, and lost opportunities (e.g., lost education) FIGURE 7-1 Analytic framework for implementing quarantine during a public health emergency.
|
From page 188... ...
Moreover, qualitative studies can complement quantitative studies by providing additional useful evidence to guide real-world decision making, because well-conducted qualitative studies produce deep and rich understandings of how interventions are implemented, delivered, and experienced. Other forms of evidence considered for evaluation of effectiveness included mechanistic evidence, evidence from modeling studies, evidence from qualitative studies, and quantitative data reported in case reports that involved a real disaster or public health emergency.
|
From page 189... ...
; psychological harms, the risk of which increases with the longer duration of quarantine (moderate COE based on six quantitative studies, qualitative evidence, and case report evidence) ; and individual financial hardship (high COE based on two quantitative studies, mechanistic evidence, and qualitative evidence)
|
From page 190... ...
• Shorter incubation period -- when quarantine can reliably separate identified indi viduals from the general population for durations commensurate with the expected duration of asymptomatic infectiousness. Quarantine may become infeasible or less effective as the result of reduced adherence if its duration must be very long because of a prolonged incubation period (the period between exposure and when infection becomes detectable)
|
From page 191... ...
. Severe acute Maybe Seven studies.
|
From page 192... ...
Home quarantine may be more feasible than providing designated facilities for quarantined individuals, but is not without concerns over such harms as increased risk of infection among those housed together and challenges with adherence. (Evidence source: synthesis of modeling studies, qualitative evidence synthesis, and case report evidence synthesis.
|
From page 193... ...
Thus, public health agencies need to consider the resources required for quarantine against its expected benefits. (Evidence source: qualitative evidence synthesis, case report evidence synthesis, and descriptive survey study evidence.
|
From page 194... ...
Refer to Section 8, "Ethical Considerations," in Appendix B4 for additional detail.) CONSIDERATIONS FOR IMPLEMENTATION The following considerations for implementation were drawn from the syntheses of quantitative comparative studies, modeling studies, qualitative research studies, and case reports, as well as descriptive surveys, the findings of which are presented in Appendix B4.
|
From page 195... ...
(Evidence source: synthesis of modeling studies, qualitative evidence synthesis, and case report evidence synthesis. Refer to Section 9, "Facilitating Adherence to and Minimizing Harms from Quarantine Measures," in Appendix B4 for additional detail.)
|
From page 196... ...
protecting quarantined individuals from experiencing avoidable harms, including social, financial, psychological, and medical harms. (Evidence source: qualitative evidence synthesis and case report evidence synthesis.
|
From page 197... ...
(Evidence source: synthesis of modeling studies, qualitative evidence synthesis, and case report evidence synthesis. Refer to Section 10, "Other Implementation Considerations," in Appendix B4 for additional detail.)
|
From page 198... ...
in the population even without intervention is relatively lower. • hen quarantine can reliably separate identified individuals from the general population W for durations commensurate with the expected duration of asymptomatic infectiousness.
|
From page 199... ...
• Ensure transparent and strategic risk communications, providing clear messaging on the rationale for quarantine. • Provide financial compensation, food, and social and psychological support to quaran tined individuals.
|
From page 200... ...
Accordingly, it is important to incorporate at least two additional outcomes into evaluations of quarantine actions: the extent to which the quarantine procedures succeed in (1) protecting the civil rights of quarantined individuals, including due process; and (2)
|
From page 201... ...
Findings from a Cochrane review examining the effectiveness of quarantine during severe coronavirus outbreaks (which included 10 modeling studies on COVID-19) indicate that quarantine is important in reducing disease incidence and mortality and that early implementation of quarantine is important to ensuring its effectiveness (Nussbaumer-Streit et al., 2020)
|
From page 202... ...
Additionally, as a complement to effectiveness research, qualitative research is vital for understanding and capturing the social responses to and implications of quarantine and this pandemic. Many of the issues discussed in the committee's review, including the timing of quarantine implementation; voluntary versus mandatory enforcement of quarantine; harms of quarantine; communication strategies; and financial, food, social, and psychological support for quarantined individuals, will require further examination in the context of the COVID-19 pandemic.
|
From page 203... ...
2018. Public health emergency preparedness and response capabilities: National standards for state, local, tribal, and territorial public health.
|
From page 204... ...
2004. Public health measures to control the spread of the severe acute respiratory syndrome during the outbreak in Toronto.
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.