Wednesday, October 15, 2014

Isolation and quarantine

I started this blog nearly three years ago. Yesterday it broke 10,000 pageviews. That may not be much compared to more popular blogs, but I'm glad to know that someone is reading what I write.

I don't have the raw data, but this graph looks like a regression line would trend upward.
I don't expect this post to get a lot of hits.
Our office has received a lot of calls in the last few weeks from health care providers who are unsure of or confused about the recommendations for monitoring people who may have been exposed to Ebola virus, so I suspect that there is similar uncertainty and confusion among the general public.
For this discussion, I'm talking about people who have been in direct contact with a person with Ebola virus disease (EVD); that is, people who have potentially been exposed to and may have been infected with the virus but have no symptoms of the disease.
Also, I'm writing about the current recommendations for contacts of cases. These recommendations may change. Please refer to the Center for Disease Control and Prevention (CDC) website for changes in its recommendations.
The CDC does not recommend quarantining people who have been in contact with a person with EVD but have no symptoms of the disease. A person who is infected with the virus but has no symptoms of the disease cannot infect other people. According to the current CDC guidelines, health care workers who have had contact with someone with EVD may return to work. Of course, that changes once a person develops a fever and symptoms of EVD.
The CDC recommends that contacts of cases take their temperature twice every day for 21 days (the longest incubation period for EVD) and notify their local health authority of fever or symptoms of EVD. Health care workers may be monitored by their employers.
We are currently working with the Washington State Department of Health, other local health jurisdictions, and hospitals to develop policies and procedures to monitor health care workers who have potentially been exposed to Ebola. This will include those of us who return from working in West Africa.
One thing to remember is that the CDC is not a regulatory agency. In general, the CDC can make recommendations and serve in advisory capacity, but it has no authority to enforce its recommendations.
Isolation and quarantine
The words isolation and quarantine are sometimes used interchangeably but, in public health, they do not have the same meaning. The CDC defines isolation as separating sick people with a contagious disease from people who are not sick. Quarantine is separating and restricting the movement of people who were exposed to a contagious disease to see if they become sick.
For example, I am a tuberculosis case manager. We routinely ask people who have tuberculosis and are contagious to isolate themselves to avoid infecting other people. Because tuberculosis is not transmitted outdoors, we do not tell a person with pulmonary tuberculosis that she or he must remain indoors. That person may leave the home but may not enter another building where other people could be exposed to tuberculosis. This is called voluntary isolation.
Washington State law gives local (county) health officers the authority to order a person into isolation. If that person fails to comply with the health officer order, we may get a court order for involuntary isolation. Washington State health officers have the authority to restrict the movement of (quarantine) individuals who are a threat to public safety. Fortunately, I've never had to do more than explain that the health officer has that authority.
The CDC has the authority to detain individuals who are entering the U.S. or traveling across state lines, but it does not have the authority to quarantine individuals within the boundaries of states or local health jurisdictions. State and local health officers have that authority.
I know that a lot of people are worried about Ebola in the U.S. I am also concerned about the risk of this epidemic spreading beyond the borders of Guinea, Liberia, and Sierra Leone to neighboring countries and out of Africa. That is why I decided to work in West Africa to help get people with EVD into treatment and end this epidemic.
Centers for Disease Control and Prevention. (2014). Infection prevention and control recommendations for hospitalized patients with known or suspected Ebola virus disease in U.S. Hospitals.
Centers for Disease Control and Prevention. (2014). Interim guidance on monitoring and movement of persons with Ebola virus disease exposure.
Centers for Disease Control and Prevention. (2014). Legal authorities for isolation and quarantine.
Washington State Legislature. (n.d.) Conditions and principles for isolation and quarantine.
Washington State Legislature. (n.d.) Tuberculosis – prevention, treatment, and control.

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