key: cord-0758839-2xfbozuj
authors: Cimolai, Nevio
title: Reanalysis of quarantine for coronavirus disease 2019 with emerging data
date: 2020-12-04
journal: Am J Obstet Gynecol MFM
DOI: 10.1016/j.ajogmf.2020.100291
sha: 81275e05936b62e7f50cfebd2196f99330fea5ea
doc_id: 758839
cord_uid: 2xfbozuj

nan

Reanalysis of quarantine for coronavirus disease 2019 with emerging data TO THE EDITOR: Vega et al 1 eloquently shared their timely and vast experience for the prevention and management of coronavirus disease 2019 in the context of the maternal-fetal-newborn unit. Their comments provide needed insight, which adds to the cumulative experience that will shape similar actions in other jurisdictions. The issue of "quarantine" is extremely important for communicability, and it is proposed that reconsideration of their suggestion in that regard be analyzed by their peers and public health officials. In particular, most contemporary analyses of transmission suggest that spread can occur commonly from both asymptomatic and symptomatic patients with severe acute respiratory syndrome coronavirus 2 infection after 7 days of disease onset. The determination of an afebrile state or a transition from symptomatic to asymptomatic does not considerably change that position. Presymptomatic shedding in any COVID-19 illness and prolonged shedding among some complex patients further add to the complexity. When patients are deisolated earlier, higher viral loads are likely to be present if they retain infectivity.

Concern with the sanctity of individual epidemiologic parameters was duly raised early in the spread of COVID-19 from China. 2 Even by that time, estimates of viral excretion gave an approximation that 0.5% to 5% of patients could shed the infectious virus past 14 days. Yang et al 3 have found that 95% of symptomatic patients manifest symptoms for up to 13.7 days. In assessing the dissemination of infection in Italy, Cartenì et al 4 projected that the 14-day restriction for quarantine could be called to question. Despite analyzing viral RNA excretion rather than the infectious virus, Woodruff et al 5 nevertheless proposed the exercise of due caution for the discontinuation of isolation given some prevailing recommendations.

Given the accumulation of COVID-19especific data to date, it could be reasonably extrapolated that 5% to 25% of patients with infection could excrete the infectious virus past 7 days regardless of their active clinical status. This issue alone could sizably affect COVID-19 transmission in both community and healthcare settings. It would seem justified to place considerable emphasis on such analyses when some of the alternative responses have included draconian "lockdown" and its unfortunate social and economic outfalls. In the context of pregnancy, data on this issue alone are worthy of further acquisition.

From the trenches: inpatient management of coronavirus disease 2019 in pregnancy

More data are required for incubation period, infectivity, and quarantine duration for COVID-19

Estimation of incubation period and serial interval of COVID-19: analysis of 178 cases and 131 transmission chains in Hubei province

How mobility habits influenced the spread of the COVID-19 pandemic: results from the Italian case study

COVID-19 infection: strategies on when to discontinue isolation, a retrospective study