2019 nCoV: With quarantines, novel coronavirus brings new and existing public health preparedness needs to the forefront

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Dr. Jeffrey Duchin

The following is a guest post by Jeffrey Duchin, MD, FIDSA

The quarantine and travel restrictions announced by the US federal government in response to the novel coronavirus outbreak may delay the onset of widespread transmission in the U.S., giving our public health systems and health care facilities more time to put mitigation plans in place, if they are needed.  It is unclear, however, whether in the long run, these policies will translate into fewer cases or lessen the severity of the outbreak in the U.S. Further, both policies pose significant implementation challenges that underscore the need sustained funding for public health infrastructure.

The ongoing debate about the value of the current travel restrictions hinge on the balance of the costs and benefits. Clearly, there are substantial costs to interrupting the flow of people, commerce, goods and services, as well as unintended negative consequences such as stigmatization. As the outbreak spreads to other countries there are questions about the feasibility and effectiveness of maintaining a travel ban strategy above and beyond our core public health focus on traveler screening and education with isolation of ill persons at entry ports.

The mandatory federal quarantine is the first such order the U.S. government has issued in more than 50 years. It is important for federal policymakers and the public to understand the tremendous amount of work and resources needed to implement this policy. State and local public health departments had very little warning to prepare to receive and manage quarantined travelers. Isolation and quarantine preparedness is one of the most challenging aspects of public health emergency response planning. It is highly resource-intensive and complex, requiring coordination of overlapping authorities across various levels of government, and complicated and resource-intensive public health and healthcare system activities. There are major logistical challenges and costs associated with finding suitable isolation and quarantine facilities, meeting the needs of the population under isolation or quarantine, monitoring their health, and ensuring timely medical evaluation and testing when necessary, including safe and secure transport from isolation or quarantine locations to and from health care facilities. With an effort that is unprecedented in my experience, our state and local public health, healthcare system and emergency management partners are working nonstop along with CDC to respond to the current request successfully.

It is extremely difficult to undertake this type of planning and response on a moment’s notice without adequate sustained, dedicated federal resources that have not been available in recent years. Two of the most important lessons to be learned from this and past outbreaks is that future emerging infectious disease threats, outbreaks, and even pandemics are inevitable, and that ongoing investments in public health and healthcare system large-scale emergency response capacity are critical to ensure our ability to respond optimally to outbreaks and population health emergencies whenever and wherever they occur.

At this time, our national public health leaders at CDC who have access to the most timely and accurate information about the emerging novel coronavirus outbreak have endorsed the current approach to delay the impact of the outbreak on the U.S. At this juncture, much remains unknown about transmission and severity of the novel coronavirus. We can’t accurately predict what the ultimate course of this outbreak will be, if it will become a global pandemic (although that seems increasingly likely), or how severe it might be in the United States.  As we learn more, all our response strategies must be reevaluated and updated to reflect the best available information. The current travel ban and quarantine policies may well be time-limited measures while we learn more about the outbreak in order to inform more long-term, evidence-based novel coronavirus disease control and mitigation strategies.

To be prepared for the next pandemic, whether it be weeks, months or years away, healthcare system readiness is essential. Resources are needed now (and must be ongoing) for both our nations’ public health system and to ensure our hospitals and community-based healthcare providers are ready to implement pandemic response activities including community and facility—based triage, evaluation and treatment of a sustained surge in ill patients, manage possible shortages of personnel and critical equipment and supplies, and continue to meet the needs of persons seeking care for serious non-outbreak related health conditions and injuries.

Jeffrey Duchin, MD, FIDSA, a member of the board of directors for the Infectious Diseases Society of America (which produces this blog), is Seattle & King County health officer for Public Health. He trained as a medical epidemiologist in the Centers for Disease Control and Prevention’s Epidemic Intelligence Service, after which he completed the CDC’s Preventive Medicine Residency program. He worked for the CDC in the National Center for Infectious Diseases, the Division of Tuberculosis Elimination, and the Division of HIV/AIDS Prevention. Jeff also co-chairs the King County Heroin and Opiate Addiction Task Force formed to confront the region’s growing heroin and opioid epidemic.

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