Announcement

Collapse
No announcement yet.

Effects of Quarantine

Collapse
This is a sticky topic.
X
X
  • Filter
  • Time
  • Show
Clear All
new posts

  • Effects of Quarantine

    Thank you Thornton for this find:

    Emerg Infect Dis. Jul 2004; 10(7): 1206–1212.
    doi: 10.3201/eid1007.030703


    PMCID: PMC3323345




    SARS Control and Psychological Effects of Quarantine, Toronto, Canada

    Laura Hawryluck,<sup>*</sup> Wayne L. Gold,<sup>*</sup> Susan Robinson,<sup>*</sup> Stephen Pogorski,<sup>†</sup> Sandro Galea,<sup>‡</sup> and Rima Styra<sup></sup><sup>*</sup>

    Author information ► Copyright and License information ►

    See letter "SARS Control and Psychological Effects of Quarantine, Toronto, Canada" in volume 11 on page 354.
    This article has been cited by other articles in PMC.



    Go to:
    Abstract

    As a transmissible infectious disease, severe acute respiratory syndrome (SARS) was successfully contained globally by instituting widespread quarantine measures. Although these measures were successful in terminating the outbreak in all areas of the world, the adverse effects of quarantine have not previously been determined in a systematic manner. In this hypothesis-generating study supported by a convenience sample drawn in close temporal proximity to the period of quarantine, we examined the psychological effects of quarantine on persons in Toronto, Canada. The 129 quarantined persons who responded to a Web-based survey exhibited a high prevalence of psychological distress. Symptoms of posttraumatic stress disorder (PTSD) and depression were observed in 28.9% and 31.2% of respondents, respectively. Longer durations of quarantine were associated with an increased prevalence of PTSD symptoms. Acquaintance with or direct exposure to someone with a diagnosis of SARS was also associated with PTSD and depressive symptoms.

    Keywords: SARS, quarantine, post–traumatic stress disorder, depression

    Severe acute respiratory syndrome (SARS) was contained globally by widespread quarantine measures, measures that had not been invoked to contain an infectious disease in North America for >50 years (16). Although quarantine has periodically been used for centuries to contain and control the spread of infectious diseases such as cholera and the plague with some success (14,68), the history of invoking quarantine measures is tarnished by threats, generalized fear, lack of understanding, discrimination, economic hardships, and rebellion (1,3,4,68).
    Quarantine separates persons who have been potentially exposed to an infectious agent (and thus at risk for disease) from the general community. For the greater public good, quarantine may create heavy psychological, emotional, and financial problems for some persons. To be effective, quarantine demands not only that at-risk persons be isolated but also that they follow appropriate infection control measures within their place of quarantine. Reporting on SARS quarantine has focused on ways in which quarantine was implemented and compliance was achieved (14,68). Adverse effects on quarantined persons and the ways in which those quarantined can best be supported have not been evaluated. Moreover, little is known about adherence to infection-control measures by persons in quarantine.
    Knowledge and understanding of the experiences of quarantined persons are critical to maximize infectious disease containment and minimize the negative effects on those quarantined, their families, and social networks. The objectives of our study were to assess the level of knowledge about quarantine and infection control measures of persons who were placed in quarantine, to explore ways by which these persons received information to evaluate the level of adherence to public health recommendations, and to understand the psychological effect on quarantined persons during the recent SARS outbreaks in Toronto, Canada.

    Go to:
    Methods

    Description of Quarantine in Toronto

    During the first and second SARS outbreaks in Toronto, >15,000 persons with an epidemiologic exposure to SARS were instructed to remain in voluntary quarantine (Health Canada, unpub. data). Data on the demographics of the quarantined population were collected, but have not yet been analyzed (B. Henry, Toronto Public Health, pers. comm.). Quarantined persons were instructed not to leave their homes or have visitors. They were told to wash their hands frequently, to wear masks when in the same room as other household members, not to share personal items (e.g., towels, drinking cups, or cutlery), and to sleep in separate rooms. In addition, they were instructed to measure their temperature twice daily. If any symptoms of SARS developed, they were to call Toronto Public Health or Telehealth Ontario for instructions (5).

    Study Population

    All persons who were placed in quarantine during the SARS outbreaks in Toronto (at least 15,000 persons) were eligible for participation in this study. The survey was announced through media releases, including locally televised interviews with the principal investigators. Information on the study and invitations to participate were posted in local healthcare institutions, libraries, and supermarkets. Ethics approval was obtained from the research ethics board of the University Health Network, a teaching institution affiliated with the University of Toronto.

    Survey Instrument

    A Web-based survey composed of 152 multiple choice and short- answer questions was to be completed after participants ended their period of quarantine. It took approximately 20 minutes to complete. Questions explored included the following: 1) knowledge and understanding of the reasons for quarantine (2), knowledge of and adherence to infection control directives, and (3) source of this knowledge.
    The psychological impact of quarantine was evaluated with validated scales, including the Impact of Event Scale—Revised (IES-R) (9) and the Center for Epidemiologic Studies—Depression Scale (CES-D) (10). The IES-R is a self-report measure designed to assess current subjective distress resulting from a traumatic life event and is composed of 22 items, each with a Likert rating scale from 0 to 4. The maximum score is 88. In a study of journalists working in war zones, the mean IES-R score of posttraumatic stress disorder (PTSD) was 20. In these persons, the presence of PTSD symptoms, as measured by this scale, was correlated with diagnostic psychiatric interviews (11). The CES-D is a measure of depressive symptoms composed of 20 self-report items, each with a Likert rating scale from 0 to 3. The maximum score is 60 (10). A score of> 16 has been shown to identify persons with depressive symptoms similar in severity to the levels observed among depressed patients (10,12,13). Open-ended questions provided respondents with the opportunity to relate the aspects of quarantine that were most difficult for them and allowed them to provide additional comments on their unique experiences.

    Statistical Analysis

    Means were calculated to summarize continuous variables. For categorical variables, group proportions were calculated. Student t tests were used to examine relationships between demographic variables and the psychological outcome variables, the scores on the IES-R and CES-D. A score of >20 on the IES-R was used to estimate the prevalence of PTSD symptoms (11). A score of >16 on the CES-D was used to estimate the prevalence of depressive symptoms (10,12,13).
    Analysis of variance (ANOVA), chi-square, and the Cochran-Armitage test for trend were used to examine relations between the IES-R and CES-D scores and the following independent variables: healthcare worker status, home or work quarantine, acquaintance of or direct exposure to someone with a diagnosis of SARS, combined annual household income, and the frequency with which persons placed in quarantine wore their masks. Linear regression for the trends between income categories and both PTSD and depressive symptoms was analyzed. The relationships between the IES-R and CES-D and whether persons in quarantine wore their masks all of the time versus never were examined by the Duncan-Waller K-ratio t tests. A p value of < 0.05 was considered to be significant for all analyses.
    Qualitative data were coded and analyzed to show emerging themes. The development and confirmation of the thematic coding structure is an iterative process involving two researchers in individual, recursive reading of the textual data and group meetings to discuss and test the emerging themes. Discrepancies were resolved by consulting specific instances in the data, discussing their relationship to established themes, and reaching consensus as a group (14).


    Go to:
    Results

    Demographics and Description of Quarantined Persons

    The survey was completed by 129 of more than 15,000 eligible persons who were placed in quarantine (Figure). All respondents completed the survey at the end of quarantine with a minimum time from the end of quarantine to the completion of the survey of 2 days. The median time from the end of quarantine to completion of the survey was 36.0 days (interquartile range, 10–66 days). Sixty-eight percent of respondents were healthcare workers, 64% were 26–45 years of age, 58% were married, 72% had a college level of education or higher, and 48% had a combined household income of >$75,000 (Canadian dollars [CAD]).
    Figure
    Number of persons in quarantine, Toronto, Canada, February 23–June 30, 2003. Figure courtesy of Toronto Public Health.


    The 129 respondents described 143 periods of quarantine with 90% of respondents being placed into quarantine only once; 66% of respondents were on home quarantine, while 34% were on work quarantine. The median duration of quarantine was 10 days (interquartile range 8–10 days). Half of respondents knew someone who was hospitalized with SARS of whom 77% were colleagues; 10% knew someone who had died of SARS (Table 1).
    Table 1
    Characteristics of quarantined persons who responded to the survey


    Persons were notified of their need to go into quarantine from the following sources: their workplace (58%), the media (27%), their healthcare provider (7%), and public health officials (9%). Most (68%) understood that they were quarantined to prevent them from transmitting infection to others; 8.5% of respondents believed they were quarantined to protect themselves from infection; 15% did not believe they should have been placed into quarantine at all; and 8.5% provided more than one of these responses.
    The source of notification for quarantine influenced understanding of the reason for quarantine. Those who were notified by the media or their workplace were more likely to understand the reason for quarantine than those who were notified by their healthcare provider or public health unit (p = 0.04). Healthcare workers were also more likely to understand the reason for quarantine compared with non–healthcare workers, 76.5% versus 52.5% (p = 0.007). Combined household income and level of education did not influence understanding of the reason for quarantine.

    Information on Infection Control Measures

    Persons received their information regarding infection control measures to be adhered to during their quarantine from the following sources: the media (54%), public health authorities (52%), occupational health department (33%), healthcare providers (29%), word-of-mouth (23%), hospital Web sites (21%), and other Web sites (40%).
    Those who did not think they had been well-informed were angry that information on infection control measures and quarantine was inconsistent and incomplete, frustrated that employers (healthcare institutions) and public health officials were difficult to contact, disappointed that they did not receive the support they expected, and anxious about the lack of information on the modes of transmission and prognosis of SARS (Appendix).
    During the outbreaks, nearly 30% of respondents thought that they had received inadequate information about SARS. With respect to information regarding home infection control measures, 20% were not told with whom they could have contact; 29% did not receive specific instructions on when to change their masks; and 40%–50% did not receive instructions on the use and disinfection of personal items, including toothbrushes and cutlery; 77% were not given instructions regarding use and disinfection of the telephone. Healthcare worker status did not influence whether respondents thought they had received adequate information regarding any of the listed home infection control measures, except regarding the frequency of mask changing: healthcare workers more frequently reported that they had received adequate information, 78.8% versus 60.5% (p = 0.03).

    Adherence to Infection Control Measures

    Eighty-five percent of quarantined persons wore a mask in the presence of household members; 58% remained inside their residence for the duration of their quarantine. Thirty-three percent of those quarantined did not monitor their temperatures as recommended: 26% self-monitored their temperatures less frequently than recommended, and 7% did not measure their temperatures at all. No differences between healthcare workers and nonhealthcare workers were found with respect to adherence to recommended infection control measures.

    Psychological Impact of Quarantine

    The mean IES-R score was 15.2±17.8, and the mean CES-D was 13.0±11.6. The IES-R score was >20 for 28.9%; the CES-D score was >16 in 31.2% of quarantined persons (Table 2). The mean IES-R scores were not different for persons on home or work quarantine, 14.1±18.8 versus 17.6±16.6 (p = 0.33); the mean CES-D scores were also not different between the groups, 12.0±12.0 versus 15.2±10.7 (p = 0.16).
    Table 2
    Prevalence of posttraumatic stress disorder and depressive symptoms according to patient demographics<sup>a</sup>


    The presence of PTSD symptoms was correlated with the presence of depressive symptoms (p < 0.0001, r = 0.78). Marital status did not offset the presence of PTSD symptoms, mean IES-R score of 14.5±16.6 for those who were unmarried versus 13.8±14.6 for those who were married (p = 0.82). Similarly, marital status did not influence the presence of depressive symptoms, with a mean CES-D score of 12.9±10.7 for those who were unmarried versus 12.5±11.4 for those who were married (p = 0.85)
    A combined annual household income of CAD <$40,000 versus CAD $40,000 to CAD $75,000 versus CAD >$75,000 was associated with increased PTSD symptoms (mean IES-R score of 24.2±20.6 versus 20.0±24.4 versus 11.8±11.6, respectively) (p = 0.03 for the three-way comparison). Linear regression testing for trend over income categories was also significant (p = 0.01). A combined annual household income of CAD <$40,000 versus CAD $40,000 to CAD $75,000 versus CAD >$75,000 was also associated with increased depressive symptoms (mean CES-D score of 18.3±15.4 versus 15.5±13.2 versus 10.9±9.2, respectively) (p = 0.05 for the three-way comparison) (Table 2). Results of linear regression testing for trend over income categories were also significant (p = 0.01).
    Neither age, level of education, healthcare worker status, living with other adult household members, nor having children was correlated with PTSD and depressive symptoms. The duration of quarantine was significantly related to increased PTSD symptoms, mean IES-R score of 23.7±27.2 for those in quarantine >10 days compared with 11.7±10.7 for those in quarantine <10 days (p < 0.05). Persons who were in quarantine for a longer duration showed a trend toward higher CES-D scores; however, this difference did not reach statistical significance (mean CES-D of 17.0±14.2 for those in quarantine >10 days versus 11.2±10.1 for those in quarantine <10 days [p = 0.07]). Acquaintance with or exposure to someone who was hospitalized with SARS was associated with a higher mean IES-R score, 18.6±20.2 versus 11.8±14.3 (p = 0.03) and a higher mean CES-D score, 15.5±12.1 versus 10.2±10.5 (p = 0.01). Overall, acquaintance with or exposure to someone who died of SARS was not correlated with PTSD or depressive symptoms (data not shown).
    Persons were categorized as having worn their masks all of the time, including times when it was not recommended, having worn their masks according to recommendations, or not having worn their masks at all. Those who wore their masks all of the time had higher mean IES-R scores (29.7±18.6 versus 14.1±17.9 versus 12.3±15.1, p = 0.003 for the three-way comparison) and higher mean CES-D scores (25.6±12.7 versus 12.2±11.1 versus 11.5±11.6, p = 0.002 for the three-way comparison). Those who wore their masks all of the time also had higher mean IES-R scores (p = 0.03) and higher mean CES-D scores (p = 0.002) than those who never wore their masks.
    All respondents described a sense of isolation. The mandated lack of social and, especially, the lack of any physical contact with family members were identified as particularly difficult. Confinement within the home or between work and home, not being able to see friends, not being able to shop for basic necessities of everyday life, and not being able to purchase thermometers and prescribed medications enhanced their feeling of distance from the outside world. Infection control measures imposed not only the physical discomfort of having to wear a mask but also significantly contributed to the sense of isolation. In some, self-monitoring of temperature provoked considerable anxiety: "taking temperatures was mentally difficult" (respondent #27) and "taking my temperature made my heart feel like it was going to pound out of my chest each time" (respondent #62).
    While most quarantined persons (60%) did not believe that they would contract SARS, 59% were worried that they would infect their family members. In contrast, only 28% were concerned that a quarantined family member would infect someone else in the home. Following quarantine, 51% of respondents had experiences that made them feel that people were reacting differently to them: avoiding them, 29%; not calling them, 7%; not inviting them to events, 8%; and not inviting their families to events, 7%.


    Go to:
    Discussion

    Persons placed in quarantine have their freedom restricted to contain transmissible diseases. This takes a considerable toll on the person. In relation to the recent global outbreak of SARS, considerable time has been spent discussing the specifics of quarantine and how to promote adherence to infection control measures. Little, if any, analysis has focused on the effect of quarantine on the well-being of the quarantined person. The objective of the study survey was to capture a range of experiences of quarantined persons to better understand their needs and concerns. This knowledge is critical if modern quarantine is to be an effective disease-containment strategy. To our knowledge, a consideration of the adverse effects of quarantine, including psychological effects, has not previously been systematically attempted.
    Our results show that a substantial proportion of quarantined persons are distressed, as evidenced by the proportion that display symptoms of PTSD and depression as measured by validated scales. Although quarantined persons experienced symptoms suggestive of both PTSD and depression, the scales that were used to measure these symptoms are not sufficient to confirm these diagnoses. To confirm the diagnoses of PTSD and depression, structured diagnostic interviews are required. Because the survey was anonymous, this was not possible.
    A score of >20 on the IES-R was used to estimate the prevalence of PTSD symptoms in our study population. This corresponds to the mean score measured on the IES-R in a study of journalists working in war zones that used diagnostic psychiatric interviews to confirm the presence of this disorder (11). Since most respondents to our survey were healthcare workers, we chose a work-related traumatic event for the comparison group. While other cutoff points may have been used to estimate the prevalence of PTSD symptoms in our population, the risk factors that we identified for increased PTSD symptoms, rather than the absolute prevalence of PTSD in our study participants, are the important findings of this study. This also applies to the risk factors that we identified for increased depressive symptoms in the respondents. Quarantined persons with risk factors for either PTSD or depressive symptoms may benefit from increased support from public health officials.
    In this population, the presence of PTSD symptoms was highly correlated with the presence of depressive symptoms even though different clinical symptoms characterize the two disorders. Kessler's National Comorbidity Study indicated a 48.2% occurrence of depression in patients with PTSD (15).
    PTSD is an anxiety disorder characterized by avoiding stimuli associated with a traumatic event, reexperiencing the trauma, and hyperarousal, such as increased vigilance (16). This disorder may develop after exposure to traumatic events that involve a life-threatening component, and a person's vulnerability to the development of PTSD can be increased if the trauma is perceived to be a personal assault (17). Increased length of time spent in quarantine was associated with increased symptoms of PTSD. This finding might suggest that quarantine itself, independent of acquaintance with or exposure to someone with SARS, may be perceived as a personalized trauma. The presence of more PTSD symptoms in persons with an acquaintance or exposure to someone with a diagnosis of SARS compared to persons who did not have this personal connection may indicate a greater perceived self-risk. The small number of respondents who were acquainted with or exposed to someone who died of SARS may explain the lack of correlation between this group and greater PTSD and depressive symptoms (44 persons died of SARS in the greater Toronto area).
    This study also notes the trend toward increasing symptoms of both PTSD and depression as the combined annual income of the respondent household fell from CAD >$75,000 to CAD <$40,000. Quarantined persons with a lower combined annual household income may require additional levels of support. Since the survey was Web-based and required that respondents have access to a computer, the survey was likely answered by a more affluent and educated subgroup of persons. Since respondents with a lower combined annual household income experienced increased symptoms of PTSD and depression, and since those with lower combined annual household incomes were not as likely to have access to a computer, the results of this survey may underestimate the prevalence of psychological distress in the overall group of quarantined persons. Overall, most respondents did not report financial hardship as a result of quarantine. This finding is likely explained by the fact that >50% of the respondents reported a combined annual household income of CAD >$75,000.
    As many as 50% of respondents felt that they had not received adequate information regarding at least one aspect of home infection control, and not all of the respondents adhered to recommendations. Why some infection control measures were adhered to while others were not is unclear. A combination of lack of knowledge, an incomplete understanding of the rationale for these measures, and a lack of reinforcement from an overwhelmed public health system were likely contributors to this problem. Of particular interest, strictly adhering to infection control measures, including wearing masks more frequently than recommended, was associated with increased levels of distress. Whether persons with higher baseline levels of distress were more likely to strictly adhere to infection-control measures or whether adherence to recommended infection-control strategies resulted in developing higher levels of distress cannot be clarified without interviewing the respondents. Regardless of the cause, this distress may have been lessened with enhanced education and continued reinforcement of the rationale for these measures and outreach efforts to optimize coping with the stressful event.
    This study has several limitations. The actual number of respondents is low compared to the total number of persons who were placed into quarantine and therefore may not be representative of the entire group of quarantined persons. However, lack of funding, confidentiality of public health records, and an overloaded public health response system limited sampling in this study. Furthermore, a self-selection effect may have occurred with those persons who were experiencing the greatest or least levels of distress responding to the survey. In addition, respondents required access to a computer to respond, which suggests that they may be more educated and have higher socioeconomic status than the overall group who were quarantined. They also had to be English speaking. Recognizing these limitations, however, an anonymous Web-based method was chosen because concerns about persons' confidentiality precluded us from access to their public health records.
    A Web-based format was chosen over random-digit dialing for both cost considerations and time constraints. The project was initiated and completed without a funding source soon after the outbreak period at a time when concerns about SARS were still a part of daily life in Toronto. Obtaining as much information about the adverse effects of quarantine as close to the event as possible was important because a study conducted several months later would have been subject to the limitations of substantial recall bias. If this study were to be repeated, a study design ensuring a more representative selection of the population that used a combination of quantitative and qualitative methods, including structured diagnostic interviews, would be recommended to overcome these concerns. In the event of future outbreaks, a matched control group of persons who were not quarantined should be considered because it would allow an assessment of the distress experienced by the community at large.
    Finally, we determined only the prevalence of symptoms of PTSD and depression in our study population because these were the predominant psychological distresses that were observed to be emerging in our SARS patient population (W.L.G., pers. comm.). We also focused on symptoms of PTSD and depression because we believed that they would be the most likely to cause illness and interfere with long-term functioning. Future studies should assess persons for other psychological responses, including fear, anger, guilt, and stigmatization. A standardized survey instrument that considers the full spectrum of psychological responses to quarantine should be developed. In the event of future outbreaks in which quarantine measures are implemented, a standardized instrument would enable a comparison between the psychological responses to outbreaks of different infectious causes and could be used to monitor symptoms over time.
    Despite these limitations, the results of this survey allow for the generation of hypotheses that require further exploration. Our data show that quarantine can result in considerable psychological distress in the forms of PTSD and depressive symptoms. Public health officials, infectious diseases physicians, and psychiatrists and psychologists need to be made aware of this issue. They must work to define the factors that influence the success of quarantine and infection control practices for both disease containment and community recovery and must be prepared to offer additional support to persons who are at increased risk for the adverse psychological and social consequences of quarantine.

    Go to:
    Appendix

    Comments from survey respondents

    Unmet informational needs:
    1. Public health /employers:
    a. Difficulty in access: "Called Public Health for 2 days. Got through 3 times; waited on hold for hours, then got **** up on." (respondent # 131)
    b. Failed expectations: "I was expecting someone from Public Health to check up on me but never got a call except on my last day of quarantine." (respondent #126); "Nobody told me anything. I was not contacted by health officials at all." (respondent# 99); "My employer should have been more forthcoming." (respondent #7); "I was not called by the hospital I worked at. I saw the quarantine on the news and spent a whole day trying to get through to my unit." (respondent #40)
    c. Lack of support: "I was looking for more support from the health care professionals. They left me in the dark to deal with this." (respondent #22)
    2. Nature of information:
    a. Details re: infection control: "I have since learned that there are a lot of precautions that no one ever told me about." (respondent #81)
    b. Inconsistencies: "Information was not always the same. Many inconsistencies." (respondent #66)
    c. Timing: "Information was given too late, as I started 1 week after exposure. Unacceptable!" (respondent #27)
    d. Specific issues:
    i. Children: "Nobody can tell me exactly where my children would be arranged to go in case I got SARS myself. I was very panicked at that time and my husband was admitted that time because of the SARS." (respondent # 78)
    ii. Onset of symptoms: "What symptoms were considered serious and what to do when I experienced those symptoms." (respondent # 21); "I was mildly alarmed to realize that I didn't know what to do if I actually did develop symptoms of SARS." (respondent # 111)
    iii. Prognosis of SARS: "Most of the really important info is largely unknown" (respondent #53); "Prognosis for SARS, how many have recovered, what health problems recovered patients still have." (respondent #8I)
    iv. Mode of transmission: "If airborne what were the chances of contracting the disease… MD unable to answer." (respondent #90)


    Go to:
    Acknowledgments

    We thank Allison McGeer for her support while we conducted this research and Gina Lockwood and Gerald Devins for their statistical support.


    Go to:
    Biography


    Dr. Hawryluck is an assistant professor of critical care/respirology at the University Health Network, University of Toronto. Her research interests include bioethical issues in medicine, SARS, decision-making, and communication regarding life-sustaining interventions.


    Go to:
    Footnotes

    Suggested citation for this article: Hawryluck L, Gold WL, Robinson S, Pogorski S, Galea S, and Styra R. SARS control and psychological effects of quarantine, Toronto, Canada. Emerg Infect Dis [serial on the Internet]. 2004 Jul [date cited]. http://dx.doi.org/10.3201/eid1007.030703


    Go to:
    References

    1. Risse GB "A long pull, a strong pull and all together": San Francisco and bubonic plague, 1907–1908. Bull Hist Med. 1992;66:260–86 [PubMed]
    2. Twu SJ, Chen TJ, Chen CJ, Olsen SJ, Lee LT, Fisk T, et al. Control measures for severe acute respiratory syndrome (SARS) in Taiwan. Emerg Infect Dis. 2003;9:718–20 [PMC free article] [PubMed]
    3. Centers for Disease Control and Prevention Update: use of quarantine to prevent transmission of severe acute respiratory syndrome—Taiwan 2003. MMWR Morb Mortal Wkly Rep. 2003;52:680–3 [PubMed]
    4. Mandavilli A SARS epidemic unmasks age-old quarantine conundrum. Nat Med. 2003;9:487 10.1038/nm0503-487 [PubMed] [Cross Ref]
    5. Toronto Public Health Severe acute respiratory syndrome (SARS), 2003. May 29 [cited 2003 Aug 30]. Available from: http://www.toronto.ca/health
    6. Barbera J, Macintyre A, Gostin L, Inglesby T, O'Toole T, DeAtley C, et al. Large-scale quarantine following biological terrorism in the United States: scientific examination, logistic and legal limits, and possible consequences. JAMA. 2001;286:2711–7 10.1001/jama.286.21.2711 [PubMed] [Cross Ref]
    7. Markel H Knocking out the cholera: cholera, class and quarantines in New York City, 1892. Bull Hist Med. 1995;69:420–57 [PubMed]
    8. Markel H Cholera, quarantines and immigration restriction: the view from John Hopkins, 1892. Bull Hist Med. 1993;67:691–5 [PubMed]
    9. Weiss D, Marmar C The impact of event scale—revised. In: Wilson J, Keane, T, editors. Assessing psychological trauma and PTSD. New York: Guilford; 1997
    10. Radloff LS The CES-D scale: a self-report depression scale for research in the general population. Appl Psychol Meas. 1977;1:385–401 10.1177/014662167700100306 [Cross Ref]
    11. Feinstein A, Owen J, Blair N A hazardous profession: war, journalists and psychopathology. Am J Psychol. 2002;159:1570–5 10.1176/appi.ajp.159.9.1570 [PubMed] [Cross Ref]
    12. Boyd JF, Weissman MM, Thompson WD, Myers JK Screening for depression in a community sample: understanding the discrepancies between depression symptom and diagnostic scales. Arch Gen Psych. 1982;39:1195–200 10.1001/archpsyc.1982.04290100059010 [PubMed] [Cross Ref]
    13. American Psychiatric Task Force for the Handbook of Psychiatric Measures Handbook of psychiatric measures, 1st ed. In: Yonkers KA, Samson JS. Mood disorder measures. Washington: American Psychiatric Association; 2000. p. 523–6.
    14. Corbin JM, Strauss A Basics of qualitative research. 2nd ed. Thousand Oaks (CA): Sage Publications;1998
    15. Kessler RC, Sonnega A, Bromet E Post-traumatic stress disorder in the National Comorbidity Survey. Arch Gen Psych. 1995;52:1048–60 10.1001/archpsyc.1995.03950240066012 [PubMed] [Cross Ref]
    16. Diagnostic and statistical manual of mental disorders, 4th ed. Washington: American Psychiatric Association; 1997
    17. Breslau N, Kessler RC, Chilcoat HD, et al. Trauma and posttraumatic stress disorder in the community: the 1996 Detroit area survey of trauma. Arch Gen Psych. 1998;55:626–32 10.1001/archpsyc.55.7.626 [PubMed] [Cross Ref]



    <hr class="whole_rhythm no_bottom_margin">Articles from Emerging Infectious Diseases are provided here courtesy of Centers for Disease Control and Prevention


    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3323345/
    Last edited by sharon sanders; August 9th, 2014, 08:19 AM. Reason: added paper
    "May the long time sun
    Shine upon you,
    All love surround you,
    And the pure light within you
    Guide your way on."

    "Where your talents and the needs of the world cross, lies your calling."
    Aristotle

    “In a gentle way, you can shake the world.”
    Mohandas Gandhi

    Be the light that is within.

  • #2
    Re: Effects of Quarantine

    Conclusion excerpt
    . . . Our data show that quarantine can result in
    considerable psychological distress in the forms of PTSD
    and depressive symptoms. Public health officials, infectious
    diseases physicians, and psychiatrists and psychologists
    need to be made aware of this issue. They must work
    to define the factors that influence the success of quarantine
    and infection control practices for both disease
    containment and community recovery and must be prepared
    to offer additional support to persons who are at
    increased risk for the adverse psychological and social
    consequences of quarantine. . . .



    http://novel-infectious-diseases.blogspot.com/

    Comment


    • #3
      Re: Effects of Quarantine

      Most likely, over the next few days and possibly into weeks ahead, the public will be hearing about sheltering-in-place or being in quarantine. A surreal concept, perhaps, for many. The above postings may be helpful in clarifying some of the issues.

      My thoughts go to those already experiencing this due to being ill or having had contact with someone who is ill.

      Comment


      • #4
        Re: Effects of Quarantine

        Hopefully the internet will help people feel less isolated. I know of several of my childrens friends who are in quarantine at the moment and they all seem to be posting on facebook, bebo etc. They seem to be getting a lot of support/encouragement/sympathy from their classmates - and that always makes things easier to cope with.
        “The only security we have is our ability to adapt."

        Comment


        • #5
          Re: Effects of Quarantine

          I agree - social networking is a just in time tool.....as long as the web doesn't get overloaded and shut down......with a virus!

          Comment


          • #6
            Re: Effects of Quarantine

            Originally posted by colormyquilt View Post
            Most likely, over the next few days and possibly into weeks ahead, the public will be hearing about sheltering-in-place or being in quarantine. A surreal concept, perhaps, for many. The above postings may be helpful in clarifying some of the issues.

            My thoughts go to those already experiencing this due to being ill or having had contact with someone who is ill.
            DHS Sets Guidelines For Possible Swine Flu Quarantines

            Posted by Declan McCullagh | 4



            <!-- sphereit start -->
            (AP / CBS)


            The U.S. Department of Homeland Security has sent a memo to some health care providers noting procedures to be followed if the swine flu outbreak eventually makes quarantines necessary.

            DHS Assistant Secretary Bridger McGaw circulated the swine flu memo, which was obtained by CBSNews.com, on Monday night. It says: "The Department of Justice has established legal federal authorities pertaining to the implementation of a quarantine and enforcement. Under approval from HHS, the Surgeon General has the authority to issue quarantines."

            McGaw appears to have been referring to the section of federal law that allows the Surgeon General to detain and quarantine Americans "reasonably believed to be infected" with a communicable disease. A Centers for Disease Control official said on Tuesday that swine flu deaths in the U.S. are likely.

            Federal quarantine authority is limited to diseases listed in presidential executive orders; President Bush added "novel" forms of influenza with the potential to create pandemics in Executive Order 13375. Anyone violating a quarantine order can be punished by a $250,000 fine and a one-year prison term.

            A Homeland Security spokesman on Tuesday did not have an immediate response to followup questions about the memo, which said "DHS is consulting closely with the CDC to determine appropriate public health measures."

            The memo from McGaw, who is DHS' acting assistant secretary for the private sector, also said: "U.S. Customs and Coast Guard Officers assist in the enforcement of quarantine orders. Other DOJ law enforcement agencies including the U.S. Marshals, Federal Bureau of Investigation, and Bureau of Alcohol, Tobacco, Firearms and Explosives may also enforce quarantines. Military personnel are not authorized to engage in enforcement."

            Quarantines are hardly new: their history stretches at least as far back as the Bible, which describes a seven-day period of isolation that priests must impose when an infection is apparent. The word literally means a period of 40 days, which cities along the Mediterranean shipping routes imposed during the plague of the 15th century, a legal authority reflected in English law and echoed in U.S. law.

            Congress enacted the first federal quarantine law in 1796, which handed federal officials the authority to assist states in combating the yellow fever epidemic. In response to the 1918 influenza epidemic, states levied quarantines and imposed mask laws – with the District of Columbia restricting residents to their homes and San Francisco adopting the slogan "Wear a Mask and Save Your Life! A Mask is 99% Proof Against Influenza." Public health authorities quarantined the entire campus of Syracuse University for two-and-a-half weeks in October of that year.

            Until recently, the last involuntary quarantine in the United States was in 1963. Then, in 2007, Andrew Speaker, an Atlanta lawyer, was quarantined inside a hospital in Denver on suspicion of having extensively drug-resistant tuberculosis. It turned out that the CDC was incorrect and Speaker had a milder form of the disease.

            The CDC's error is one example of how quarantines can raise civil liberties issues. If a suspected swine flu patient is confined to a hospital isolation ward for a week or two, who pays for the bills? What if private businesses find their buildings requisitioned in an emergency? Or if hospital employees charged with enforcing the quarantine fail to show up for work?

            McGaw's memo on Monday also said that the federal plan to respond to pandemic influenza was "in effect."

            The Bush administration released the National Strategy For Pandemic Influenza in November 2005; it envisioned closer coordination among federal agencies, the stockpiling and distribution of vaccines and anti-viral drugs, and, if necessary, government-imposed "quarantines" and "limitations on gatherings."

            A Defense Department planning document summarizing the military's contingency plan says the Pentagon is prepared to assist in "quarantining groups of people in order to minimize the spread of disease during an influenza pandemic" and aiding in "efforts to restore and maintain order."

            http://www.cbsnews.com/blogs/2009/04...y4975598.shtml

            ************************************************** ***
            Homeland Security Issues Alert On Mandatory Quarantine Procedures
            Posted By admin On April 29, 2009 @ 8:55 am
            Paul Joseph Watson

            Wednesday, April 29, 2009

            The Department of Homeland Security has sent out an alert to health care providers outlining how BATF, FBI, and U.S. Marshals will be called upon to impose mandatory quarantines in the event of a widespread swine flu outbreak in the U.S.
            According to the report, “DHS Assistant Secretary Bridger McGaw circulated the swine flu memo, which was obtained by CBSNews.com, on Monday night. It says: “The Department of Justice has established legal federal authorities pertaining to the implementation of a quarantine and enforcement. Under approval from HHS, the Surgeon General has the authority to issue quarantines.”
            The memo states, “U.S. Customs and Coast Guard Officers assist in the enforcement of quarantine orders. Other DOJ law enforcement agencies including the U.S. Marshals, Federal Bureau of Investigation, and Bureau of Alcohol, Tobacco, Firearms and Explosives may also enforce quarantines. Military personnel are not authorized to engage in enforcement.”
            However, a separate Defense Department planning document on dealing with pandemics states that the Pentagon will use the forces at its disposal to assist in “quarantining groups of people in order to minimize the spread of disease during an influenza pandemic” and aid in “efforts to restore and maintain order.”

            As we reported yesterday, so-called “involuntary isolation” is already being enforced in certain areas of the United States. The state’s health director in North Carolina, Dr. Jeffrey Engel, said that authorities were already involuntarily isolating patients who may have the swine flu virus. He refused to divulge the location of where the victims were being quarantined.


            News reports such as this one from MSNBC are prevaricating around the contention that quarantines are a normal event that Americans should be comfortable with. In reality, there has only been one case of “involuntary quarantine” in the U.S. in the last 45 years.
            “In 2007, Andrew Speaker, an Atlanta lawyer, was quarantined inside a hospital in Denver on suspicion of having extensively drug-resistant tuberculosis. It turned out that the CDC was incorrect and Speaker had a milder form of the disease,” states the CBS report.
            The MSNBC report also falsely claims that quarantines will solely be handled on a state/local level, when in reality, Bush’s executive order 13375 outlines a federal response, and the DHS memo lists numerous federal authorities that will have powers of quarantine.
            In addition, the Bush administration’s National Strategy For Pandemic Influenza, released in November 2005, states that the federal government will impose “quarantines” and “limitations on gatherings”.
            With Time Magazine busy preparing Americans to accept enforced mass vaccination programs and telling them to “trust” the government and “forgive” them when the vaccines cause death and injuries, the prospect of mandatory quarantines will likely be the precursor for any such nationwide vaccination program. The vaccine to supposedly combat swine flu is being manufactured by Baxter International, who were caught red-handed last month attempting to release bird flu vaccines which were contaminated with the deadly avian flu virus itself.
            Swine flu has caused the death of one toddler in the U.S. and in fact only seven of the supposed 159 fatalities in Mexico have been confirmed as swine flu - meaning the other 152 could have been due to any number of infectious diseases that routinely kill Mexicans in the thousands on a yearly basis.
            The comparative threat of swine flu does not correlate with the feverish reaction of authorities, who in the initial stages of the outbreak refused to take any measures to contain it, such as closing the border with Mexico, but after the virus had already begun to spread, they were quick to prepare draconian control measures while hyping the inevitability of a pandemic.
            Meanwhile, the hysteria whipped up by the media has spread faster than the actual virus itself.

            <hr class="Divider" style="text-align: center;">
            URL to article: http://www.infowars.com/homeland-sec...ne-procedures/
            "In the beginning of change, the patriot is a scarce man (or woman https://flutrackers.com/forum/core/i...ilies/wink.png), and brave, and hated and scorned. When his cause succeeds, the timid join him, for it then costs nothing to be a patriot."- Mark TwainReason obeys itself; and ignorance submits to whatever is dictated to it. -Thomas Paine

            Comment


            • #7
              Re: Effects of Quarantine

              Niko. Great find. Thanks.

              Comment


              • #8
                Re: Effects of Quarantine

                Great pun intended.

                Comment


                • #9
                  Re: Effects of Quarantine

                  Originally posted by twiggy8085@aol.com View Post
                  Great pun intended.
                  Welcome twiggy8085@aol.com. Great sense of humor is good.

                  Comment


                  • #10
                    Re: Effects of Quarantine

                    http://www.reuters.com/articlePrint?articleId=USHKG2279

                    Hong Kong hotel quarantine move stirs controversy
                    Sat May 2, 2009 3:53am EDT
                    By Tan Ee Lyn

                    HONG KONG, May 2 (Reuters) - Travellers quarantined in a Hong Kong hotel for a week after a Mexican guest tested positive for the H1N1 flu expressed dismay on Saturday at the tough steps, while an infectious disease expert said the authorities had over-reacted.

                    Police wearing surgical masks sealed off the Metropark hotel on Friday night after test results on the 25-year-old Mexican man were confirmed, ordering approximately 200 guests and 100 staff to stay in the hotel for the next seven days.
                    The measures taken by the authorities in Hong Kong underscore the concern here about the new flu and the confirmed case, Asia's first. Hong Kong was badly hit by the SARS virus in 2003 and has had many episodes of H5N1 bird flu for more than a decade.

                    Officials said no one would be allowed to leave the hotel in the Wanchai district, an area popular with tourists.

                    "They said everybody needed to go back to their rooms. I don't want to go to my room because I want to be out," an Australian man in the hotel told local television by telephone.

                    "They told me I will stay here. I won't be allowed out and this is it."

                    Brice Chevallereau, a French tourist, checked into the hotel on Friday afternoon but did not stay the night. When he returned to the hotel on Saturday, he was told by authorities he would have to be quarantined.

                    "Why do I have to go inside?" Chevallereau asked. "I just stayed two minutes in the lobby. It's not fair."

                    Journalists and camera crews massed on the street outside the hotel, which is being guarded by police and cordoned off with blue and white tape. Shops near the hotel were shuttered.

                    "How can there be business? The police vans are all around here," said Li Mingtai, a waiter at a nearby restaurant.

                    Twelve guests who had refused to stay were taken to a lodging house close to the border with mainland China. The site was used to quarantine Hong Kong people who were exposed to the SARS virus back in 2003, a government spokesman said.

                    PASSENGERS URGED TO COME FORWARD

                    The Mexican man arrived in Hong Kong from Mexico on Thursday following a stopover in Shanghai. He developed a fever after arriving and took a taxi to a hospital on Thursday evening. He is in a stable condition, officials said.

                    Authorities appealed for 142 passengers and crew on the same flight as the Mexican to report to health officials.

                    Lo Wing-lok, an infectious disease expert, said the government was over-reacting.

                    "He would have been infectious starting from the time he was on the plane. Think about all the people around him on the plane, while he was going through customs, waiting for baggage, in the taxi, in the hotel and when he got to hospital," Lo said.

                    "So how can it be effective if the government is just trying to isolate people in the hotel, it is a mission impossible."

                    Health officials said the "essential needs" of those inside the hotel would be looked after. They would also get regular medical check-ups and psychologists were on standby.

                    An elderly couple passed a bag of clothes to police at the entrance for their daughter, who works in the hotel.

                    The new virus, which is largely swine and part avian and human, has killed up to 101 people in Mexico, but confirmed cases in other countries have been mild.

                    Nevertheless, news of the infected traveller caused jitters in Hong Kong and some people were taking no chances.

                    In subways, ferry terminals and on the streets, more people went about their business on Saturday wearing surgical masks, although some had masks fashioned out of cloth.

                    At the checkout counters in a supermarket, residents rifled through masks and sterilisers.

                    A sign nearby said: "Prevent flu infection." (Additional reporting by Sui-Lee Wee and Stefanie McIntyre, editing by Dean Yates)
                    Thought has a dual purpose in ethics: to affirm life, and to lead from ethical impulses to a rational course of action - Teaching Reverence for Life -Albert Schweitzer. JT

                    Comment


                    • #11
                      Re: Effects of Quarantine

                      from the news feed
                      http://www.abc.net.au/news/stories/2...28/2583316.htm

                      Swine Flu HQ: Sunday too far away
                      By Sarah Collerton
                      Life in swine flu HQ: Sarah turns her attention to the washing up. (ABC News)
                      News Online's Sarah Collerton has been in quarantine since Monday after a housemate tested positive to swine flu. Sarah is keeping an online diary of the experience and this is her fourth instalment.Living in "Swine Flu HQ" is really just a week-long waiting game. But what was initially an anxious wait on results (all clear) has morphed into a wait on just getting out of this place.
                      Authorities have insisted the five of us cannot leave this house, on the outskirts of Brisbane, until Sunday, so we're doing our best to stay entertained and out of each other's hair.
                      The sickest of the bunch, "Swiney Todd", is feeling a lot better today; his nose has dried up and his cough quelled.
                      We're still not sure if he ever had the swine, but if he did, he's almost better. No-one else is exhibiting symptoms at all.
                      What we're left wondering is, can we contract this new strain of flu twice? Is it like the measles? Other strains of flu can only be contracted once, but is this a newer, meaner flu that bulldozes that concept?
                      Authorities weren't really certain when I asked. A public-health nurse from Population Health, the Queensland Health Department that looks after disease control in the state, told me he wasn't sure and someone else would phone me about it.
                      He said he thinks victims would develop antibodies to fight off the disease like regular flu, but he again said he wasn't completely sure because it's a such a new strain.
                      Later, another Population Health nurse called back and said she'd put me in touch with the media department to answer my inquiry.
                      Logic would say this is like other strains of flu. It can mutate and mutate until it's a whole different strain, to which, even if you've had swine flu, you won't be immune.
                      And as Australia enters its peak winter flu season, it's not a great time for swine flu to spread across our shores.
                      The confusion about the virus - to which I've been exposed - is not exactly making it easier to grasp.
                      Glorious food
                      I'm not too sure how we've managed such a feat, but we've hoed down much of the $245 worth of groceries left on our doorstep less than two days ago.It probably helps that we're locked up with a chef, Jason, who is pumping out lovely meals such as homemade gnocchi (no complaints here).
                      With the question: "What do you guys want me to cook for ...?" being posed at least three times a day, I'm almost certain there are worse ways to be quarantined.
                      And we've had a great support network, with people offering to drop off food, DVDs and books, and I can only hope that other Australians who may have to enter swine flu quarantine will have the same sort of help.
                      As we've passed the halfway point, spirits are fairly high, though there have been, as can be expected, a few minor wars over the TV remote.
                      Thought has a dual purpose in ethics: to affirm life, and to lead from ethical impulses to a rational course of action - Teaching Reverence for Life -Albert Schweitzer. JT

                      Comment


                      • #12
                        Re: Effects of Quarantine

                        bump this.

                        Comment


                        • #13
                          Re: Effects of Quarantine

                          Household Responses to School Closure Resulting from Outbreak of Infl uenza B, North Carolina
                          April J. Johnson,* Zack S. Moore,*† Paul J. Edelson,* Lynda Kinnane,‡ Megan Davies,*† David K. Shay*, Amanda Balish,* Meg McCarron,* Lenee Blanton,* Lyn Finelli,* Francisco Averhoff,* Joseph Bresee,* Jeffrey Engel,† and Anthony Fiore*


                          School closure is a proposed strategy for reducing infl
                          uenza transmission during a pandemic. Few studies have
                          assessed how families respond to closures, or whether other
                          interactions during closure could reduce this strategy’s
                          effect. Questionnaires were administered to 220 households
                          (438 adults and 355 children) with school-age children
                          in a North Carolina county during an infl uenza B virus
                          outbreak that resulted in school closure. Closure was considered
                          appropriate by 201 (91&#37 households. No adults
                          missed work to solely provide childcare, and only 22 (10%)
                          households required special childcare arrangements; 2
                          households incurred additional costs. Eighty-nine percent
                          of children visited at least 1 public location during the closure
                          despite county recommendations to avoid large gatherings.
                          Although behavior and attitudes might differ during a
                          pandemic, these results suggest short-term closure did not
                          cause substantial hardship for parents
                          . Pandemic planning
                          guidance should address the potential for transmission in
                          public areas during school closure.

                          Source:
                          http://www.cdc.gov/eid/content/14/7/pdfs/1024.pdf

                          Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 14, No. 7, July 2008
                          We were put on this earth to help and take care of one another.

                          Comment

                          Working...
                          X