GESTIÓN EN SALUD PÚBLICA: BioEdge: Coronavirus has killed 1500. But are quarantines the answer to stopping the epidemic?

domingo, 16 de febrero de 2020

BioEdge: Coronavirus has killed 1500. But are quarantines the answer to stopping the epidemic?

BioEdge: Coronavirus has killed 1500. But are quarantines the answer to stopping the epidemic?

Bioedge

Coronavirus has killed 1500. But are quarantines the answer to stopping the epidemic?

by Michael Cook | 16 Feb 2020 |

The latest figures for the coronavirus (now known as COVID-19) epidemic are about 67,000 confirmed cases of globally and 1,500 reported deaths. The fatality rate is currently 2.3%. It has spread to at least 29 countries, although nearly all of the cases and deaths have been in China.

The response of many governments, including Australia and the United States, is to ban or restrict travel to and from China.

And while travel bans are frequently used to stop the spread of an emerging infectious disease, a new University of Washington and Johns Hopkins University study of published research found that their effectiveness is mostly unknown.

However, lead author Nicole Errett, of UW, that is largely due to the fact that there has been very little research into the effectiveness of travel bans. Only a handful of studies exist and these are based on simulations, not actual bans.

"Some of the evidence suggests that a travel ban may delay the arrival of an infectious disease in a country by days or weeks. However, there is very little evidence to suggest that a travel ban eliminates the risk of the disease crossing borders in the long term," she says.

"When assessing the need for, and validity of, a travel ban, given the limited evidence, it's important to ask if it is the least restrictive measure that still protects the public's health, and even if it is, we should be asking that question repeatedly, and often," said co-author Lauren Sauer, of Johns Hopkins University's School of Medicine.

Consequently, the authors write, additional research is "urgently needed" to inform policy decisions, especially in light of the tremendous social, economic and political impacts of their implementation.

On the BMJ blog, a psychiatrist and a psychologist from King’s College London warn that quarantines, like tourniquets, are effective but dangerous. The lockdown in Wuhan, the epicentre of the outbreak, a city of 11 million, could have substantial psychological effects. “During disease outbreaks, community anxiety can rise following the first death, increased media reporting and an escalating number of new cases. Mass quarantine is likely to raise that substantially, for multiple reasons,” they write.

“Ever since the plague of Justinian, imposed quarantine has rightly remained part of our public health arsenal. But as with every medical intervention, there are side effects that must be weighed in the balance and alternatives that must be considered. Voluntary quarantine, for example, may be associated with good compliance and less psychological impact, particularly when explained well and promoted as altruistic. Whether the uncertain epidemiological benefits of this new form of mandatory mass quarantine outweigh the uncertain psychological costs is a judgement that should not be made lightly.”

Michael Cook is editor of BioEdge

I haven’t done a comprehensive peer-reviewed study of this issue, but my working hypothesis is that at certain positions in the zodiac, people start discussing euthanasia. How else could you explain that this week’s newsletter is stuffed full of news about end-of-life issues? These come from countries as distant as Australia, the UK, Spain, Switzerland and Canada, so it’s not as though they’re all drinking from the same tap.

Hopefully next week we’ll have a wider range of issues. But for a bit of variety, we have featured an interesting response to a ban on abortion in the American state of Alabama.