# Presentation: 446289

## SARS Containment Strategies :Detect, Isolate, Quarantine

- <date/time>

**SARS Containment Strategies :*****Detect, Isolate, Quarantine***

- Martin Cetron, M.D. SARS III Broadcast May 20, 2003

## Public Health Tools: Definitions

- <date/time>

**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:

**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

## First Indian SARS patient, Punde,Goa  NYT April 2003

## Slide 5

## Contagion Epidemic ModelingGoal: R< 1, Extinction or Quenching

**Public health notified**

**2****o 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)

**2****o contacts exposed and infected**

**Time** (days)

## Quarantine

- <date/time>

**Quarantine**

***A collective action for the common good***

**Public good**

**Individual liberties**

***Paramount to meet needs of  individuals infected and exposed****** ***

## (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.

- 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**

## Framework for Isolation and Quarantine Measures in  a SARS Outbreak

- <date/time>

**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**

## Travel Advisory = “Defer Non-Essential”

**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”**

## Travel Alerts = “Head’s Up”

**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”**

## Empty jewelry showcases from Hong Kong and Singapore

**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

- <date/time>

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

## 1. Pre-departure Screening

**1. Pre-departure Screening**

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## Slide 21

## Disinfecting Guangzhou City Streets, NYTimes April 2003

## Constructing a SARS Hospital in Beijing

**Constructing a SARS Hospital in Beijing**