Medical Quarantine -- Protecting Your Family from Infection, by Dr. Cynthia Koelker

Sunday, Jan 16, 2011

Plague.  Yellow fever.  Cholera.  Diphtheria.   Diseases which evoke images of death and despair.  
Though less likely to transmit a fatal illness, would you open your door to someone with hepatitis, strep throat, or methacillin-resistant staph?  What about a person suffering from vomiting, diarrhea, a cough, or lice, or a fever?  Are you immune to measles, polio, and whooping cough – and would you even recognize these conditions?  How will you know if someone is going to come down with influenza in the next day or two?

Before antibiotics, before anti-virals, before immune globulin, societies used quarantines to protect their populations.  As early as the Middle Ages quarantines were imposed on potentially infected ships to reduce the risk of plague spreading to port cities. 

What will you do if someone shows up, seeking shelter?  Can you trust a child who appears healthy to be free of disease?  Does loving your neighbor as yourself require you to put your entire family at risk? 

In times of scarcity, when the marvels of modern medicine are unavailable, medical quarantine offers a possible solution.  The term quarantine applies specifically to apparently well people who may have been exposed to a contagious disease, and therefore may (or may not) become ill.  (For an obviously ill person, isolation procedures should be enacted, a topic for a future article.)

Almost every transmissible disease has an incubation period during which the person is infected but not yet showing signs of disease.  Quite often, a person can be contagious for one to several days before exhibiting symptoms.  Blood borne infections in asymptomatic individuals can sometimes be transmitted months or years before the infected person becomes symptomatic (as in HIV), hence the need for universal precautions.

In recent years the Haitian orphans provide an example of how the U.S. treats potentially contagious immigrants.  Though not quarantined in the usual sense, per the CDC even the apparently healthy children were all examined for:  bacterial and protozoal diarrhea, hepatitis A and E, typhoid fever, dengue fever, malaria, leptospirosis, tuberculosis, syphilis, intestinal parasites, Giardia spp., and Cryptosporidium.  They also had their immunization status checked and updated for diphtheria, pertussis, tetanus, measles, rubella, polio, hepatitis A and B, Haemophilus influenzae type b, meningocococcus, pneumococcus, and varicella (chicken pox).

Lacking the means to do any of this, what constitutes a reasonable approach to strangers seeking help?

For the purposes of this article, I’ll assume those seeking to join your group are not suffering from any apparent signs of infection including fever, chills, vomiting, diarrhea, cough, runny nose, peculiar behavior, or visible rash.  Again, lack of apparent infection does not guarantee health.  Certain illnesses such as chicken pox and influenza are often highly contagious even before symptoms have developed.  With other microbes, such as strep and typhoid, occasionally a person will develop a carrier state where they are able to transmit an infection but are not themselves infected.  In other cases an infection may be subclinical, that is, too mild to detect, as in the case of a toddler with infectious mononucleosis. 

The above reasons are the basis for quarantining apparently healthy individuals, isolating them from your established, (hopefully) healthy group, until sufficient time has passed to convince you that the well-appearing newcomers are, indeed, most likely healthy.  Even then, this cannot assure that an asymptomatic carrier is not in your presence, but the risk decreases as evidence of prolonged wellness accumulates.     

Quarantine measures depend on potential routes of transmission:  airborne, droplet-borne, direct contact, vector-borne (mosquitoes, fleas), fomite-borne (doorknobs, clothing, equipment, toys, or other inanimate object), food-borne, and feces-borne.  Blood-borne infections should not be an issue without exposure to blood or other body fluids.  (Warning: don’t have sex with strangers.) 

Ideally the quarantine area will be a separate building from your own living quarters, such as an outbuilding, garage, empty house, or barn.   If you choose to offer a room within your home, choose one vented to the outside, without ductwork connecting to the rest of the house.  Make sure the room has a negative pressure by leaving a window cracked, so the air flows into the room from the remainder of the house rather than vice versa.  If you allow newcomers within your home, have them fold their arms across their chests as you lead them to the quarantine room, to prevent potential contamination of walls, doorknobs, and other surfaces. 

Food utensils must be kept entirely separate.  Do not offer to wash dishes nor remove waste.  When offering food, do not touch a potentially contaminated dish with your own utensils.  If this occurs, either leave them with the quarantined population, or sterilize them (by boiling or with a 10% bleach solution.)
A 5-gallon bucket with attached toilet seat and sturdy disposable bags is adequate for waste disposal, preferably with an adequate supply of sturdy disposable plastic bags until the quarantine is lifted.

Who should be quarantined?  The answer could be anyone outside your group who wishes to join you.  Of course, this will depend on several factors, including known epidemics, length of time since societal breakdown, potential resources of newcomers, etc.  Even a few days of separation are better than none at all.  People from unvaccinated populations may pose a greater threat than those likely to have had standard immunizations.  No matter how long you wait, you may not know if an asymptomatic carrier is in your midst. 

How long to impose a quarantine?  Many latent viral infections will manifest themselves within a period of 3-5 days, and most within 10-14.  A three-week period of wellness assures against most transmissible infections, though such a prolonged period may impose hardship on both host and guest.  Certain viruses such as infectious mononucleosis and hepatitis A sometimes have an incubation period of 6 weeks before symptoms occur.  Anyone over the age of 30, however, is presumed to have had mono whether they’ve ever exhibited symptoms or not.  A table at Wikipedia, culled from other sources, lists incubation periods of common illnesses.

Most illnesses are not truly airborne, but rather spread via droplet contamination of surfaces including hands, doorknobs, utensils, and tools  (TB, anthrax, and influenza may be either airborne or droplet-borne.)  It is not likely you will become infected by standing across the room from a person as long as you keep your hands to yourself.  If you do touch something, do not, repeat, do not touch your face until you have washed your hands adequately.  The mucus membranes of the eyes, nose, and mouth are the primary entry points for most contagious diseases. 

If your newcomers still appear well at the end of whatever quarantine period you’ve chosen, don’t neglect to do a rudimentary physical exam.  Check their hair for nits (lice eggs) and their skin for rashes.  Ask about known infections, including sexually transmitted diseases.  Keep your ears open for a cough, or wheezing, or abnormal behavior.

This brings us, perhaps, to the point of turning someone away.  Before you even start down the road of quarantine, you should have a plan in place.  Will you turn away a child?  A slow-moving grandmother?  A hard-working adult?  Will your decision be influenced by the potential contribution of the newcomer?  Would you welcome a carpenter with lice?  What about a gourmet cook with herpes?  Or a doctor with shingles?

If I were a layman considering a post-Armageddon scenario, I would update my immunizations now, beginning with those protective against diphtheria, hepatitis A and B, tetanus, pertussis (whooping cough), polio, measles, mumps, rubella, meningitis, chicken pox, pneumonia, and influenza.  Although other illness such as yellow fever, typhoid, and Japanese encephalitis are rare in the United States, immunizations are available.  See the American Academy of Family Physicians recommendations for a list of vaccines and associated costs. 

Note: Family quarantine will be addressed in detail in my upcoming book, Armageddon Medicine.

Learning to help yourself is a process, but an easy place to start is with my book, 101 Ways to Save Money on Health Care, which includes dozens of sections on treating yourself affordably.  Available for under $10 online, the book offers practical advice on treating: respiratory infections, pink eye, sore throats, nausea, diarrhea, heartburn, urinary infections, allergies, arthritis, acne, hemorrhoids, dermatitis, skin infection, lacerations, lice, carpal tunnel syndrome, warts, mental illness, asthma, COPD, depression, diabetes, enlarged prostate, high blood pressure, high cholesterol, and much more.

Dr. Koelker has recently started a new medical blog on surviving 2012 and TEOTWAWKI at www.armageddonmedicine.net.  She welcomes your questions, comments, and critiques.


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