- Page navigation anchor for RE: Critical Debates for Quarantine and Isolation in the COVID-19 ContextRE: Critical Debates for Quarantine and Isolation in the COVID-19 Context
Letter to the Editor,
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Critical for COVID-19 are definitions of incubation period, timing for infectivity, self-isolation, and quarantine (patients and contacts). Diagnostic tests depend on amplification technologies which do not discriminate viable and non-viable virus.
As with SARS Co-V and MERS Co-V, SARS-CoV-2 live virus shedding can occur for more than 14 d. after onset.(1,2) Some infected patients show little if any symptoms, otherwise termed asymptomatic shedding.(3) Pre-symptomatic shedding indicates that incubation time to infectiousness is a few days prior to conventional thoughts (i.e., acquisition to first evidence of illness).(4) Incubation times extend beyond fourteen days.(3,5)
Current epidemiological parameters based on statistical analyses are partially data driven, but use 95-97.5% confidence. Outliers may not be common in small populations. Prolonged excretion or incubation outliers complicate spread if populations are much larger. The latter creates inherent uncertainty for infection control whether community or healthcare. The infectious period begins before overt clinical symptoms or signs are apparent analogous to other respiratory viruses. Extension to safer end limits for excretion past fourteen days attracts discussion. Extension to quarantine for laboratory-confirmed infections or definitive close contacts needs re-consideration. More stringency to the follow-up of casual contacts is applicable.
Where infections are few and...Competing Interests: None declared.References
- 1. Chan PK, To WK, Ng KC, et al. Laboratory diagnosis of SARS. Emerg Infect Dis 2004;10(5):825-31.
- 2. Bin SY, Heo JY, Song M-S, et al. Environmental contamination and viral shedding in MERS patients during MERS-CoV outbreak in South Korea. Clin Infect Dis 2016;62(6):755-60.
- 3. Wang Y, Wang Y, Chen Y, Qin Q. Unique epidemiological and clinical features of the emerging 2019 novel coronavirus pneumonia (COVID-19) implicate special control measures. J Med Virol 2020 Mar 5. doi: 10.1002/jmv25748
- 4. Li P, Fu JB, Li KF, et al. Transmission of COVID-19 in the terminal stage of incubation period: a familial cluster. Int J Infect Dis 2020 Mar 16. pii: S1201-9712(20)30146-6
- 5. Leung C. The difference in the incubation period of 2019 novel coronavirus (SARS-ScV-2) infection between travelers to Hubei and non-travelers: the need of a longer incubation period. Infect Control Hosp Epidemiol 2020 Mar 18:1-8. doi: 10.1017/ice.2020
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