Costs and Benefits of Quarantine and Isolation

 

Clearly, at least in the US, ebolaphobia has been contagious.  But lets look at the concepts of quarantine and isolation.  According to CDC:

  • “Isolation separates sick people with a contagious disease from people who are not sick.
  • Quarantine separates and restricts the movement of people who were exposed to a contagious disease to see if they become sick.”

I want to focus on the concept of quarantine.  The operative phrase in the CDC definition is “who were exposed to a contagious disease”.  What precisely does that mean — is it that they are almost certain to progress to illness (i.e., the level of exposure was sufficiently high to give a near 100% probability), or that they were in circumstances where they could have received a dose (but they have perhaps a less, or much less probability of progressing to illness)?


There are clear costs and potential benefits to quarantine.  The obvious costs include the following:

  • lost wages for individuals unable to work during the quarantine period
  • room and board if the quarantine is not home quarantine
  • medical monitoring
  • costs associated with enforcement
  • there is the less tangible, but nonetheless real, cost of reducing civil liberties of the affected persons
  • for quarantine of health care workers after they have cared for patients (either in Africa or domestically) there is the cost that is also not well quantifiable in deterring others from giving such vital services in the future.

There are also potential benefits, which may be more difficult to calculate.  For the fraction of individuals who will succumb to disease, placing them in quarantine may reduce the spread of disease in others.  But to adequately quantify this one needs to employ a disease transmission model, which will require estimation of the underlying parameters, and also the underlying baseline disease prevalence.


Right now rather than such rational decision making, the mad rush towards quarantine seems to be political.  The general consensus seems to be that a signal early symptom of Ebola is a rapid onset of fever.  Therefore, if a person is deemed to be responsible (and presumably a default ought to be that health care workers are regarded as such), self monitoring and reporting is sufficient.


It seems to be unfortunate that decision making now has a strong element of science denial.

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One thought on “Costs and Benefits of Quarantine and Isolation

  1. A few words on the legal aspects of Quarantine…

    1.
    Quarantine is not only cost-effective but even means a severe restriction of freedom for affected people.

    2.
    Quarantine is thought to be a proven way to avoid the spread of certain virus diseases

    3.
    Vague legal concepts like “were exposed” might lead a judge who i.e. has to order a quarantine into a factually and legally indissoluble conflict. I – insofar – totally agree with you.
    a) “Exposure” is the result of a subsumption of factual circumstances
    b) There is no evidence-based and generally valid definition of those circumstances which may lead to the assumption: “exposure”
    c) In many cases not even a medical expert would be able to exclude the “exposure” ultimately – due to the lack of self-perception of the (to be defined) circumstances
    d) In contrast: medical science has agreed upon the specific prerequisites to assume an Ebola Suspicion Case and is capable of validating the infection itself labordiagnostically

    4.
    Most European infection protection Acts have a binominal system to find a decision wether to make a Quarantine order or not.
    a) Mandatory: The authority in charge shall seclude (quarantine) a person which either suffers from (…) a hemorraghic fever or is suspected of suffering from a hemorrhagic fever (hospital or appropriate medical setting).
    b) Discretion: The authority in charge may seclude a person who
    aa) doesn’t belong to the just above mentioned persons and
    bb) is suspected of having been infected with hemorrhagic fever
    –>Quarantine: (hospital OR) in an appropriate way (medical setting, home,…) if there are no opposing reasons obvious which may lead to the conclusion that the person would not obey the order.
    c) The order has to include the duration of quarantine

    5.
    The above described terms have numerous advantages:
    –> a (fair) consideration of peoples rights and financial aspects with the avoidance of a spread
    –> consideration of the medical nomenclature in the context with epidemic diseases
    –> existing international pathways to determine “suffer from VHD”, “suspected VHD case”
    –> existing risk assessment pathways to determine a contact persons individual risk
    –> easy to interpret by judges/authorities/medical experts
    –> determination of duration in an quarantine order allows an individualisation of the restriction

    6.
    It seems to be obvious that the incubation period may last longer than 21 days. And I again totally agree with you that a disease transmission control would be a good tool. What would be your list of criteria for such a model? Would you suggest regional differences for the models algorithms?

    BR, Thomas

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