Public Health Guidance for Community-Level Preparedness and Response to
Severe Acute Respiratory Syndrome (SARS) Version 2

Supplement D: Community Containment Measures, Including Non-Hospital
Isolation and Quarantine

III\. Management of SARS Patients in Isolation

Preventing transmission from SARS patients is critical to controlling
SARS. This requires limiting the public interactions of possible or
known SARS patients (e.g., at work, school, out-of-home child care) and
preventing transmission wherever the patients are housed during the
period of infectivity (10 days after the resolution of fever, provided
respiratory symptoms are absent or improving).

SARS patients should be isolated in a hospital only if medically
necessary. Local and state authorities should also be prepared to
isolate patients at home or in alternative facilities designated for
this purpose. SARS preparedness planning must address home isolation of
SARS patients, the availability and use of existing or temporary
structures as alternative facilities for isolation, the management of
patients housed at home or in alternative facilities, and resources for
supplies and services.

> ***Objective***: Separate and confine patients who meet the case
> definition for probable or confirmed SARS-CoV disease or SARS report
> under investigation (RUI) during the period of communicability (See
> MMWR 52(49):1202-1206
> \[[www.cdc.gov/mmwr/preview/mmwrhtml/mm5249a2.htm](http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5249a2.htm)\]).
>
> Activities aimed at separating persons with known or possible SARS-CoV
> disease should be modulated as needed based on the status of the
> outbreak. Basic activities should be initiated with the identification
> of the first confirmed or probable case or SARS RUI. Enhanced
> activities may become necessary as an outbreak evolves and the number
> of persons requiring isolation increases.

### Basic Activities 

-   SARS patients should be admitted to a healthcare facility for
    isolation only if clinically indicated or if isolation at home or in
    a community facility cannot be achieved safely and effectively.
    **Isolation of SARS patients in hospitals is described in detail in
    Supplement C**.

-   Before a SARS patient is placed in a residence or community facility
    for isolation, arrangements should be made to ensure that the
    residence has the features necessary for provision of appropriate
    care to the patient and to determine if sufficient infection control
    measures can be established to prevent/limit exposures to household
    members, other primary caregivers, and the community. Guidelines on
    evaluation of residences for isolation are provided in Appendix D3
    and in Supplement I.

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-   During the period of home isolation, household members not providing
    care should be relocated if possible so that only the primary
    caregiver and the patient remain in the residence. If household
    members cannot be relocated, they should minimize their contact with
    the SARS patient. Persons at risk for serious SARS complications
    (e.g., persons with underlying heart or lung disease, persons with
    diabetes mellitus, elderly persons) should not have contact with the
    patient.

-   The SARS patient in home isolation and all persons in contact with
    the patient should follow the infection control recommendations
    described in Supplement I.

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-   Close contacts of SARS patients [^1]should be vigilant for fever
    (i.e., measure temperature twice daily), respiratory symptoms, and
    other symptoms of early SARS-CoV disease, such as chills, rigors,
    myalgia, headache, or diarrhea. If symptoms develop, the designated
    health department should be contacted to arrange for immediate
    medical evaluation and follow-up.

### Enhanced Activities

> If a surge in patients overwhelms healthcare capacity or if home
> isolation is not feasible, health departments may need to use
> alternative facilities for isolation of SARS patients. Additional
> information on community isolation of SARS patients is provided in
> Appendix D3 and in Supplement I.

For more information, visit
[www.cdc.gov/ncidod/sars](http://www.cdc.gov/ncidod/sars/) or call the
CDC public response hotline\
at (888) 246-2675 (English), (888) 246-2857 (Español), or (866) 874-2646
(TTY)

[^1]: Close contact: A person who has cared for or lived with a person
    with SARS-CoV disease or had a high likelihood of direct contact
    with respiratory secretions and/or body fluids of a person with
    SARS-CoV disease. Examples of close contact include kissing or
    hugging, sharing eating or drinking utensils, talking within 3 feet,
    and direct touching. Close contact does not include activities such
    as walking by a person or briefly sitting across a waiting room or
    office.