Isolation the best treatment plan for coronavirus outbreak

Officials: Quarantines must be carefully implemented

Isolating people who test positive for the novel coronavirus will be the primary response to any outbreak in Connecticut, according to public health experts, but the state is awaiting guidance from the Centers for Disease Control and Prevention about further measures.

Putting people without symptoms into quarantine, while it may be an effective way to limit the spread of the disease, may be too aggressive until more is known about how the respiratory illness spreads.

“The national public health strategy related to the new strain of coronavirus — as outlined by the CDC — is focused on containment,” Av Harris, spokesman for the state Department of Public Health, said in an email Monday.

“That means identifying new cases of coronavirus, isolating those cases, and identifying every person each one of those cases has come into contact with. This has been communicated consistently from the federal to the state and local level and we have reiterated this strategy to local health districts, hospitals, doctors, and all health care providers. Isolation of individual cases could involve hospitalization but it could also involve voluntary quarantine at home, with active monitoring of the individual by local health authorities and/or medical providers. It all depends on the individual case. Active monitoring could also vary depending on the severity of the case, how cooperative the individual is to isolation, etc.”

On Friday, the Trump administration issued and order banning foreign nationals who have traveled to China in the previous 14 days from entering the United States, and quarantining U.S. citizens and family members who have been to Hubei province in the last 14 days.

A group of 195 Americans who arrived on a plane last Wednesday are under quarantine at March Air Reserve Base in Riverside, Calif. In a briefing Monday, Dr. Nancy Messonnier, director of the CDC’s National Center for Immunization and Respiratory Diseases, said they are the only people under quarantine so far.

Saad Omer, director of the new Yale Institute for Global Health, said Monday the federal order “is within the range of options public health people have available. It may be OK. They need to be careful about ramping it up.”

The order was the first federal quarantine in 50 years, according to Messonnier.

She said 167 cases have tested negative by the CDC, including two from Connecticut; 11 have tested positive, including two by person-toperson transmission; and 82 are pending.

“Even if an initial screening test comes back negative from CDC’s laboratory, it does not guarantee these people won’t get sick,” she said. “A negative test most likely means a person is not infected. However, it may mean that an infection has not developed enough to be detected by the test. This is a new virus. And the best timing and right type of sample to determine if someone is infected with this new virus has not yet been determined.”

In October 2014, then-Gov. Dannel Malloy signed an order allowing the state health department to quarantine people returning from three countries hit by the Ebola epidemic: Guinea, Liberia and Sierra Leone. A family of six was quarantined in West Haven at the time.

No cases of coronavirus, which began in Wuhan, China, have been confirmed in Connecticut, and the chances of travelers entering the state is low, according to Max Reiss, spokesman for Gov. Ned Lamont. President Donald Trump’s order directed all flights from China to arrive at 11 international airports, including John F. Kennedy in New York and Newark Liberty in New Jersey, where passengers would be examined. Bradley International Airport is not one of the 11.

He said the state health department “in the event of there being a case … would take the steps they’ve already taken, where they would be in communication with the CDC,” he said. So far, all potential cases have been sent to the CDC for testing.

Reiss said the state is waiting to find out “if there’s anything extra the feds want us to do.” If anyone were to test positive for coronavirus, “that person would obviously have to go in continued observation.”

Omer said one of the concerns about taking measures that are too aggressive is that groups that are put under quarantine may be subject to bias and stigma. Public health measures should include “looking out for each other, guarding against fearinduced xenophobia,” he said. “If there is a specific geographic origin, people become a little more xenophobic toward another community that is unwarranted.”

He said trust in government is essential. “Community responses are more effective if there is community cohesion because there’s better reporting, there’s better compliance measures. We are not helpless in the face of this outbreak,” he said.

Nathan Grubaugh, an epidemiologist at the Yale School of Public Health, said that, while there are cities in China “in complete lockdown … It’s very important to keep a balance between individuals and public health. There’s always this message that you have to do something very aggressive or you are seen as weak.”

Grubaugh said it’s important that people in isolation or quarantine are taken care of in terms of getting medications and food, and that they not be in danger of losing their jobs. “The overreactions may end up doing more harm than good.” Like Omer, he said trust is important to avoid “unintended consequences.”

Coronavirus is “not nearly going to be as serious as seasonal flu,” Grubaugh said. “I don’t think there’s anything that suggests that we would have a large outbreak in the United States.”

Messonnier said at Monday’s briefing that the restrictions on entering the country should help contain the disease here. “With the closing of Wuhan on the 21st [of January] and Hubei on the 24th, the number of travelers coming out of either of those locations should be trailing off,” she said. “And given that we are talking about quarantine for 14 days from the time that you left Hubei, we are rapidly getting to the end of that cycle, and, therefore, we expect the number of individuals to fit within that quarantine requirement to be decreasing.”

Dr. Phillip Brewer, medical director for student health services at Quinnipiac University, said identifying cases of coronavirus is complicated by its presenting similar symptoms as flu, and this is a particularly heavy flu season.

“Every single patient we see, no matter what they’re here for, we take a travel history from them,” he said. If the patient has been to China or has been in contact with someone who recently arrived from there, “and they have fever, cough or shortness of breath, the next step is to isolate them” and treat them as a “person under investigation.” The state health department is then contacted.

“If they are otherwise healthy and have minor illness … they should go home and self-isolate at home, a room apart from anyone else … and they have to do that for two weeks,” Brewer said. If a student lives in a dorm, they will be moved to an unoccupied dorm room for the duration, he said.

Stephanie Reitz, spokeswoman for the University of Connecticut, said in an email, “UConn has about 2,700 undergraduate and graduate students across all of its campuses from China. Knowing they’re likely worried about friends and family at home, we’re working with them to be sure they know about available resources and to reassure them that the UConn community is here for them. That’s especially true given the new travel restrictions.”

Bob Rader, executive director of the Connecticut Association of Boards of Education, said school boards should follow the guidance of state health officials when making decisions about closing schools in the event of an outbreak.

“As time goes on and we learn more and more about how these viruses are spread, and I assume that will happen with the coronavirus, school districts will have to make decisions but we’re hoping the state government will provide guidance based on their expertise,” he said.

On Monday, Rader and other officials from CABE were in Washington, D.C., for the Advocacy Institute conference with 1,000 public education officials. “I haven’t heard a word about [coronavirus],” he said. “No one is talking about closing schools yet.”