Should you quarantine because of coronavirus? It depends on who you ask
Experts do not agree on how COVID-19 quarantines should work
This story was originally published by ProPublica.
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People who have been exposed to the coronavirus are being given incomplete or misleading information about whether they should quarantine themselves, exposing major gaps in the public health response to the pandemic and illuminating disagreement among officials about how useful the tactic even is at this point in the disease’s spread.
Travelers disembarking a plane from Rome to John F. Kennedy Airport in New York City on Tuesday said they were not told that they needed to stay home for two weeks, despite a clear policy by the Centers for Disease Control and Prevention saying they should. A woman exposed to the coronavirus at a New York wedding was told by state officials she didn’t need to go into quarantine, even though county officials said she did. In fact, they thought the venue had already called and told her.
Even the journalists covering the virus are not immune from confusion. As three ProPublica reporters were working on this story Tuesday night, word came that an attendee at NICAR, a data-reporting conference in New Orleans they all attended, had tested positive. We were told by newsroom management to work from home, but one of our editors, who had direct contact with the person who was infected, was told by a state health agency he could still go out, as long as he kept a 6-foot distance from others. A different state agency said he needed to isolate himself in a room at home, having no contact even with his family.
While health officials offer near uniformity on how to conduct self-isolation, which is what you do when you are sick, it’s hard to get a straight answer on what to do when you’ve been in contact with someone who tested positive.
Interviews with people across six states who have been exposed to the coronavirus show that even when agencies like the CDC or local health departments have a clear standard on paper, they often fail to carry out their own policies. People say agencies are giving wildly different advice to those in similar circumstances. This may be appropriate, considering the varying situations in different geographic areas; some have given up on tracking down people for quarantine and begun canceling public events. But the failure to clearly explain what to do and why has led to confusion and mistrust.
Many proactive, civic-minded citizens appear to be taking matters into their own hands, deciding on their own to stay at home, frustrated, scared and anxious, while they wait on health officials to return their calls.
The lack of clear instruction, exacerbated by a paucity of tests, comes at a critical juncture, as the number of reported cases in the United States has risen above 1,000 — a considerable increase over a week ago, yet still not so many that it’s too late for the country to curb the spread of the disease, according to public health experts.
“We need to be putting out clear and consistent messages to have a huge public health impact now,” said Dr. Megan Murray, professor of epidemiology at the Harvard T.H. Chan School of Public Health. “The data from China and from previous epidemics is absolutely clear that in cities that put clear social distancing and quarantine measures early, the epidemics have been small.”
Not everyone agrees on whether imposing quarantines on individual people is the best way to approach the virus right now. Quarantines can drain a health department’s resources because they require teams of “disease detectives” to retrace a sick patient’s steps and ask all the people who came into contact with them to self-quarantine. At a certain point, local authorities might decide that this form of containment eats up too many resources, given the number of cases, and move on to what’s known as mitigation — canceling large events and asking people to work from home and avoid public transit.
On Monday, Sacramento County, California, called off all 14-day quarantines for anyone not exhibiting symptoms. As part of the new measures, the county advised people who are elderly as well as people with underlying conditions, like heart disease or immunodeficiency disorders, to stay home and away from social gatherings where people are at arm’s-length distance. Dr. Peter Beilenson, the head of the county’s Department of Health Services, told The Sacramento Bee that the decision was designed to conserve resources and focus on reducing risks for the most vulnerable people. Two neighboring California counties announced similar efforts Tuesday.
Dr. Thomas Farley, head of the Philadelphia Department of Public Health, who previously worked in the CDC’s Epidemic Intelligence Service, said he thinks it’s too early to abandon containment efforts like quarantine — especially since there’s evidence that it worked well in China and helped to reduce cases.
“If we abandon containment,” he said, “we will just allow the virus to spread.”
When state and local officials don’t seem to agree — or communicate
Five days after Elisheva Avital attended a wedding in Rockland County, New York, her heart sank when she saw a tweet that a waiter at the banquet hall had tested positive for COVID-19. It was March 6, a Friday night, about 20 minutes before sundown. As a strict Jewish observer of the Sabbath, she couldn’t use the phone after dark. She called the hotline for her state, New Jersey, desperate for information. She waited on hold and then the line disconnected. She called again and waited a few minutes, but time ran out.
Avital waited anxiously through the Sabbath and then started calling again Saturday night. Once someone finally answered, she peppered him with her concerns. What if the caterer had served her food or touched someone? “The person was clearly, evidently annoyed with me for asking questions and kept saying, ‘If you think you had contact with the person, you can self-quarantine,’” she told ProPublica. “He didn’t tell me how to interact with my children.”
Unable to get answers, Avital asked a friend, who is a pulmonologist, for help. The pulmonologist called the local health department, where an official confirmed to him that someone at the event had, indeed, tested positive for the coronavirus.
That Sunday, six days after the wedding, the Rockland County Health Department put up a press release saying those who attended the event could have been exposed. The delay came because the worker had not been forthcoming, according to county spokesperson John Lyon. The release did not specify whether wedding attendees should quarantine themselves.
Avital decided to stay at home while continuing her efforts to get clarity from state and local health departments. On Tuesday, after repeated attempts to get in touch, she heard back from someone at the New York State Department of Health. “They told me that given the length of time that has passed without Rockland notifying me of an official quarantine, I don’t have to be quarantined,” she said
Lyon, however, told ProPublica that the county agency had reached out to the wedding venue and asked it to alert attendees that they should be in a precautionary quarantine for two weeks. When ProPublica told him that Avital hadn’t heard from the county Health Department or anyone at the venue, he paused. “That is concerning. I’ll relay that to the Department of Health.”
His office put out a press release Tuesday announcing six confirmed cases countywide and recommending three school closures. But Avital and other wedding guests still had not heard updates from the county Health Department as of Wednesday morning. “I’m incredibly frustrated,” Avital said. “People are still living under the assumption that we’re in a functioning society and we can trust our public systems to keep us safe — this has shown me we can’t.”
When two countries don’t agree
On the same day Avital went to the wedding, her two sisters attended the American Israel Public Affairs Committee in Washington, D.C.
Dina Rabhan left the conference for Israel, where she lives, and already knew what she had to do. The Israeli Ministry of Health had made it clear that any resident returning from an international conference had to self-quarantine for two weeks, under threat of fines or criminal charges.
Three days later, she found out that at least two people at the conference had tested positive for COVID-19. Rabhan thinks her chances of having contracted the coronavirus are low, but she’s content to stay home. She sees it as her civic duty. “We all have a shared sense of not wanting what happened in Italy and other countries to happen in our little country here,” she said. She checks the Health Ministry’s website daily for updates.
Israel began imposing restrictions early. By Feb. 4, it required everyone who’d recently been to mainland China to self-quarantine. By Feb. 23, officials expanded the quarantine list to include four other countries, Hong Kong, and Macau. Then this Monday, they made quarantine mandatory for all travelers returning from abroad. As of March 11, the country had 75 confirmed cases and no deaths, according to the World Health Organization.
“I’m definitely grateful there is a place I can look and find answers on what I can do,” Rabhan added. “We’re getting very clear messages.”
Her sister, who also attended the conference, returned to Long Island and called the New York City Department of Health. In a text message shared with ProPublica, her sister wrote, “NYC dept of health said no quarantine necessary since they” — the attendees who came down COVID19 — “were asymptomatic at AIPAC and therefore not contagious. That’s their guidelines.” The New York City Health Department didn’t respond to a request for comment.
A group of George Washington University students who also attended the conference initially self-quarantined for a night, but the university later discontinued the measures after consulting academic experts and the D.C. Department of Health.
When no one can agree on when to test or how long to quarantine
Christine Norrie’s teenage daughter, Jo, got back from Italy after a school trip on Feb. 23. She had visited Rome, Florence and Assisi — cities currently under lockdown in an attempt to slow the spread of the virus, which has infected more than 12,000 across the country. About five days after her return, she started feeling sick and was diagnosed with an upper respiratory infection. Her doctor said she didn’t need COVID-19 testing because she was otherwise healthy but recommended she stay home for two weeks as a conservative measure.
Jo’s symptoms persisted. So Christine called New York’s general information hotline and was routed to an official with the Department of Health, who advised her to seek testing. She booked an online visit with an ER doctor. “Basically, it seemed that if we want to test we would have to seriously lobby for it due her symptoms being mild,” Norrie said.
The ER physician recommended they continue self-isolating. But the timelines she was given by the various medical personnel were scattershot: Jo’s pediatrician had directed her to self-isolate for two weeks from the day she visited the office. The ER doctor said isolation meant two weeks from the onset of symptoms. And when Norrie consulted the CDC’s website, the agency said that meant two weeks from the day she left Italy.
Confused, Norrie decided to keep Jo home for the longest period of time suggested. “I’m grateful she’s an excellent student and she can manage taking the time off from school,” she said. “No matter how hard it is to stay at home, we’ll take the more liberal amount.”
When federal officials have clear guidelines but fail to fill you in
The guidance from the CDC was clear: Anyone flying into the United States from Italy should go home and stay there for two weeks. But on Tuesday afternoon, one critical group hadn’t gotten the memo: passengers. ProPublica went to John F. Kennedy Airport to meet passengers coming off a flight from Rome. Eight spoke to a reporter, and all of them expressed surprise that over the course of the journey, no one had instructed them to self-quarantine.
“Nothing in Rome. Nothing from the airlines. … No one told me to quarantine,” said Yan Meshoyrer, on his way home to New Jersey. “If I didn’t watch CNN, I’d have no idea this was happening.” Jessica Andir, a Milan native living in Rome, said that before the trip, she was worried that agents with Customs and Border Protection would grill her about the outbreak in her hometown. Instead, she ended up worrying about how little she was told: “Absolutely nothing.”
A CDC spokesperson told ProPublica that the entity responsible for telling travelers about the recommended quarantine depends on how people fly in. Customs is supposed to direct travelers from China and Iran to CDC officials stationed at the airport. Those coming from China are supposed to receive detailed booklets, which contain instructions to call their local health department and stay home for two weeks and include a journal to write down their temperature twice a day. Those coming from Iran should get shorter self-quarantine guidance. For those coming directly from Italy and South Korea, airlines are supposed to give passengers instructions on their flights; for those not flying direct, they’re supposed to get the instructions from CBP.
The passengers on the plane said they heard nothing from Alitalia Airlines before they landed. Alitalia did not respond to ProPublica’s questions.
A CBP spokesperson did not answer repeated questions about whether its agents are telling people who arrive from Italy to self-quarantine.
Dr. Cyrus Shahpar, former team lead of CDC’s Global Rapid Response Team, said that at a time when resources are limited, the government’s scattershot approach to self-quarantining all but defeats the purpose: “If you’re doing something with limited effectiveness and you’re only doing it halfway, it’s going to be extremely ineffective.”
When even investigative journalists are having trouble getting answers
As we were calling people around the country to learn how hard it was to get answers from public officials, we received news that brought our reporting (quite literally) closer to home. The three of us had just returned from an 1,100-person conference in New Orleans, and Tuesday night, we learned one of the attendees was later diagnosed with COVID-19. ProPublica’s president, Richard Tofel, told all of us not to return to the office for two weeks.
Suddenly, we were fielding questions from worried colleagues. Conference attendees started a spreadsheet with the conflicting information they’d received from their local health departments. Some couldn’t get through to anyone at all.
Andrea Suozzo, a newspaper editor in Winooski, Vermont, came back from the conference Sunday and woke up the next morning feeling under the weather with a sore throat. When she learned about the attendee who tested presumptively positive Tuesday evening, she started to panic.
“I called the Vermont Health Department,” she told ProPublica, “and they said to call my doctor or 211. I called my doctor and they said, don’t come in, and call the urgent care. I called the urgent care center, and their voicemail said, ‘If you think you might have COVID-19, don’t come in — stay home.’ I called 211, and they said nothing in the system can happen without going through your primary care provider.”
On Wednesday, Suozzo was waiting for a call from her doctor with instructions. “I just want to make sure I’m on somebody’s radar,” she said. “I just have no idea what to do or who to talk to.”
Scott Klein, a deputy managing editor at ProPublica, was also trying to navigate the disparate information he was receiving. Klein had spoken to the person who tested positive. He was sure they’d stood within 6 feet of each other at the conference. “Ironically, we talked about doing a coronavirus project together,” Klein said.
Klein first called the state Department of Health where the person who tested positive lives. He was initially told that for him to have been at-risk, he needed to be within 6 feet of someone showing symptoms — and the attendee hadn’t had symptoms until leaving the conference. But then the official changed course, saying the person who tested positive didn’t need to be showing symptoms for Klein to be at-risk. The department official told Klein he would get a call back to clarify and said Klein could go get groceries and gas for his car so long as he stayed more than 6 feet away from people. The official also advised Klein to call his local department of health for further guidelines.
When he got through to the New York State Department of Health, an official instructed him to remain in a room isolated from his wife and kids and to use a mask. “They seemed to be giving me information as though I already had symptoms,” Klein said. He tried calling the New York City Department of Health afterward, but he was put on hold and didn’t wait for the call to go through.
Given the diverging information from health departments, Klein decided to move forward in what he felt was the most responsible way. “I’m going to stay home and not leave my apartment, but I don’t have the ability to be in an isolated room. I live in a small New York apartment,” Klein said. “I’ll do the best with the circumstances I have.”