Browsing by Subject "Quarantine"

Now showing 1 - 8 of 8
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    A School-Based SARS-CoV-2 Testing Program: Testing Uptake and Quarantine Length After In-School Exposures.
    (Pediatrics, 2022-02) Boutzoukas, Angelique E; Zimmerman, Kanecia O; Mann, Tara K; Moorthy, Ganga S; Blakemore, Ashley; McGann, Kathleen A; Smith, Michael J; Nutting, Boen; Kerley, Karen; Brookhart, M Alan; Edwards, Laura; Rak, Zsolt; Benjamin, Daniel K; Kalu, Ibukunoluwa C

    Objectives

    Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-related quarantines, which are required after close contact with infected individuals, have substantially disrupted in-person education for kindergarten through 12th grade (K-12) students. In recent recommendations, shortened durations of quarantine are allowed if a negative SARS-CoV-2 test result is obtained at 5 to 7 days postexposure, but access to testing remains limited. We hypothesized that providing access to in-school SARS-CoV-2 testing postexposure would increase testing and reduce missed school days.

    Methods

    This prospective cohort study was conducted in one large public K-12 school district in North Carolina and included 2 periods: preimplementation (March 15, 2021, to April 21, 2021) and postimplementation (April 22, 2021, to June 4, 2021), defined around initiation of an in-school SARS-CoV-2 testing program in which on-site access to testing is provided. Number of quarantined students and staff, testing uptake, test results, and number of missed school days were analyzed and compared between the preimplementation and postimplementation periods.

    Results

    Twenty-four schools, including 12 251 in-person learners, participated in the study. During preimplementation, 446 close contacts were quarantined for school-related exposures; 708 close contacts were quarantined postimplementation. Testing uptake after school-related exposures increased from 6% to 40% (95% confidence interval: 23% to 45%) after implementation, and 89% of tests were conducted in-school. After in-school testing implementation, close contacts missed ∼1.5 fewer days of school (95% confidence interval: -2 to -1).

    Conclusions

    Providing access to in-school testing may be a worthwhile mechanism to increase testing uptake after in-school exposures and minimize missed days of in-person learning, thereby mitigating the pandemic's ongoing impact on children.
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    COVID's Impact on Non-communicable Diseases: What We Do Not Know May Hurt Us.
    (Current cardiology reports, 2022-07) Gordon Patti, Karl; Kohli, Payal

    Purpose of review

    In this review, we outline the impacts of the COVID-19 pandemic on non-communicable diseases around the world.

    Recent findings

    The mechanisms of COVID-19's impact on non-communicable diseases are both direct and indirect. The direct mechanisms include direct vascular and myocardial injury as well as pancreatic injury increasing incidence of new-onset diabetes. Indirect effects of the pandemic on non-communicable disease include delayed presentation for acute illness including STEMI and the impact of social distancing and quarantine policies on socialization, mental health, physical activity, and the downstream health impacts of inactivity and deconditioning. International focus has been on disease variants, infection control and management, healthcare system, and resource utilization and infection incidence. However, the impact of this pandemic on non-communicable diseases has been largely overlooked but will manifest itself in the coming years to decades.
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    Life and Liberty: Economic, Political and Ethical Issues Arising from 21st Century Quarantines for Influenza
    (2017-04-24) Serat, Simone
    Quarantine is a word that elicits fear among many. However, it is also a long-utilized and important policy tool for controlling the spread of infectious diseases. This thesis considers the role of quarantine for influenza outbreaks during the twenty-first century. I thematically review scientific literature on the ethical, social and political, and economic issues that have arisen from or have the potential to arise from quarantines for influenza. After identifying these issues, I make policy recommendations targeted at mitigating them. I then compare these with the World Health Organization’s (WHO) Influenza Preparedness and Response Guidance to determine where our recommendations overlap and diverge. I propose a set of five additional recommendations to the WHO Guidance for governments considering implementing quarantines for influenza: develop of a body of experts and stakeholders for policymaking, use least-restrictive policy measures first, establish a duty to treat and its limits, determine who will be prioritized during cases of scarcity, and establish support and compensation mechanisms for quarantined individuals. My research contributes to the discourse around quarantine for influenza by identifying a broad scope of consequences of quarantine for influenza. It also contributes to the existing literature on quarantine design for influenza by proposing policies targeted at addressing the issues I identify. While this research is a start, there is still a great need for further research to prepare for and learn from influenza outbreaks. My recommendations fit well alongside existing influenza pandemic preparedness plans such as the WHO’s Pandemic Influenza Preparedness and Response Guidance during an influenza outbreak to develop robust disease control policy for influenza outbreaks.
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    Reciprocity in Quarantine: Observations from Wuhan's COVID-19 Digital Landscapes.
    (Asian bioethics review, 2020-11-20) Ni, Yanping; Fabbri, Morris; Zhang, Chi; Stewart, Kearsley A
    The 2003 SARS pandemic heralded the return of quarantine as a vital part of twenty-first century public health practice. Over the last two decades, MERS, Ebola, and other emerging infectious diseases each posed unique challenges for applying quarantine ethics lessons learned from the 2003 SARS-CoV-1 outbreak. In an increasingly interdependent and connected global world, the use of quarantine to contain the spread of SARS-CoV-2, or COVID-19, similarly poses new and unexpected ethical challenges. In this essay, we look beyond standard debates about the ethics of quarantine and state power to explore a key quarantine principle, Reciprocity, and how it is being negotiated by healthcare workers, volunteers, and citizens in the context of the Wuhan, China, quarantine. We analyze Reciprocity through the lens of two Wuhan case studies: (1) healthcare workers, particularly nurses, who are simultaneously essential workers and quarantined citizens, asked by their hospital administration to shave their heads because adequate PPE was not available, and (2) citizen-to-citizen mutual aid societies attempting to fill gaps in essential supplies left unfilled by the state. We analyze social media and video-blogs from Wuhan, on the platforms of Douyin and Sina Weibo, to understand how people define and respond to ethical and legal obligations in the wake of COVID-19. It is no surprise that quarantine principles from the 2003 SARS outbreak are inadequate for COVID-19 and that both infectious disease outbreak responses and ethics must adapt to the virtual age. We offer ideas to strengthen and clarify Reciprocal obligations for the state, hospital administrators, and citizens as the globe prepares for the next wave of COVID-19 circulating now.
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    Telehealth transformation: COVID-19 and the rise of virtual care.
    (Journal of the American Medical Informatics Association : JAMIA, 2020-06) Wosik, Jedrek; Fudim, Marat; Cameron, Blake; Gellad, Ziad F; Cho, Alex; Phinney, Donna; Curtis, Simon; Roman, Matthew; Poon, Eric G; Ferranti, Jeffrey; Katz, Jason N; Tcheng, James
    The novel coronavirus disease-19 (COVID-19) pandemic has altered our economy, society, and healthcare system. While this crisis has presented the U.S. healthcare delivery system with unprecedented challenges, the pandemic has catalyzed rapid adoption of telehealth, or the entire spectrum of activities used to deliver care at a distance. Using examples reported by U.S. healthcare organizations, including ours, we describe the role that telehealth has played in transforming healthcare delivery during the 3 phases of the U.S. COVID-19 pandemic: (1) stay-at-home outpatient care, (2) initial COVID-19 hospital surge, and (3) postpandemic recovery. Within each of these 3 phases, we examine how people, process, and technology work together to support a successful telehealth transformation. Whether healthcare enterprises are ready or not, the new reality is that virtual care has arrived.
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    Test-to-Stay After Exposure to SARS-CoV-2 in K-12 Schools.
    (Pediatrics, 2022-05) Campbell, Melissa M; Benjamin, Daniel K; Mann, Tara; Fist, Alex; Kim, Hwasoon; Edwards, Laura; Rak, Zsolt; Brookhart, M Alan; Anstrom, Kevin; Moore, Zack; Tilson, Elizabeth Cuervo; Kalu, Ibukunoluwa C; Boutzoukas, Angelique E; Moorthy, Ganga S; Uthappa, Diya; Scott, Zeni; Weber, David J; Shane, Andi L; Bryant, Kristina A; Zimmerman, Kanecia O; ABC SCIENCE COLLABORATIVE

    Objectives

    We evaluated the safety and efficacy of a test-to-stay program for unvaccinated students and staff who experienced an unmasked, in-school exposure to someone with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Serial testing instead of quarantine was offered to asymptomatic contacts. We measured secondary and tertiary transmission rates within participating schools and in-school days preserved for participants.

    Methods

    Participating staff or students from universally masked districts in North Carolina underwent rapid antigen testing at set intervals up to 7 days after known exposure. Collected data included location or setting of exposure, participant symptoms, and school absences up to 14 days after enrollment. Outcomes included tertiary transmission, secondary transmission, and school days saved among test-to-stay participants. A prespecified interim safety analysis occurred after 1 month of enrollment.

    Results

    We enrolled 367 participants and completed 14-day follow-up on all participants for this analysis. Nearly all (215 of 238, 90%) exposure encounters involved an unmasked index case and an unmasked close contact, with most (353 of 366, 96%) occurring indoors, during lunch (137 of 357, 39%) or athletics (45 of 357, 13%). Secondary attack rate was 1.7% (95% confidence interval: 0.6%-4.7%) based on 883 SARS-CoV-2 serial rapid antigen tests with results from 357 participants; no tertiary cases were identified, and 1628 (92%) school days were saved through test-to-stay program implementation out of 1764 days potentially missed.

    Conclusion

    After unmasked in-school exposure to SARS-CoV-2, even in a mostly unvaccinated population, a test-to-stay strategy is a safe alternative to quarantine.
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    The effectiveness of public health interventions against COVID-19: Lessons from the Singapore experience.
    (PloS one, 2021-01) Ansah, John P; Matchar, David Bruce; Shao Wei, Sean Lam; Low, Jenny G; Pourghaderi, Ahmad Reza; Siddiqui, Fahad Javaid; Min, Tessa Lui Shi; Wei-Yan, Aloysius Chia; Ong, Marcus Eng Hock

    Background

    In dealing with community spread of COVID-19, two active interventions have been attempted or advocated-containment, and mitigation. Given the extensive impact of COVID-19 globally, there is international interest to learn from best practices that have been shown to work in controlling community spread to inform future outbreaks. This study explores the trajectory of COVID-19 infection in Singapore had the government intervention not focused on containment, but rather on mitigation. In addition, we estimate the actual COVID-19 infection cases in Singapore, given that confirmed cases are publicly available.

    Methods and findings

    We developed a COVID-19 infection model, which is a modified SIR model that differentiate between detected (diagnosed) and undetected (undiagnosed) individuals and segments total population into seven health states: susceptible (S), infected asymptomatic undiagnosed (A), infected asymptomatic diagnosed (I), infected symptomatic undiagnosed (U), infected symptomatic diagnosed (E), recovered (R), and dead (D). To account for the infection stages of the asymptomatic and symptomatic infected individuals, the asymptomatic infected individuals were further disaggregated into three infection stages: (a) latent (b) infectious and (c) non-infectious; while the symptomatic infected were disaggregated into two stages: (a) infectious and (b) non-infectious. The simulation result shows that by the end of the current epidemic cycle without considering the possibility of a second wave, under the containment intervention implemented in Singapore, the confirmed number of Singaporeans infected with COVID-19 (diagnosed asymptomatic and symptomatic cases) is projected to be 52,053 (with 95% confidence range of 49,370-54,735) representing 0.87% (0.83%-0.92%) of the total population; while the actual number of Singaporeans infected with COVID-19 (diagnosed and undiagnosed asymptomatic and symptomatic infected cases) is projected to be 86,041 (81,097-90,986), which is 1.65 times the confirmed cases and represents 1.45% (1.36%-1.53%) of the total population. A peak in infected cases is projected to have occurred on around day 125 (27/05/2020) for the confirmed infected cases and around day 115 (17/05/2020) for the actual infected cases. The number of deaths is estimated to be 37 (34-39) among those infected with COVID-19 by the end of the epidemic cycle; consequently, the perceived case fatality rate is projected to be 0.07%, while the actual case fatality rate is estimated to be 0.043%. Importantly, our simulation model results suggest that there about 65% more COVID-19 infection cases in Singapore that have not been captured in the official reported numbers which could be uncovered via a serological study. Compared to the containment intervention, a mitigation intervention would have resulted in early peak infection, and increase both the cumulative confirmed and actual infection cases and deaths.

    Conclusion

    Early public health measures in the context of targeted, aggressive containment including swift and effective contact tracing and quarantine, was likely responsible for suppressing the number of COVID-19 infections in Singapore.
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    U.S. regional differences in physical distancing: Evaluating racial and socioeconomic divides during the COVID-19 pandemic.
    (PloS one, 2021-01) Zang, Emma; West, Jessica; Kim, Nathan; Pao, Christina
    Health varies by U.S. region of residence. Despite regional heterogeneity in the outbreak of COVID-19, regional differences in physical distancing behaviors over time are relatively unknown. This study examines regional variation in physical distancing trends during the COVID-19 pandemic and investigates variation by race and socioeconomic status (SES) within regions. Data from the 2015-2019 five-year American Community Survey were matched with anonymized location pings data from over 20 million mobile devices (SafeGraph, Inc.) at the Census block group level. We visually present trends in the stay-at-home proportion by Census region, race, and SES throughout 2020 and conduct regression analyses to examine these patterns. From March to December, the stay-at-home proportion was highest in the Northeast (0.25 in March to 0.35 in December) and lowest in the South (0.24 to 0.30). Across all regions, the stay-at-home proportion was higher in block groups with a higher percentage of Blacks, as Blacks disproportionately live in urban areas where stay-at-home rates were higher (0.009 [CI: 0.008, 0.009]). In the South, West, and Midwest, higher-SES block groups stayed home at the lowest rates pre-pandemic; however, this trend reversed throughout March before converging in the months following. In the Northeast, lower-SES block groups stayed home at comparable rates to higher-SES block groups during the height of the pandemic but diverged in the months following. Differences in physical distancing behaviors exist across U.S. regions, with a pronounced Southern and rural disadvantage. Results can be used to guide reopening and COVID-19 mitigation plans.