FeaturePerspective

Experts wary about necessity, effectiveness of coronavirus travel ban

Amesh A. Adalja, MD 
Amesh A. Adalja
Jeanne Marazzo, MD, MPH 
Jeanne Marazzo

In response to the ongoing coronavirus outbreak, which has so far infected 12 individuals in the United States, several airlines have delayed travel to mainland China and the CDC has begun 14-day quarantines of U.S. citizens arriving from Wuhan, leaving some health care providers to question the necessity of these restrictions.

“I do not believe quarantining is warranted right now,” Amesh A. Adalja, MD, senior scholar at Johns Hopkins Center for Health Security, told Healio. “I think what we have is a virus spread through respiratory symptoms that is in multiple different countries, likely has a spectrum of illness and that includes a lot of mild illnesses that are not being diagnosed all over the world. I think it's more important to move from trying to contain this virus to preparing for larger outbreaks.”

In the wake of the U.S. declaring the coronavirus outbreak a public health emergency, airlines including Delta, American and United have suspended flights to China. As of press time, the CDC has identified 293 “people under investigation” for quarantine and coronavirus testing, 206 of which have tested negative for the virus and 76 of which are still awaiting results. In addition to those already under quarantine, four new planes carrying U.S. citizens from Wuhan will land at four separate U.S. military bases for testing in the coming days, Nancy Messonnier, MD, director of the CDC’s National Center for Immunization and Respiratory Diseases, announced in a CDC telebriefing.

Adalja noted that travel bans have previously been ineffective, and sometimes even counterproductive, in disease containment efforts like those implemented to prevent the spread of HIV.

Since the beginning of the outbreak, 12 cases of Coronavirus have been confirmed in the United States – slightly more than the eight confirmed cases of SARS in the U.S. during the 2003 outbreak.

“When you are thinking about management of infectious disease outbreaks and restricting the population, we want to start with the least restrictive measures first, and then only move to using physical force when it's absolutely necessary — when someone has proven that they are not going to comply and are putting other people at risk,” Adalja said. “I don't think moving straight into quarantine is ever the correct decision.”

Jeanne Marazzo, MD, MPH, professor of medicine and director of the Division of Infectious Diseases at the University of Alabama at Birmingham, told Healio she is hopeful the quarantine will help the situation, noting that even with a low severity rate of 15% in China, further spread could result in a “heavy toll.”

“Like many difficult decisions, it’s one that has to be weighed carefully with all of the implications and benefits clearly enumerated,” Marazzo said. “Health departments have long used it and still do for control of diseases like tuberculosis when it’s clear that the infected individual poses a real danger to public health. Imposing quarantine requires that the inconvenience — and sometimes more — to those quarantined is outweighed by the benefits to society at large.”

Adalja noted potential negative outcomes of the quarantine and travel ban could include further stigmatization of China, as well as difficulties transporting resources to outbreak zones. He also said the quarantine may take away from “other vital public health activities,” like local and state level efforts to prepare for widespread infection.

Both Marazzo and Adalja both emphasized the importance of influenza preparedness and basic hygiene measures as the coronavirus outbreak continues.

“Use common sense — wash your hands frequently, stay away from others to the extent possible if you are ill with an influenza-like illness and please get your influenza vaccine,” Marazzo said. “Although it is not as effective this year as we would have liked, it still could confer, on average, a one-third reduction in the likelihood of getting influenza, and it can reduce the severity of your illness if you do get it.”

Panic is not the appropriate reaction at this moment in time, Adalja told Healio.

“We're still in the middle of a flu season,” he said. "It is much more likely that you contract flu than you will coronavirus.” – by Eamon Dreisbach

Reference:

CDC. 2019 novel coronavirus (2019-nCoV) in the U.S. https://www.cdc.gov/coronavirus/2019-ncov/cases-in-us.html. Accessed February 5, 2020.

Disclosure: Adalja reports no relevant financial disclosures. Marazzo’s relevant financial disclosures could not be confirmed at the time of publishing.

Amesh A. Adalja, MD 
Amesh A. Adalja
Jeanne Marazzo, MD, MPH 
Jeanne Marazzo

In response to the ongoing coronavirus outbreak, which has so far infected 12 individuals in the United States, several airlines have delayed travel to mainland China and the CDC has begun 14-day quarantines of U.S. citizens arriving from Wuhan, leaving some health care providers to question the necessity of these restrictions.

“I do not believe quarantining is warranted right now,” Amesh A. Adalja, MD, senior scholar at Johns Hopkins Center for Health Security, told Healio. “I think what we have is a virus spread through respiratory symptoms that is in multiple different countries, likely has a spectrum of illness and that includes a lot of mild illnesses that are not being diagnosed all over the world. I think it's more important to move from trying to contain this virus to preparing for larger outbreaks.”

In the wake of the U.S. declaring the coronavirus outbreak a public health emergency, airlines including Delta, American and United have suspended flights to China. As of press time, the CDC has identified 293 “people under investigation” for quarantine and coronavirus testing, 206 of which have tested negative for the virus and 76 of which are still awaiting results. In addition to those already under quarantine, four new planes carrying U.S. citizens from Wuhan will land at four separate U.S. military bases for testing in the coming days, Nancy Messonnier, MD, director of the CDC’s National Center for Immunization and Respiratory Diseases, announced in a CDC telebriefing.

Adalja noted that travel bans have previously been ineffective, and sometimes even counterproductive, in disease containment efforts like those implemented to prevent the spread of HIV.

Since the beginning of the outbreak, 12 cases of Coronavirus have been confirmed in the United States – slightly more than the eight confirmed cases of SARS in the U.S. during the 2003 outbreak.

“When you are thinking about management of infectious disease outbreaks and restricting the population, we want to start with the least restrictive measures first, and then only move to using physical force when it's absolutely necessary — when someone has proven that they are not going to comply and are putting other people at risk,” Adalja said. “I don't think moving straight into quarantine is ever the correct decision.”

Jeanne Marazzo, MD, MPH, professor of medicine and director of the Division of Infectious Diseases at the University of Alabama at Birmingham, told Healio she is hopeful the quarantine will help the situation, noting that even with a low severity rate of 15% in China, further spread could result in a “heavy toll.”

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“Like many difficult decisions, it’s one that has to be weighed carefully with all of the implications and benefits clearly enumerated,” Marazzo said. “Health departments have long used it and still do for control of diseases like tuberculosis when it’s clear that the infected individual poses a real danger to public health. Imposing quarantine requires that the inconvenience — and sometimes more — to those quarantined is outweighed by the benefits to society at large.”

Adalja noted potential negative outcomes of the quarantine and travel ban could include further stigmatization of China, as well as difficulties transporting resources to outbreak zones. He also said the quarantine may take away from “other vital public health activities,” like local and state level efforts to prepare for widespread infection.

Both Marazzo and Adalja both emphasized the importance of influenza preparedness and basic hygiene measures as the coronavirus outbreak continues.

“Use common sense — wash your hands frequently, stay away from others to the extent possible if you are ill with an influenza-like illness and please get your influenza vaccine,” Marazzo said. “Although it is not as effective this year as we would have liked, it still could confer, on average, a one-third reduction in the likelihood of getting influenza, and it can reduce the severity of your illness if you do get it.”

Panic is not the appropriate reaction at this moment in time, Adalja told Healio.

“We're still in the middle of a flu season,” he said. "It is much more likely that you contract flu than you will coronavirus.” – by Eamon Dreisbach

Reference:

CDC. 2019 novel coronavirus (2019-nCoV) in the U.S. https://www.cdc.gov/coronavirus/2019-ncov/cases-in-us.html. Accessed February 5, 2020.

Disclosure: Adalja reports no relevant financial disclosures. Marazzo’s relevant financial disclosures could not be confirmed at the time of publishing.

    Perspective
    Peter J. Hotez

    Peter J. Hotez

    Travel bans are a tough call when fighting potential pandemic threats. I am always reluctant to implement travel bans because of the risk that they wind up being counterproductive. Travel bans hurt national economies and often encourage other countries to limit their transparency to avoid potential bans. Travel bans can also divert resources away from other urgently required activities. A major reason offered by the U.S. government for this current travel ban was the fact that the 2019 nCoV is a new and previously undescribed human pathogen. The claim was made that it will take the U.S. government time to fully understand the risk of this pathogen to Americans. This is understandable, but my expectation is that the ban would be time limited and lifted as soon as there is a comfort level managing individuals with possible coronavirus infections.

    • Peter J. Hotez , MD, PhD, FASTMH, FAAP
    • Professor of pediatrics
      Dean, National School of Tropical Medicine
      Baylor College of Medicine
      Co-director, Center for Vaccine Development
      Texas Children’s Hospital

    Disclosures: Hotez reports no relevant financial disclosures.

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