Coronavirus and Quarantine

Health education poster, Hong Kong. Photo by Shawn Smallman

As I write these words nurses in Hong Kong are on strike to protest the fact that the Chief Executive, Carrie Lam, will not close the border to China. To be clear, the executive has sharply restricted entry to Hong Kong, closed most crossings, and forbidden entry from the most affected Chinese state, Hubei.  But there are still strong calls for a complete border closure coming from within Hong Kong’s medical community.  Similarly, the United States has restricted flights from China to U.S. citizens only; some U.S. airlines had already canceled service to China. All such quarantine measures are controversial.

On social media, such as Twitter, and in the press, a number of experts have denounced all quarantines as being not only ineffective but also in violation of WHO guidelines. These authors worried about panic overcoming good judgement, the economic costs of restricting travel, the stigma imposed on those from affected areas (Chinese in particular, but also all Asia), and the importance of upholding International Health Regulations. These are valid and important points. Some authors have also pointed to studies based on computer models showing that quarantines are ineffective with highly contagious respiratory diseases.

Recently the tone has shifted in the discussion, as it has become clear that some cases of the virus are being spread asymptomatically. The number of cases has grown quickly. Some apparent facts (such as no human to human transmission) that seemed true in mid-January are no longer true. So the stridency of the debate about quarantine has declined, but the debate continues.

So is there any role for quarantines to manage such a pandemic? And is there some other way to make a judgement that relies less on computer models? I would suggest that looking at the past history of respiratory pandemics, such as the 1918 influenza pandemic, might be useful. Can history suggest particular circumstances in which quarantines may work? …

Novel Coronavirus outbreak in China

Fighting SARS Memorial, Hong Kong, These busts and plaques commemorate health care workers who volunteered to fight SARS, and then sadly were infected and died. Photo by Shawn Smallman

As I write this blog post all travel has been banned in Wuhan, and two neighboring cities (Huanggang and Ezhou) in China. The cause for this travel ban is a novel coronovirus, which is currently called nCoV2019, although it will likely receive a new name soon. Coronaviruses are a virus that causes respiratory diseases, such as SARS in 2003, and MERS in the Middle East. SARS was a bat virus that passed through a civet cat at a Wet Market, and then jumped to humans. Although the outbreak was ultimately brought under control, it was contained at a very high cost. The Fighting SARS Memorial pictured above commemorates Hong Kong health care workers who died while serving their patients. …

MERS in South Korea

Photo of Korea from space by NASA, and obtained from the CIA World Factbook.
Photo of Korea from space by NASA, and obtained from the CIA World Factbook.

I have blogged about MERS before on this site, but this disease has faded from the news for the last year, until the most recent outbreak in South Korea. Middle East Respiratory Syndrome is an infectious disease caused by a corona virus, in the same manner as the SARS outbreak of 2003. The disease first appeared in Saudi Arabia in 2012, and has continued to circulate there since. In Saudi Arabia the virus has seemed to spread particularly well in a health care setting. While a number of infected people –many of whom have been health care professionals- have carried the virus to other countries, in every case the outbreak has been contained. The outbreak in Korea has been different because of its scale –eleven people have died and over three thousand have been quarantined- and speed.

South Korean citizens have criticized the government for responding too slowly to the outbreak. One person, for example, broke voluntary quarantine and traveled to China, where he ultimately fell ill. There is no question, however, that South Korea is now taking the outbreak seriously. Over 1,800 schools and daycares are closed, even though the World Health Organization (WHO) says that this measure is unnecessary. An entire small Korean village (approximate population 130) has been placed under quarantine with guards manning checkpoints. The authorities are tracking peoples’ cellphone location to make sure that they are remaining in quarantine, and health authorities are checking on people at their homes. At the time of this writing, it seems as though MERS may have peaked in South Korea, and hopefully will soon begin to fade. …

New Map of MERS

European Centre for Disease and Infection Control map of MERS, November 2014
European Centre for Disease and Infection Control map of MERS, November 2014

I’ve discussed MERS before in this blog, but this virus has faded from public attention as Ebola has become a major health crisis in West Africa. This recent map by the European Centre for Disease and Infection Control, however, makes clear why MERS remains a global health challenge.

Shawn Smallman, Portland State University

MERS continues to spread

"Virus" by renjith krishnan at
“Virus” by renjith krishnan at

The news regarding the respiratory virus MERS-COV continues to be worrying. A second case of MERS has now been reported in the United States in Orlando, Florida. This individual is a health care worker from Saudi Arabia who traveled to the U.S., as was the previous case. This fact raises serious concerns about infection control measures in Saudi Arabia’s hospitals, as I discussed in an earlier post. Fortunately, he seems to be recovering. Equally significant, two Indonesians have recently fallen ill with the disease. The first died on April 29th, and the second is seriously sick. This man had gone to Saudi Arabia on pilgrimage. Given that there is no vaccine for MERS, nor is one likely to be developed in the near future, the continued appearance of MERS amongst health care workers from Saudi Arabia, and its spread outside the Kingdom’s borders, is a worrying sign. There are also concerns in the United Kingdom, given that both of the recent cases in the United States arrived after transiting through Heathrow. …

MERS and Saudi Health Care Workers

Historical photo of the 1918 Spanish influenza ward at Camp Funston, Kansas, showing the many patients ill with the flu- U.S. Army photographer
Historical photo of the 1918 Spanish influenza ward at Camp Funston, Kansas, showing the many patients ill with the flu- U.S. Army photographer

The CDC just reported the first case of MERS in the United States. A health care worker from Saudi Arabia recently traveled to the U.S. from Riyadh, Saudi Arabia, and became sick five days ago in Indiana. He has certainly been in contact with other people recently, not only on the flights, but also during a stopover in London.  He also took a bus trip from Chicago to Indiana. As usual, Ian MacKay’s blog has some of the best information on this virus, including a truly chilling chart of case counts. This makes clear the rapid growth of cases over the last month. Recent analyses have not identified any mutations in the virus that might account for this change. Another possibility for the spike in cases may be that infection control measures are breaking down in Saudi Arabia now, much as there were such initial failures with SARS in Canada in 2003. …

MERS, the next pandemic?

"Camel Caravan In A Desert" by m_bartosch at
“Camel Caravan In A Desert” by m_bartosch at

MERS COV (Middle East Respiratory Syndrome Coronavirus) first appeared in Saudi Arabia in 2012. This disease is caused by a corona-virus, much like the SARS epidemic in 2003. A great deal of work was done early in the epidemic to identify the original host for this virus. Although there is a great deal of evidence associating the virus with camels, which are also infected, it now seems that the original host may be the Egyptian tomb bat, an appropriately scary name for a disease vector. Given that many other viruses seem to have bats as their original hosts, this would be unsurprising if true. The disease is a respiratory virus, which causes difficulty breathing, coughing, and fatigue. Roughly 40% of patients die. …

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