Criticism of the British government’s decision not to impose a mandatory lockdown to slow the spread of COVID-19 has grown in recent days, but available research suggests that quarantines should be used sparingly to maintain morale and ensure compliance when it is most needed.

This is according to a literature review in the Lancet, a leading medical journal, that seeks to understand the available evidence surrounding the efficacy of quarantines/isolation. It was put together by members of Kings College London’s department of psychological medicine.

Basis of the review: 22 studies. “These studies were done across ten countries and included people with SARS (11 studies), Ebola (five), the 2009 and 2010 H1N1 influenza pandemics (three), Middle East Respiratory Syndrome (two), and equine influenza (one). One of these studies related to both H1N1 and SARS”, the authors write.

Why it matters: In light of the various approaches to dealing with COVID-19, political pressure is mounting as countries around Europe impose strict lockdowns to stem the spread of the virus, but evidence points to a risk of “fatigue” at the peak of the outbreak if restrictions are imposed too soon.

What you need to know: Quarantines are problematic because of the restriction of liberty inherent within them. For this reason, their effectiveness hinges on two key factors:

  • that the reasons for a quarantine are communicated clearly by authorities;
  • that the period of quarantine should be short and should not be changed unless absolutely necessary.

The available studies were all looking at different elements and outcomes of a quarantine intervention, but in aggregate reveal key stressors during the intervention:

  • Duration (those quarantined for more than 10 days reported significantly higher post-traumatic stress symptoms than those separated for less time).
  • Fears of infection, especially of infecting family members.
  • Frustration and boredom.
  • Inadequate supplies
  • Inadequate information (“Lack of clarity about the different levels of risk, in particular, led to participants fearing the worst”; additionally, perceived difficulty complying with quarantine protocols were significant predictors of PTSD symptoms.)

Bottom line: Altruism is better than compulsion. “Feeling that others will benefit from one’s situation can make stressful situations easier to bear,” the authors write.

“Reinforcing that quarantine is helping to keep others safe, including those particularly vulnerable (such as those who are very young, old, or with pre-existing serious medical conditions), and that health authorities are genuinely grateful to them, can only help to reduce the mental health effect and adherence in those quarantined.”

Insight from WARC: “Behavioural science tells us that a natural fear of the unknown, authority bias and social herding have all contributed to the enormity of this behaviour change,” writes Ashok Sethi, General manager, Illuminera Institute, of the nationwide response of Chinese citizens to the virus.

Sourced from the Lancet, WARC