Reanalysis of quarantine for coronavirus disease 2019 with emerging data

To the Editor:

Vega et al¹ eloquently shared their timely and vast experience for the prevention and management of coronavirus disease 2019 (COVID-19) in the context of the maternal-fetal-newborn unit. Their comments provide needed insight, which adds to the cumulative experience that will shape similar actions in other jurisdictions. The issue of “quarantine” is extremely important for communicability, and it is proposed that reconsideration of their suggestion in that regard be analyzed by their peers and public health officials. In particular, most contemporary analyses of transmission suggest that spread can occur commonly from both asymptomatic and symptomatic patients with severe acute respiratory syndrome coronavirus 2 infection after 7 days of disease onset. The determination of an afebrile state or a transition from symptomatic to asymptomatic does not considerably change that position. Presymptomatic shedding in any COVID-19 illness and prolonged shedding among some complex patients further add to the complexity. When patients are deisolated earlier, higher viral loads are likely to be present if they retain infectivity.

Concern with the sanctity of individual epidemiologic parameters was duly raised early in the spread of COVID-19 from China.² Even by that time, estimates of viral excretion gave an approximation that 0.5% to 5% of patients could shed the infectious virus past 14 days. Yang et al³ have found that 95% of symptomatic patients manifest symptoms for up to 13.7 days. In assessing the dissemination of infection in Italy, Cartenì et al⁴ projected that the 14-day restriction for quarantine could be called to question. Despite analyzing viral RNA excretion rather than the infectious virus, Woodruff et al⁵ nevertheless proposed the exercise of due caution for the discontinuation of isolation given some prevailing recommendations.

Given the accumulation of COVID-19–specific data to date, it could be reasonably extrapolated that 5% to 25% of patients with infection could excrete the infectious virus past 7 days regardless of their active clinical status. This issue alone could sizably affect COVID-19 transmission in both community and healthcare settings. It would seem justified to place considerable emphasis on such analyses when some of the alternative responses have included draconian “lockdown” and its unfortunate social and economic outfalls. In the context of pregnancy, data on this issue alone are worthy of further acquisition.