March 31, 2020

expert reaction to review of evidence on public adherence to quarantine

A review, published in the journal Public Health, reviews the evidence on public adherence to quarantine.

Dr Tom Wingfield, Senior Clinical Lecturer and Honorary Consultant Physician, Liverpool School of Tropical Medicine (LSTM), said:

“In the UK, we have all taken responsibility for controlling the coronavirus outbreak and are doing really well with social distancing. The comments from Professor Neil Ferguson and his team yesterday suggest that we may be starting to see the first positive impact of our collective actions on Covid-19 case numbers. It’s vital that we don’t take this encouraging early trend as a reason to relax social distancing measures but instead stay steadfast and keep following the guidance to stay at home.

“The article by the King’s College London team published today on quarantine during the Covid-19 pandemic show that clear and consistent messaging about social distancing and quarantine, and why they are needed, is key to empower people to make informed decisions. In the UK, we are reliant on the government and other related bodies such as Public Health England for these messages. It is vital that the information and education provided they provide are on platforms that reach us, whether newspapers, online, or by phone. The article also highlights the importance of providing supplies of food, medication and other essentials during quarantine or social distancing, especially to vulnerable groups.

“These are difficult times but we should be proud in the UK that we are doing a great job of working together to stop transmission of the coronavirus. Despite the encouraging signs, the social distancing measures and other restrictions to our daily lives will be needed for some weeks and possibly months to come and, by continuing to observe them, we are all contributing to controlling coronavirus in the UK. Let’s keep at it.”

Prof Susan Michie, Director of the UCL Centre for Behaviour Change, University College London, and Fellow of the Academy of Medical Sciences, said:

“This timely study brings together findings of 14 studies (different countries and times) of factors associated with adhering to quarantine (separating and restricting the movement of people who have potentially been exposed to a contagious disease). Adherence to quarantine varied from 0% to 92%.

“Both motivational and financial/practical issues were important for adherence. The need to work and fear of loss of income were identified as reasons for not adhering. People were more likely to adhere to quarantine advice if they had more knowledge about the disease and the quarantine advice, and if they were convinced of the benefits of quarantine and the risks of the disease. Social pressure and collective commitment were associated with adhering whilst rumours of others not adhering undermine it.

“These findings suggest that key steps to enabling adherence to the current social isolation advice are to ensure financial security for all (e.g. ensuring that 5 million self-employed people are provided financial security now, rather than in June), ensure people have sufficient supplies, ensure the advice is clear and has a clear rationale, and encourage people to focus on benefits for others and for the NHS.”

Prof Lucy Yardley, Professor of Health Psychology, at the University of Bristol and University of Southampton, said:

“This paper provides a very useful summary of the scientific basis for the Public Health England strategy for encouraging adherence to self-isolation. It is clear from our empty streets and public spaces that the vast majority of people have got the message that we must all avoid social contact so that we can slow down the spread of coronavirus and prevent the health system being overwhelmed. Although there have been a few examples of a few people who have not yet understood or have not followed the public health advice on social distancing these only make the headlines because they are so rare!”

Dr Michael Head, Senior Research Fellow in Global Health, University of Southampton, said:

“This new review is very welcome and reinforces the viewpoint that there can be very different levels of compliance with quarantine interventions such as social distancing, varying from zero to almost 100%.

“The public health and epidemiology data is vital, but these differences in the behavioural response highlight the difficulty of making decisions around when to recommend quarantines, to what level, and importantly when to relieve any lockdown measures.

“Who would want to be a decision-maker right now?”

Dr Jennifer Cole, Biological Anthropologist, Royal Holloway, University of London, said:

“This is an extremely timely review of what we know from existing literature about quarantine and self-isolation that draws on experience from past outbreaks and early learnings from the current one, and considers the importance of factors such as mental health impacts, practicality of long-term compliance (particularly for socially disadvantaged groups), and clear messaging to the public.

“A particularly important factor in messaging is to ensure that those people being asked to adhere to quarantine fully understand the benefits of doing so and the disadvantage of non-compliance – not only for themselves but for society as a whole, as they may be being asked to make sacrifices for the benefit of others, which requires messages to appeal to morality as well as individual needs.

“Trust in the messages and individuals and agencies they come from is critical, and this requires openness and honesty from the UK Government, particularly in terms of when messages change on the basis of new and updated information, and recognition of groups for whom compliance may pose a challenge. It also shows that it is important to listen to the difficulties of those who are not easily able to quarantine completely and provide as much support as is needed so that they are able to increase adherence.”

Prof Robert Dingwall, Professor of Sociology, Nottingham Trent University, said:

“This is a valuable contribution, especially in its implication that government messaging needs to adopt a more positive note – moving away from rules and bans to encouragement and engagement in doing the right thing. The paper also shows how difficult it is to sustain adherence to quarantine measures for more than a few days. Government should consider more of a focus on the objectives of quarantine than on the precise means and trust people to devise their own solutions within a broader framework of guidance. Police harassment of citizens sitting on park benches or lonely beaches is not helpful.”

Professor Melissa Leach, Director, Institute of Development Studies and co-lead of the Social Science in Humanitarian Action Platform, said:

“We know from past disease outbreaks including SARS and Ebola, that providing clear, transparent, up-to-date and consistent public communications about quarantine measures is essential in order for them to be successful.

“The variety of social and cultural contexts and communities affected should be taken into account when considering how to communicate information, including accessible communication methods, language and dialect preferences, and levels of education and literacy.

“During a health crisis, community concerns and anxieties should also be recognised, listened to and fed back to public health officials, who can use those insights to more effectively tailor their communications on quarantine measures.”

“We also know from past epidemics that quarantine measures implemented by governments are more likely to be effective if they have community buy-in, and work with local forms of collective action instigated by communities themselves. There were many examples in the West African Ebola outbreak, while for COVID-19, we are seeing supportive local social networks and community actions emerging across the world.

“People find it impossible to adhere to quarantines when desperate for food and other basic needs; governments need to ensure that provision arrangements are in place to enable people to stay at home”.

‘How to improve adherence with quarantine: Rapid review of the evidence’ by Rebecca K. Webster et al. was published in Public Health at 11am UK time on Tuesday 31 March 2020
DOI: 10.1016/j.puhe.2020.03.007

Declared interests
None received.

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