Quarantine vital but poses unique challenges, say researchers

As the number of positive cases of Covid-19 in SA climbed to 1,280 on Sunday night, many people in the country are grappling with the reality of a lockdown in a country with such dire inequality.

But in a low-resource setting, it’s not just lockdown that is complicated. Quarantine is too, according to a trio of doctors at the University of Pretoria, who define it as “separating and restricting the movement of people who were exposed to a contagious disease but are not yet symptomatic for a period of time, to see if they become sick”.

This is different from isolation, which separates those who are confirmed sick from the general population and even close family members.

“Quarantine is particularly important for diseases like Covid-19,” the virus of which can still be spread by a person who is asymptomatic, said researchers Sumaiya Adam, Gerhard Lindeque and Priya Soma-Pillay from the university’s department of obstetrics and gynaecology.

They say quarantine and isolation “may achieve outcomes comparable to vaccination programmes”, especially if implemented timeously after the onset of an outbreak.

Though quarantine diminishes an individual’s personal liberty, “society benefits a great deal from quarantining a person who may be carrying a deadly disease — at a relatively low cost to society and a moderate cost to the person quarantined”.

Quarantining should only be implemented when it is “justified”, when an individual has a “moral duty” to do so.

Describing quarantine as a “blunt instrument” in the control of infectious disease, they said it is sometimes “one of the only possible means of responding to an infectious disease threat, particularly when the disease shows rapid transmission”.

Here in SA, however, quarantine on its own is not a silver bullet because of the many complications present in a low-resource setting.

Many hospitals are already overcrowded because of an overstretched health care system. In this context, say the researchers, “presumably sick people” and “those who are healthy” are in the mix together, which increases the risk of transmission.

Another risk is that some people “may try to escape the stricken cities for less-infected areas”.

Others “may hide symptoms and signs from public-health workers” — for example by taking fever-reducing drugs to bring their temperature down, as noted in China.

Also, they say, an “integral failing of most quarantines” is that people see the restrictions as an “imposition on their rights” and therefore try to bypass them. In doing so, they endanger public health.

But with a disease that one can spread without showing symptoms, it plays a vital role.

Though being told to quarantine may be controversial — “particularly when it begins to affect the livelihoods of individuals” — this is not an excuse for deviating from a control strategy.

“Doctors have a strong obligation to support public health in the control of communicable disease,” added Adam, Lindeque and Soma-Pillay.