# 7379
Singapore, which already issued warnings to travelers planning to visit the Middle East last month (see MERS-CoV: Singapore Issues Umrah Health Advisory) has set aside eight chalets at a local resort to be used as quarantine housing for anyone suspected of being exposed to the MERS coronavirus.
Singapore was one of those areas very hard hit by SARS ten years ago, and they were among the first countries to implement quarantine measures.
First a statement by Singapore’s Ministry of Health, then I’ll be back with some background on how quarantine was used (successfully) with SARS a decade ago to contain the virus.
STRENGTHENING PREPAREDNESS FOR EMERGING INFECTIOUS DISEASES
Strengthening preparedness for emerging infectious diseases
As at 7 Jun 2013, the World Health Organisation (WHO) has reported a total of 55 confirmed cases of Middle East Respiratory Syndrome Coronavirus (MERS-CoV) worldwide, since the disease was first reported in September 2012.
There are currently no cases of MERS-CoV in Singapore. The risk of an outbreak in Singapore remains low. However, given today’s globalised travel patterns, the Government remains vigilant and is stepping up its operational readiness in the event of an imported case.
As a precautionary measure, the Government will put on standby the Home Team NS (HTNS) Pasir Ris Chalets as possible quarantine housing from 17 June 2013 (Monday) at 1.00pm. This is to ensure that quarantine facilities can be deployed at short notice to safeguard public health, if the need arises.
Options Available to Members to Minimise Inconvenience
HTNS members who have made prior bookings at the chalets may continue with their holiday plans at the HTNS Pasir Ris Chalets or opt to cancel their bookings. Instead of outright cancellation of bookings, these voluntary options minimise inconveniences. The public can continue with their holiday plans at the chalet until the time comes for the chalets to be activated as quarantine facilities
When the facility is activated to house the persons served with the Quarantine Order – Persons Under Quarantine (PUQ), chalet occupiers will be requested to check-out of the chalets within 3 hours upon receiving the notice, which will be served between 8.30am to 6.00pm. They will be given a full refund of their booking fee and vouchers worth $100, as a gesture of goodwill.
For HTNS members who prefer to make alternative holiday plans, they may opt to cancel their bookings for chalets booked on or after 17 June 2013. They will be similarly given a full refund of the booking fee and a $100 voucher, as a gesture of goodwill.
HTNS will contact all affected members. We seek the understanding of families who have made prior bookings at the HTNS Pasir Ris chalets.
Capacity at the HTNS Pasir Ris Chalets
Should HTNS Pasir Ris Chalets be activated as a Government Quarantine Facility (GQF), seven of the eight units will serve as quarantine housing with the remaining unit functioning as the operations centre. 21 persons can be quarantined under this arrangement.
The Government will continue to monitor developments and stands ready to respond to any evolving situation to safeguard the public health of all people in Singapore.
For more information, please visit the webpage www.e101.gov.sg/mers-cov.
Although the terms are often used interchangeably by the public, the CDC sums up the difference between quarantine and isolation this way:
- Isolation applies to persons who are known to be ill with a contagious disease.
- Quarantine applies to those who have been exposed to a contagious disease but who may or may not become ill.
So presumably, these chalets would be used for people who have been exposed to a MERS infected person, but are not yet symptomatic (or only mildly so).
Earlier this year, in EID Journal: A Brief History Of Quarantine, I wrote about the use of quarantine and isolation with the 2003 SARS outbreak:
During the 2003 SARS epidemic, Isolation was used in the United States for patients who were ill, but since transmission of the virus was very limited here, quarantine was not recommended for those exposed (cite).
In other countries, where transmission risks were greater, quarantines were used – quite successfully – in order to contain the virus.
- Singapore was one of the first countries to mandate quarantines when more than 800 family members of SARS patients were ordered to stay in their homes.
- Hong Kong sealed part of the Amoy Gardens Apartment complex after scores of cases erupted there, and later moved all remaining residents to two holiday camps where they were quarantined.
- And Toronto, Canada closed schools and quarantined thousands in their bid to contain the virus (see The SARS Experience In Ontario, Canada).
The graph below shows two distinct phases of disease transmission in Canada, both apparently dampened by the implementation of quarantines.
While the aggressiveness of quarantine measures taken in Toronto have been criticized by some (see Severe acute respiratory syndrome: Did quarantine help?), many experts have stated that quarantining those exposed (usually in their own homes) helped to halt the epidemic.
A 2003 MMWR report from China’s CDC, called Efficiency of quarantine during an epidemic of severe acute respiratory syndrome--Beijing, China, 2003 found:
The use of quarantine, in combination with enhanced surveillance, isolation of SARS patients, and comprehensive use of PPE by health-care workers, appears to have been effective in controlling the recent epidemic of SARS in Beijing.
Limiting quarantine to persons who have contact with an actively ill SARS patient will likely improve the efficiency of quarantine and allow for better focus of resources in future outbreaks.
While unlikely to be popular among those caught up in one - particularly early in an outbreak - quarantines may be one of the most effective tools that public health officials have in their arsenal.
That said, the value of quarantines tends to diminish quickly as the number of cases, and geographic spread of a disease, increases.
