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In addition to testing and contact tracing, Asian countries have concentrated the isolation of mild symptomatic cases. But the West does not.
A large center in Singapore that organizes an aerospace exhibition that has been renovated to house thousands of beds for people with asymptomatic or mild nCoV symptoms. South Korea requires dormitories, including worker housing from some technology companies, for this purpose.
Since March 4, when South Korea’s infectious disease law has tightened, people who are positive for nCoV in the country cannot refuse to isolate themselves.
In Vietnam and the Hong Kong Special Administrative Region of China, where Covid-19 has been nearly stopped, the hospital can accept both mild and severe cases, but authorities go one step further. . They also put people in close contact with infected people in intensive isolation facilities, because people with Covid-19 can transmit the virus to others even before symptoms appear.
The exhibition center in Wuhan was converted into a field hospital in February to care for patients with mild symptoms. Photos: Reuters.
This approach differs greatly from most Western countries, where people who need medical care are admitted to hospitals, while mild cases, which represent the majority of cases, are mainly required to isolate themselves. at home Many public health experts in Europe and the United States say they need to change that, while others argue that concentrated isolation is too restrictive of personal liberties and forcing people with nCoV to separate from relatives.
In Italy, where more than 219,000 cases have been reported, health officials recognize households as the main source of infection. Andrea Checchi, mayor of San Donato Milanese in Milan, said he was aware of this trend when looking at the list of nCoV infections in the city. “The same last name and phone number are repeated,” he said. “Many people are infected in homes.”
Italy’s National Institutes of Health found that more than a fifth of people who have been positive for nCoV since April 1 may have been infected by family members, according to data updated last week. This rate is only after the number of infections in nursing homes, which represents approximately half of the confirmed cases.
In cities like Milan, people infected with nCoV are selected to be quarantined in specialized hotels. But encouraging them to isolate families is not a priority for the government, and most infected people stay home. That mistake must be corrected, warns Roberto Burioni, a virologist at the San Raffaele Hospital in Milan. “This is very essential,” he said.
Experts say it is difficult for family members to avoid contact at home entirely. Even minor cases need physical and mental care, and families tend to be subjective after a few days of isolation, Annelies Wilder-Smith, professor of new infectious diseases at the College of Thermal Medicine. and said Sanitation London.
Some people suspect that they have nCoV but do not get tested and when the symptoms decrease they conclude that they may have never been infected, when in fact they may have infected with nCoV and transmitted the virus to others.
Wilder-Smith and a team of experts compared the two types of isolation and published the results in the Lancet medical journal. They estimate that in a city of 4 million people, home insulation will help reduce 190,000 cases, or 20%. Meanwhile, when applying concentrated insulation, that number will be almost 550,000, or 57%.
However, he said that concentrated isolation at facilities like convention centers or military barracks could be considered offensive to most Europeans and Americans. “This sounds scary to the West,” he said.
A doctor with nCoV infection isolated at home with her husband and children in Italy last month. Photos: NYTimes.
The city of Wuhan, where the outbreaks began in China, soon realized that it should not be isolated at home. Wuhan authorities discovered that the family members were contagious and began a strict isolation campaign in February. Suspicious cases or mild symptoms and those who have had close contact with the infected are admitted to field hospitals or quarantine centers.
In South Korea, when cases increased in late February, many mild cases were initially isolated at home because the country did not have enough beds for everyone. But officials then quickly moved on to concentrated isolation in the company’s dorms for people without severe symptoms. They have beds, wifi and in some places TV.
No Korean patient refused to remain isolated as Korea tightened regulations, violators can be fined or jailed for violating. Almost all field treatment facilities are now closed, approximately 85% of patients across the country have been discharged, and South Korea no longer faces a shortage of patient beds.
Harvey Fineberg, chairman of the Standing Committee on New Infectious Diseases at the National Academy of Science, Technology and Medicine in Washington, DC, said the United States could begin central isolation in a spirit of self-reliance. prayer, use of hotel or public facility facilities, and nursing arrangements.
Centralized isolation also has other advantages. Doctors realize that many people with nCoV who do not have severe symptoms may suddenly have difficulty breathing. By concentrating the isolation, they monitor for worsening symptoms and are rushed to a hospital, according to Todd Pollack, an infectious disease specialist at Harvard Medical School and who participates in a health program in Vietnam. .
Vietnam has smoothed out the epidemic curve, when only 288 nCoV cases were recorded, 25 days with no detectable cases in the community, thanks in part to isolation. Nguyen Nhan Hoa, 29, owns an electrical appliance store, quarantined at a military training center in Hanoi last month after a woman selling onions infected him with nCoV. They were both wearing masks and he did not accept the money returned by the woman, but he was still isolated to avoid it.
Hoa shared a room with 7 other people, provided with soap, toothpaste, and shampoo. Health workers measure their temperature twice a day, and soldiers deliver rice three times a day. The speaker plays music every night, including the song “Jealousy” that encourages hand washing and revolutionary songs.
Insulation facilities may not be very comfortable with shared baths and toilets. But Le Thu Hoai, a 32-year-old financial analyst who lived in London for 16 years, said she was happy to accept quarantine when she and her 2.5-year-old son flew back to Vietnam to blame for the situation in the UK. The Hoai complex said that even if the government does not compel it, it will go into segregation, perhaps in a short-term hotel or rental house instead of going to its parents’ house in Hanoi.
The two-week isolation period was uncomfortable because Hoai was pregnant, but it was said that she should not pay too much attention to the problem in the midst of a public health emergency. She and her children were initially isolated in a library and in the same room as someone else. When her son had a cough, they were transferred to a barracks with more nurses and doctors.
Wilder-Smith, who lived in Singapore for 18 years, said Westerners could gradually accept concentrated isolation. Blocks and masks used to be difficult to accept, but now these measures have been widely used.
“What is not acceptable today can be accepted tomorrow, if everyone understands why it needs to be done,” he said.
Phương Vũ (The O WSJ)
