Tag: Quarantine

How to Manage Patients in Quarantine, Smartly


Smart Quarantine as the next step to combat COVID-19

As the nation and the world grapple with the impact of the COVID-19 pandemic, there is growing consensus among experts that we need a sustainable system of specific lockdowns, social distancing, and extreme resource provision in terms of labor, ventilators and PPE to arm hospitals and health providers as they deal with the onslaught of patients. Even while some American states start to slowly open up, we need a system that can manage COVID-19 over the coming months and years–especially if this Fall brings a second wave.

Writing in the NY Times on April 7, Harvey Fineberg and colleagues summarized an as yet overlooked issue. There are many patients who may or do have COVID-19, but are not sick enough to need hospital care, or who have been discharged from hospitals. We need to keep these patients away from hospitals but if they shelter in place in their household there is a high risk they will infect their families or housemates. This likelihood is even higher if they are homeless,  incarcerated, or living in other group arrangements.

Instead of sheltering in place at home Fineberg and colleagues suggest those patients enter “smart quarantine” in temporary isolated accommodation, such as hotels or college dormitories, where they can be looked after by medical teams and tested semi-regularly. But whether they are at home or in temporary accommodation, leaving those patients with minimal support to be tested at the end of 14 days is not enough. A significant proportion of them will develop COVID-19 and some of those are going to be admitted to hospital. In addition several patients have been discharged from hospital, but still need to be monitored. We are going to need to be able to closely monitor a significant number of people even while the majority of them will need relatively limited amounts of care.

The good news is that we have had a couple of decades of development of the technologies and services required to both care for and monitor these patients, while keeping the main resources such as ventilators for those in hospitals. Pulling together available technologies and services, we will be able to quickly and accurately manage these patients, ensure their best outcomes, and spare scarce hospital resources. There are seven main components of this process, which I am calling “smart care in quarantine.”

The Process

Upon either a positive test for COVID-19 or a suspicion of those symptoms awaiting testing, patients can be admitted to isolation at home or in, say, empty hotels. 

1. Monitoring equipment. Patients can be given FDA regulated monitoring devices which will work using bluetooth and WiFi (or 4G cellular). The main monitoring tools required are:

  • Pulse Oximeters
  • Thermometers
  • Stethoscopes (with acoustic recording)
  • Weight Scales
  • Video & audio via iPad, phone or computer
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The Czar of Ebola


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As every American now knows, Ebola is a horrible African hemorrhagic fever with a high mortality rate and relatively low risk of transmission, except in cases where the disease is transmitted, where the risk of transmission is very high.

The disease has infected 8,000 people in West Africa. WHO officials predict that up to 1.5 million people could be infected by the end of January 2015.

In the United States Two people are known to have been infected with the disease.  Both are nurses.  Their names are Nina Pham an Amber Joy Vinson.

We now have an Ebola Czar to educate us about these facts and others as they become available.

Facing criticism from Congress this week over the handling of the crisis, President Obama named Ron Klain, a former chief of staff for vice president Joe Biden and Washington loyalist.  Critics wanted either somebody with a medical backround or experience handling infectious diseases. Until yesterday, Klain worked for Steve Case.

Technically, of course Klain is not a czar, although almost everybody will call him by that title. His technical title is Federal Ebola Response Coordinator.

“He is smart, aggressive, and levelheaded; exactly the qualities we need in a czar to steer our response to Ebola,” said Sen. Charles Schumer (D., N.Y.).

“By appointing a Democrat political operative as the Ebola czar, it is clear that the president sees Ebola as a political crisis and not a health crisis,” said one critic, Rep. Bill Cassidy (R., La.).

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