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A survey of CENTRALIZED QUARANTINE (CQ) practices, or lack thereof

Background: Wuhan first tried home quarantine, part of standard epi procedure, but found that these ‘mild’ patients were
*infecting their families.*
1/
2/
 Centralized quarantine (CQ) means infected people not needing hospitals stay in govt-run facilities where they are to some degree physically detained.
3/
 Singapore at first neglected, but has now adopted centralized quarantine (CQ.)

Because their 2nd wave of imported cases had a direct 2x or so multiplier effect in home quarantine. Image
4/
 PRC which first learned this painful lesson is holding international arrivals in CQ.

I am not sure what happens to domestic non-hospitalized positives. https://t.co/3OL5eTtB44
5/
 Canada is telling mild positives to isolate at home in a separate room.

Epidemiologist says, “I think it’s a big mistake. It’s like they’re all just lemmings, walking off a cliff, not learning from countries that have succeeded.” theglobeandmail.com/world/article-…
6/
 From above article by @nvanderklippe Image
7/
 Serbia said they will be doing CQ https://t.co/ji5lztr8Ia
8/
 Vietnam has been sending arrivals to CQ for last 3 weeks. Not sure about domestic mold cases. vietnamtimes.org.vn/all-travelers-…
9/
 The US has CQ sites but... https://t.co/PDodJPPSX2
10/
 After failing to prepare PPE and tests, failure to set up CQ for a highly communicable disease is the next totally avoidable blunder in many countries worldwide. https://t.co/e2GjsrVGwi
11/
 Large scale testing followed by CQ can at some point alleviate the need for the blunt force lockdowns https://t.co/PyGntCJd6w
12/
 Is there still a Not Invented Here syndrome in the west?

Please folks, look it up in the old epi textbooks. You (can claim to have) invented
—-> centralized quarantine (CQ)
https://t.co/hIT8tt5ZJc
13/
 This is a big concern, and people are just tired of repeating themselves about CQ https://t.co/waPLyfT0YY
14/
 “The most important thing was...” https://t.co/ZGcDIT7cv4
15/
 CQ “may have been the biggest factor” https://t.co/IlUrd8mJbq
16/
 Centralized quarantine (CQ) in the US has been proposed in NYT, but somehow we are mostly litigating other things. https://t.co/U6zbjgQlJA
17/
 US objections to this proposal are that it would discourage people from coming forward to be tested (below) and that it would separate families.

Well, it's a US political decision. This one, if it goes badly, Americans don't get to blame on Trump.
18/
 Until the middle of this graph, Singapore had things under control. All cases traced, remember?

And then the early blue cases landed, home Q only, that spread to the yellow cases ('local linked') that ignited the red cases ('local unlinked').
19/
 Iceland data confirm home quarantine leads to family group infections.

Not just a ‘crowded Asian flats’ thing. https://t.co/NvmNWnTrIl
20/
 "Centralized quarantine is the next step"
21/
 "There's a bunch of empty hotels right now" for centralized quarantine.
22/
 "Home isolations FAILED in Wuhan." They had to switch to centralized quarantine.
23/
 I'll take miserable over dangerous.

"Harvey Fineberg, a former president of the National Academy of Medicine... said many people would welcome the opportunity to shelter somewhere outside their home, provided there was adequate care."
washingtonpost.com/world/asia_pac…
24/
 PRC centralized quarantine studied 'clinically' in Lancet. "They served to isolate patients with mild to moderate COVID-19 from their families and communities, while providing medical care, disease monitoring, food, shelter, and social activities."
25/
 Below Feb 28 NYT article is the first time I, an amateur, heard that home quarantine wasn't going to work.

The professionals must surely have better and earlier information. Why aren't they acting on it, except for ideological hangups?nytimes.com/2020/02/28/wor…
26/
 (cont)
After the initial blunder, "new orders had gone out across Wuhan" for centralized quarantine. PRC may be a monster in many aspects, but it is a learning monster. Image
27
(cont)
Initially it was little more than a plush prison. Mistake. Fixes had to be made. The knowledge is out there. (NYT free to read: nytimes.com/2020/02/28/wor…) Image
28/
 Note the word ‘safely’ in step 2. Home quarantine with family members or roommates is not safe. https://t.co/xlDRU0JY7k
29/
 Centralized quarantine, or infect your household. Choose?
https://t.co/DtyD5elprR
30/
 Philippine city implements centralized quarantine
31/
 Japan preparing hotel rooms for mild and subclinical cases; i.e. Japan is going to be doing CENTRALIZED QUARANTINE japantimes.co.jp/news/2020/04/1…
32/
 New York City arranges a form of voluntary centralized quarantine https://t.co/3ILjn9JG4n
33/
 https://t.co/b2ZDYDCOxm
34/
 https://t.co/dTqmyux8QD
35/
 https://t.co/oRbTVHBkLI
36/
 case management flowchart featuring CQ for everyone who isn’t hospitalized

h/t @Comparativist Image
37/
 Among the 7 recommendations listed by ProPublica https://t.co/pwOZGGJ7EY
38/ https://t.co/gLxtgIwQY3
39/
 Centralized quarantine was credited in rapidly bringing down case numbers somewhere. I forget where because it’s been a while now. https://t.co/WzrG2ydFuh
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More from @benbenchia see all

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Ben Chia
@benbenchia
1/
 A question have been asking myself: When infections hit multiple family members (e.g. as a result of home quarantine of mild cases) what are the chances of orphaning any children?

(thread)
2/
 For any infected person (incl. undiagnosed/mild), the probability of this doubly tragic outcome is:

Cohort IFR x cohort IFR x (probability of transmission)

some guesses using IFR for older folks
a) 0.5% x 0.5% x 60% = 15 per million
b) 1% x 1% x 80% = 80 per million
3/
 For a clinically confirmed case, the formula changes to:

Your CFR x partner's IFR x (probability of transmission before isolation)

a) 2% x 0.5% x 40% = 40 per million
b) 2.5% x 1% x 50% = 125 per million
Read 7 tweets
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Ben Chia
@benbenchia
This March 2, 2019, image is the last published on @38North of the Sohae engine test stand without its post-Hanoi white cladding.
(source: 38north.org/2019/03/sohae0…)
1/
@38north 2/
By March 6, everything had been closed up. Unless this thing has been torn up in the last 9 months without anyone noticing, the structure remains unchanged. Barring this, I assert that this stand could not have mounted a solid motor vertically.
3/
 Sorry, that’s @38NorthNK .

No further construction at the test stand has been reported from March.

However, there was an addition of what looks like office/lab space at the horizontal assembly facility, begun before January, roofed over May 2019. (38north.org/2019/05/sohae0…)
Read 8 tweets

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