Covid-19: Practical support for those in home quarantine needed

A resident association volunteer speaks to a foreign worker who has been ordered to quarantine at home. Loss of income is the main reason for lack of compliance to self-isolation. — Filepic

Helping people to self-isolate after testing positive for Covid-19 must now be a top priority for the UK government, argued experts in The BMJ on Jan 27 (2021).

Dr Muge Cevik at the University of St Andrews and colleagues say the focus should be on those working in high exposure occupations, living in overcrowded housing or who do not have a home, and should include free and safe accommodation, alongside adequate income support, job protection and help with caring responsibilities.

Most countries have used testing as a tool to interrupt transmission chains by encouraging isolation of contacts, they explain.

However, the ability to quarantine until test results are available, and to isolate if positive, depends on people having the space and resources to do so.

They point to UK survey data suggesting that less than one in five people are able to adhere to isolation protocols.

Notably, lower rates of adherence have been reported among men, younger people, key workers, those living with dependent children, and those in lower socioeconomic groups.

Although willingness to self-isolate was high across all respondents, the self-reported ability to isolate was three times lower among those earning less than £20,000 (RM111,129) a year or who had less than £100 (RM556) saved.

This finding is consistent with reports that lost wages are the primary reason for not following isolation guidelines.

However, several well-described models have been shown to enhance compliance with quarantine and isolation, they write.

For example, in the United States, schemes that offer people with positive results a menu of supportive services, including free deliveries of food and medicines, transport, and even dog walking, to help them quarantine at home or in free hotel accommodation.

“These interventions have led to high rates of test uptake, number of contacts identified and adherence to self-isolation, contributing to reducing total household and community transmission,” say the authors.

As vaccines are rolled out, even small improvements in people’s ability to quarantine and isolate can have an important effect on slowing transmission, hospital admission and death, especially among those most at risk of Covid-19, they add.

“The next phase of the public health response must align testing strategies with people’s lived realities,” they argue.

“Ultimately, people need to be able to isolate without fear of a substantial damage to their work, income, family or caring responsibilities.”

And they conclude: “We can’t wait for vaccine-mediated decreases in morbidity and mortality to manifest. Too many lives have been lost or destroyed.

“Integrating equitable support services for those most at risk for Covid-19 is a national emergency and governments should act accordingly.”

The BMJ editor-in-chief Dr Fiona Godlee said: “The UK’s political leaders seem to have their heads in the sand while waiting for the vaccine to rescue us.

“Unless they take other effective action to control the spread of the virus, they will be judged to have been fatally negligent.”

She added: “Huge sums have been spent on test and trace, but even if this were being well managed, it works only if those who test positive are able to self-isolate.

“Action is urgently needed to support people to self isolate, to break the chain of infection, move us safely out of lockdown, ease the strain on the NHS (National Health Service), and prevent more avoidable illness and death.”