Coronavirus: Global flare-ups show need for forced isolation of cases

MELBOURNE • Flare-ups from Australia to Japan show the world has not learnt an early lesson from the coronavirus crisis: to stop the spread, those with mild or symptom-free coronavirus infections must be forced to isolate, both from their communities and family.

In Australia, where Victoria state has been reporting record deaths, some 3,000 checks last month on people who should have been isolating at home found 800 were out and about. In Japan, where the virus has roared back, people are staying home but are not in isolation: 40 per cent of elderly patients are getting sick from family members in the same apartments.

The failure to effectively manage contagious people with mild or no symptoms is a driving factor behind some of the world’s worst resurgences.

But lessons from Italy, South Korea and others that have successfully contained large-scale outbreaks show that there is a tried-and-tested approach to cutting off transmission: move them out of their homes into centralised facilities while they get over their infections, which usually does not require longer than a few weeks.

“A laissez-faire approach naively trusting everyone to be responsible has been shown to be ineffective, as there will always be a proportion who will breach the terms of the isolation,” said Dr Jeremy Lim, adjunct professor at the National University of Singapore’s Saw Swee Hock School of Public Health.

Faced with a new cluster this week after 102 days without a locally transmitted case, New Zealand has quickly enacted this strategy, placing around 30 people – including at least two children below the age of 10 – into centralised quarantine.

But other countries facing a sustained spread, like Australia and the United States, are not broadly enacting the policy despite its proven track record. Their unwillingness – or inability – to do so underscores the challenges faced by liberal democracies whose populations are less likely to tolerate measures that require individual sacrifice for the greater good.

The existence of a large group of carriers who hardly feel sick is a unique feature of the coronavirus crisis, and a major factor that has driven its rapid spread across the globe. Unlike in previous outbreaks like the 2003 Sars epidemic, many infected people do not feel ill enough to stay home, and so spread the pathogen widely as they go about their daily lives.

The US Centres for Disease Control and Prevention has estimated that 40 per cent of Covid-19 infections are asymptomatic.

In Wuhan, the Chinese city where the coronavirus first emerged last year, mildly sick patients were originally turned away from hospitals and told to rest at home, given that the overwhelmed healthcare system needed to tend to the most severe cases.

But health experts soon found that these people would infect their family members and others as they moved around in the community, precipitating a deluge of cases.

Bringing mild or asymptomatic patients to designated facilities – re-purposed convention centres, hotels and stadiums – for basic medical care marked a turning point in the city’s fight against the coronavirus. Simply separating them from healthy people halted the pathogen’s silent spread through the community.

The strategy has since been used in Italy, Singapore and South Korea at the height of their own coronavirus outbreaks earlier this year. Faced with a resurgence last month, Hong Kong converted an exhibition centre to accommodate mild Covid-19 patients and is building more such facilities.

In New Zealand, the government put “a lot of thought” into enacting the policy, and is asking family members of confirmed cases to go into centralised quarantine with them if they require care, said director-general of health Ashley Bloomfield.

The approach is effective first because it prevents people from infecting family members in the same household – over 80 per cent of cluster infections in cities in China were in households after patients with mild symptoms were allowed to stay home, said a Lancet study.

Beyond household spread, the strategy is necessitated by a facet of human nature: left to their own devices, some people just will not follow the rules.

In Australia and Japan, infected people who have been told to stay home have gone out for a variety of reasons.

“It is far better to be more aggressive in the short term with even mild cases than it is to allow such cases to slip under the radar,” said Dr Nicholas Thomas, associate professor in health security at the City University of Hong Kong.


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