Entry Ban, Quarantine Measures Underway in US for Novel Coronavirus

Kari Oakes

February 03, 2020

FROM A CDC PRESS BRIEFING

An additional 5 cases of 2019 novel coronavirus (2109-nCoV) have been confirmed in the United States, bringing the total number of confirmed cases to 11, Nancy Messonnier, MD, director of the National Center for Immunization and Respiratory Diseases, said during a Centers for Disease Control and Prevention press briefing.

Four of the new cases are in California, and one in Massachusetts. Although four of the new cases have recent travel history to Wuhan, China, the epicenter of the 2019-nCoV outbreak, the fifth is a close household contact of one of the other California patients, said Dr. Messonnier. This last case is the second instance of person-to-person spread of 2019-nCoV in the United States.

"We expect to find additional cases of the novel coronavirus in the United States," she said. "We expect to see more cases of person-to-person spread among close contacts. And we continue to expect this will happen given the explosive nature of this outbreak in China."

As of the morning of Feb. 3, 167 persons under investigation, or PUIs, for possible 2019-nCoV have tested negative for the virus, and an additional 82 PUIs have testing pending — this latter figure includes some tests that are still in transit to the CDC, said Dr. Messonnier.

During the briefing, Dr. Messonnier emphasized both the aggressive nature of the U.S. public health response and the rationale for quick and assertive action. "The goal of our public health response is to protect and contain," she said. "Strong measures now may blunt the impact of this virus on the United States."

She cited the intensity of transmission in Hubei Province, the expansion of transmission to other provinces in China, the expansion of cases outside of China, and sporadic ongoing deaths from 2019-nCoV as drivers of the aggressive U.S. public health response.

A presidential proclamation is currently in place that bars U.S. entry to foreign nationals who have visited mainland China within the past 14 days; the ban does not apply to travelers from Hong Kong and Macao. Immediate family members of U.S. citizens and individuals who have U.S. permanent resident status are exempted from the entry ban and will be allowed entry into the United States.

However, explained Dr. Messonnier, those who have traveled to China recently and are permitted entry will be subject to screening. All passengers with such recent travel will be directed to one of 11 U.S. airports set up to perform additional screening.

As of Feb 3, the list of airports includes:

  • San Francisco International Airport in California.

  • Los Angeles International Airport in California.

  • Hartsfield-Jackson Atlanta International Airport in Georgia.

  • Daniel K. Inouye International Airport in Hawaii.

  • O'Hare International Airport in Illinois.

  • Detroit Metropolitan Airport in Michigan.

  • Newark Liberty International Airport in New Jersey.

  • John F. Kennedy International Airport in New York.

  • Dallas/Fort Worth International Airport in Texas.

  • Washington Dulles International Airport in Virginia.

  • Seattle-Tacoma International Airport in Washington.

Travelers who have been to Hubei Province in the previous 14 days will have an additional health assessment at which they will be screened for fever, cough, or difficulty breathing. Any American citizens or exempt individuals who are symptomatic would then be transferred for further medical evaluation. Asymptomatic travelers in this category will be subject to a mandatory 14-day quarantine near their point of entry, rather than continuing on to their final destinations.

Dr. Messonnier emphasized that the mandatory 14-day quarantine is specifically for Americans or exempt individuals returning from Hubei Province, adding that the CDC is presently working with individual states to determine the exact venues for quarantine.

American citizens and exempt individuals returning from other parts of mainland China will be routed to one of the 11 airports and will also receive additional health screening. Symptomatic individuals in this travel category would be referred for further evaluation before being able to complete their itinerary.

Asymptomatic American citizens and exempt individuals who are returning from mainland China — but not Hubei Province — will be allowed to travel on to their final destinations, but will be asked to stay home as much as possible and to monitor their health during the 14 days after their return.

The U.S. Department of State is bringing back more Americans from Wuhan province this week, and these individuals will also be kept under federal quarantine for 14 days.

"There are likely to be confirmed infections among returning travelers," said Dr. Messonnier. "It is important to note that this strategy is not meant to catch every single traveler returning from China with novel coronavirus; given the nature of this virus and how it's spreading, that would be impossible, but working together we can catch the majority of them.

"The goal here is to slow the entry of this virus into the United States," she said, adding that the nation's health care and public health systems stand on high alert to detect the virus in community settings. In response to questioning from the press, Dr. Messonnier defended the stringent quarantine measures, noting that they are in line with those taken by some other nations, and with the aggressive action being taken by the Chinese government itself. "These actions are science based and aimed at protecting the health of all Americans," she said.

The real-time reverse transcription polymerase chain reaction (rRT-PCR) assay that the CDC has developed detects 2019-nCoV in both respiratory and serum specimens. Dr. Messonnier reported that the CDC is today filing an emergency use authorization (EUA) application to the U.S. Food and Drug Administration to expedite access to the assay for public health laboratories across the country. "This will greatly enhance our capacity to test for this virus," she said, noting that EUA approval may come as soon as the end of this week.

Although the CDC is poised to send an expert team to China, it's still awaiting favorable results from the international negotiations currently underway. "This is a horrible situation in China," said Dr. Messonnier. "Our presence on the ground in China would be a help to China. ... Science should trump everything else; that's what we're hoping — that the scientific expertise of the global community can be brought to bear on the incredibly complicated, difficult situation that our colleagues in China are dealing with."

This story originally appeared on MDedge.com.

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