March 18th, 2020
Dear community,
I would like to clear up a misunderstanding regarding contagiousness/ infectiousness of this new corona virus.
Our current understanding is that people are infectious just before and during the time that they have symptoms like cough, sore throat, fever and or shortness of breath. This is our current understanding of its behavior.
To clear up the misunderstanding surrounding the 14 day self-isolation vs the 24-48 hours period of contagion, the issue is the difference between incubation period and contagious period:
INCUBATION PERIOD: Yes, we self-isolate or quarantine for 14 days as that is our best evidence guess on how long it takes for someone to develop symptoms from coronaviruses in general
(See CDC FAQ: For COVID-19, the period of quarantine is 14 days from the last date of exposure, because 14 days is the longest incubation period seen for similar coronaviruses. Someone who has been released from COVID-19 quarantine is not considered a risk for spreading the virus to others because they have not developed illness during the incubation period)
CONTAGIOUS PERIOD: 24-28 hours before they develop symptoms to when symptoms resolve and test negative
Good resources: https://www.cdc.gov/coronavirus/2019-ncov/faq.html#basics
https://www.jwatch.org/na51083/2020/03/13/covid-19-incubation-period-update
In this particular case, immediately after informing us of a positive result from this non-community healthcare worker, we contacted various experts including Public Health personnel. We reviewed time lines of travel, time of exposure, a 36 hour stay in New York City, dates of return and the development of symptoms.
This healthcare worker took all the appropriate measures when a spouse started having symptoms. This individual did not take any risks. The time line from exposure in New York City to the development of her symptoms, very mild by the way, and self-isolation resulted in NO RISK to employees nor community members.
During the analysis, the Public Health Authorities as well Infectious Disease experts at the MUHC presented us a “worst case scenario”. Some other known viruses do shed 24 to 48 hours before symptoms. Remember this is a brand new virus and we still do not know it well. Even with this “worst case scenario”, the time lines demonstrate that she was not in any way contagious on the day she worked in the clinic. They, a world-renowned department of Infectious diseases reassured us repeatedly, because we too were worried, there was absolutely no indication to do contact tracing.
This individual acted appropriately at the appropriate time and kept the community safe of any potential exposure both within and outside KMHC walls.
I have to commend her for quick action and keeping us all safe. From one of our physicians “Perfectly done by our physician, partner and hospital.”
Due to these events, we are reviewing our manners of practice regarding staff and indications to self-isolate.
I want to reassure the community that we are working tirelessly both in front and behind the scenes to keep you the community safe and as well informed as possible.
As this pandemic evolves, we will be continually changing and adjusting our manners of practice and messages to the community. There is no looking back because what was the right decision yesterday may no longer apply tomorrow. We all have to stay in the present and look to the future. We have no choice in the matter.
On a final note, we do have a choice in following all the decisions and recommendations made by the Kahnawake COVID-19 Pandemic Task Force. My greatest worry is that many community members have or are returning after travelling outside Quebec since March 12 and are not choosing to self-isolate. I see this as one of the biggest threats because many more community members will be needlessly exposed to the Pandemic virus the COVID-19. The consequence is loss of Elders, Mohawk speakers and traditional healers.
Practice good respiratory etiquette; wash your hands, stay at home and no gathering.
Dr. Suzanne Jones, MD CM Director of Professional Services
