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Thread 🧵- INCUBATION TIME LONGER THAN 14 days. ⚠️This is a serious problem that I can’t stress enough because we based all our quarantine on this magical 14 day number. But many people have longer incubation periods than 14 days- this is problem. #COVID19…
2) For weeks, the WHO and CDC have been saying that while half of those #COVID19 exposed get sick within about five days, they recommend 14-day quarantines for anyone knowingly exposed to the virus to prevent its spread...
3) ...That quarantine period was extrapolated from an analysis published in January of a small sample of patients in Wuhan, China, which suggested that 95% of those #COVID19 infected would show symptoms within 12 and a half days. But...
4) But new studies indicate that it takes some people much longer to develop symptoms after they’re exposed – spurring some scientists to raise an alarm that 14 days not enough. Some public health experts are calling for longer quarantine periods, especially low testing countries
5) A team of scientists from five universities in China and Canada released a study in mid-March that found that nearly 1 in 8 patients had incubation times longer than 14 days, leading them to question whether current quarantine recommendations are optimal. #COVID19
6) “As the outbreak is fast-moving in the world, based on this analysis we recommended that an extension of adults’ quarantine period to 17 or 21 days could be more effective,” they wrote. #COVID19
7) That team found that of 2,015 #COVID19 cases they studied across China – sample that included 100 children – 233 patients had incubation periods longer than the 14-day quarantine period recommended, or nearly 12%. The range of incubation days they saw ranged from 0 to 33 days.
8) “If you have 10 people in the city get #COVID19, maybe not (a) big deal,” said one of the researchers. But, he said, if you have 10,000 people infected, you will have 1,200 people missed by the quarantine. “So that is a disaster.”
9) Another study found that for every 10,000 exposed #COVID19, 101 would develop symptoms after a 14-day quarantine. Reuters reported on one such case in late Feb, that of a 70-year-old man in China’s Hubei Province who did not show symptoms until 27 days after he was infected!
10) “Because the U.S. has such, such low testing rates and such poor coverage of the community in terms of identifying new cases that crop up, I would take a much more conservative approach, as in increasing the quarantine duration in the U.S.,” said Eric Feigl-Ding. #COVID19
11) “I would advocate we need a much more stringent quarantine because it is like a perimeter around someone who may have #COVID19. But if you don’t have a good testing for someone that escapes this quarantine detection, then you better have a comprehensive, longer quarantine.”
12) “If your goal is to catch 99 out of 100 people, maybe 14 days of quarantine is OK,” Feigl-Ding said in response to the new findings. “One person may slip by and infect other people. So the question is, are you going to tolerate that kind of risk?” #COVID19
13) “...This study should make every public health leader ask what is an acceptable risk tolerance for cases slipping out. I think our risk tolerance should be more than 1 in 100. It should potentially be 1 in 10,000.” #COVID19
14) Feigl-Ding said researchers need to study whether the incubation period varies by age, gender and underlying health conditions.
“We should have solved this problem two months ago,” Feigl-Ding said. #COVID19
15) “The point of quarantines at this point is not necessarily to catch every single sick person,” said Justin Lessler, an associate professor of epidemiology at Johns Hopkins University and a co-author of the Annals of Internal Medicine study. #COVID19
16) He said the cost of taking nurses or firefighters out of the community during the quarantine period has to be balanced with the risk that they might develop COVID-19 and spread it.
“It’s not for us to say what that balance should be,” he said. #COVID19
17) Sandy Adler Killen is an emergency room nurse at a Northern California hospital that, as of Sunday, had handled about 10 confirmed COVID-19 patients. “We do not have the capability” to quarantine exposed health care workers for more than two weeks. #COVID19
18) “If we had numerous staff members that had to be quarantined for long periods of time, it’s just not tenable.” Longer quarantines carry financial implications as well, Bollinger points out. “Those people that you’re quarantining need to be paid,” she said. #COVID19
19) Felicia Goodrum, an immunobiologist, emphasized that vast majority of those exposed present symptoms w/in 14 days of known exposure. “Does that leave outliers on tail end of that curve?” “Yes, absolutely. So would it be safer to quarantine for 16 days? Absolutely.” #COVID19
20) given the irregular incubation period, it is critical that people be tested for #COVID19 on final day of quarantines. “That would be the way, especially in a high-risk situation where you’re talking about HCW going back to work or, say, a caregiver at a nursing home”
21) The risks of the looser #COVID19 CDC recommendations were on clear display early in the U.S. outbreak when, in late February, the agency released from isolation a woman who had been evacuated from Wuhan. When she arrived in the U.S...
22) ...she was taken to a health care facility near Joint Base San Antonio-Lackland and was in isolation for a few weeks after testing positive for #COVID19. But after testing negative twice, she was released and visited a hotel and mall while a third test was pending.
23) That test came back positive. By that time, she had been out in the community for 12 hours. San Antonio Mayor @Ron_Nirenberg called the patient’s release a federal “screw-up,” declared a public health emergency and sued the federal government. #COVID19
24) “I would encourage the federal administration to not wash its hands of the responsibility to protect the public,” Mayor @Ron_Nirenberg said. #COVID19
25) Recent studies from China & Europe showed that people can shed #COVID19 virus well after recovery. One study- researchers found cases shedding the virus for a median of 20 days after they got sick, half of them were shedding for even longer periods – the longest was 37 days
26) These new studies are very preliminary, but they have caught the attention of doctors dealing with #COVID19 patients and struggling to make sense of glaring difference between the recommendations of WHO and CDC. “This is a big contention currently,” said Dr. Frederick Davis.
27) among biggest hardships of getting sick has been not knowing whether she had #COVID19, whether she may have been infectious & exposed people before she felt ill, or how long might be contagious now once feels better. “The uncertainty has really been the most difficult part”
28) BOTTOMLINE: 📌14 day quarantine might not be long enough because of really long duration. 📌Virus shedding duration even after recovery. ➡️ Thus, we need to be careful from a precaution principle. Maybe increase quarantine time to 16 or 17 days to be more certain. #COVID19 🤔
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