key: cord-1015142-oe0jraqe
authors: Cardwell, Karen; O’Neill, Sinéad M.; Tyner, Barrie; Broderick, Natasha; O’Brien, Kirsty; Smith, Susan M.; Harrington, Patricia; Ryan, Mairin; O’Neill, Michelle
title: A rapid review of measures to support people in isolation or quarantine during the Covid‐19 pandemic and the effectiveness of such measures
date: 2021-05-14
journal: Rev Med Virol
DOI: 10.1002/rmv.2244
sha: 221f29d953a21d790f894040cd95bfe14987ee6d
doc_id: 1015142
cord_uid: oe0jraqe

This rapid review aimed to identify measures available to support those in isolation or quarantine during the coronavirus disease 2019 (Covid‐19) pandemic, and determine their effectiveness in improving adherence to these recommendations and or reducing transmission. The rapid review consisted of two elements, the first was a review of guidance published by national and international agencies relating to measures to support those in isolation (due to case status) or quarantine (due to close contact status) during the Covid‐19 pandemic. Five categories of support measures were identified in the international guidance, they were: Psychological, addiction and safety supports, Essential supplies, Financial aid, Information provision and Enforcement. The second element was a rapid literature review of the effectiveness of measures used to support individuals in isolation or quarantine during any pandemic or epidemic setting, due to respiratory pathogens. A systematic search of published peer‐reviewed articles and nonpeer‐reviewed pre‐prints was undertaken from 1 January 2000 to 26 January 2021. Two Australian publications met the inclusion criteria, both based on data from a survey undertaken during the 2009 H1N1 pandemic. The first reported that 55% of households were fully compliant with quarantine recommendations, and that there was increased compliance reported in households that understood what they were meant to do compared with those who reported that they did not (odds ratio [OR]: 2.27, 95% confidence interval [CI]: 1.35–3.80). The second reported that access to paid sick and or carer's leave did not predict compliance with quarantine recommendations (OR: 2.07, 95% CI: 0.82–5.23). Neither reported on reduction in transmission.

March 2020, the World Health Organisation (WHO) declared the coronavirus disease 2019 (Covid-19) outbreak a global pandemic.

As of 16 March 2021, there have been almost 120 million cases and over 2.5 million deaths from laboratory-confirmed cases of Covid -19 worldwide. 1 In the context of the overall public health response to Covid-19, effective management of cases and their contacts is key to reducing the spread of Covid-19. In regard to cases, that is, those with confirmed or suspected Covid-19 infection, isolation is the term used to describe their separation from those who are not infected.

Quarantine is the term used to describe separation of those exposed or potentially exposed to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) from others, as a precautionary measure because they may have the disease. 2, 3 Measures to support individuals in isolation and quarantine should be considered to improve compliance with the recommendations. 4 As such, the aim of this rapid review was to (1) identify the measures being taken internationally to support compliance with isolation and quarantine recommendations during the Covid-19 pandemic (a review of international guidance) and (2) to determine the effectiveness of such measures during pandemics or epidemics involving respiratory pathogens (a review of primary research studies) on compliance and reduction in spread of infection.

A detailed summary of the methods used in this rapid review is provided in the protocol, 5 which is in accordance with Cochrane rapid review methodology guidance. 6 In short, official national and international agency websites from a predefined list were searched for measures implemented to support those in isolation or quarantine during the Covid-19 pandemic. Supports identified were then categorised by theme. Following a scoping exercise, it was evident that there was a lack of evidence relating to the effectiveness of measures implemented to support those in isolation or quarantine during the Covid-19 pandemic.

Therefore, evidence of the effectiveness of measures implemented to support those in isolation or quarantine relating to other respiratory pathogens (e.g., SARS-CoV and Middle East respiratory syndrome [MERS] ) from an epidemic or pandemic situation from 2000 to 2021 were included. A systematic search of published peer-reviewed articles and nonpeer-reviewed preprints was undertaken from 1 January 2000 up to 26 January 2021; no language restrictions were applied. All potentially eligible papers were exported to Covidence (www.covidence.org) and titles/abstracts and full texts were single screened for relevance based on the inclusion/exclusion criteria outlined in the protocol. Data extraction and quality appraisal of included studies was completed by a single reviewer and checked by a second reviewer; the Joanna Briggs Institute checklist for analytical cross sectional studies was used for quality appraisal of included studies. 7 3 | RESULTS

In total, guidance from the European Centre for Disease Prevention and Control (ECDC), WHO and official national and international agency and or government websites from 19 countries, relating to measures to support those in isolation or quarantine, were included in this review. The findings were summarised into five main categories of support measures. Table 1 provides a summary of the measures found to support individuals who are in isolation or quarantine during the Covid-19 pandemic.

Psychological support measures were identified in 18 of the 19 countries reviewed; this included mental health support, addiction support as well as support for victims of violence (domestic and or child abuse). This support is available to those isolating, quarantining, or those affected by restrictions in general. Available support was varied and included information leaflets, helplines, online appointments or video conferences with counsellors or psychologists. The information on websites did not specify if organisations were government funded, whether there was a fee for those using the service, nor did they specify which organisations existed before the Covid-19 pandemic.

In line with recommendations from the ECDC 8 and the WHO, 9, 10 agency and or government websites for Austria, 11 Australia, [12] [13] [14] [15] Belgium, 16 Canada, 17, 18 Demark, 19 England, 20,21 Finland, [22] [23] [24] [25] France, 26, 27 the Netherlands, 28 Typically, the support offered is in the form of online information portals and information sheets, as well as helplines and online counselling services. Official agency and or government websites for Wales 35 and Singapore 36 have listed resources for mental health and victims of violence. Ireland 37, 38 has resources for mental health support and addiction support, and Iceland 39 and Northern Ireland 40 listed resources for mental health support (see Table 1 ). 

The WHO recommend that national communication strategies equip the public with comprehensive information about Covid-19. 58 All countries reviewed provided some form of information support for those isolating or quarantining. 11, 12, [14] [15] [16] [17] [18] [19] 21, 24, 27, 28, 30, 33, 35, 36, 38, 54, [59] [60] [61] [62] [63] [64] [65] [66] [67] [68] [69] [70] [71] [72] In addition to specific information to support those required to isolate or quarantine, information sources typically provided comprehensive information regarding a wide range of Covid-19 related issues. The most common form of information support available could be accessed via helplines or websites; some countries (Australia, 12, 15 France, 68 New Zealand 30 and Wales 35 ) also provided information through mobile phone applications (see Table 1 ).

All countries reviewed provided details of financial support available to those who are isolating or quarantining. 13, 28, 36, 40, 45, 50, 51, 65, [73] [74] [75] [76] [77] [78] [79] [80] [81] [82] [83] [84] [85] [86] [87] [88] [89] [90] Some countries provide individuals with a certificate informing them of their need to isolate or quarantine; which enabled them to access available financial supports. The payments varied between countries and were typically a fixed amount rather than a percentage of the individual's salary (see Table 1 ).

Of the 19 countries reviewed, only Australia, 55 Belgium 91 and France 89 reported monitoring those who should be isolating or quarantining (subject to regional variation). Austria, 46 Australia, 14, 55, [92] [93] [94] Belgium, 86,95 Canada, 51 England, 21 Iceland, 96 New Zealand, 97 Northern Ireland, 98 Norway, 99 Scotland, 100 Singapore, 101 Table 1 ). Voluntary home quarantine of cases and close contacts was the main intervention used to limit transmission of (H1N1)pdm09 flu virus during the initial response to the outbreak of the disease in Australia.

The trigger for closure of mainstream schools was two or more confirmed cases in separate classes. 104, 105 The findings published in 2011, 105 whereby there is punishment for breaking regulations. 109 

Others reviews identified did not report on the effectiveness (i.e., noncompliance, as did lack of support with obtaining essential items 6 of 11 -(e.g., food). Inconsistency in information provision or in the application of recommendations between jurisdictions created confusion and lack of confidence even among those who intended to comply.

Stress and stigma associated with quarantine was also cited as a reason for noncompliance. 111 Similarly, in a review by Webster et al., 107 boredom, inadequate supplies, lack of information, financial pressures and stigma. 112 The authors concluded that if isolation is indicated, the duration of isolation should not be any longer than necessary, and that adequate information and supplies should be provided. 112 In the same way that the provision of adequate, factual information is important in empowering individuals to adhere to isolation recommendations, warning people about misinformation and providing them with counterarguments against false information and conspiracy theories is equally important. 113 As highlighted previously, evidence on the effectiveness of penalties for lack of compliance with the regulations is lacking. Instead, people should be made aware of the practical and emotional support that is available to them throughout this time and the benefits of isolation for themselves and society as a whole should be outlined. 114 As such, promoting solidarity and altruism through community engagement, outreach initiatives and collaboration on communication strategies is vital in ensuring compliance. 115 In addition to the provision of measures to support those in isolation (e.g., adequate essential supplies and financial support)

there is a need to effectively communicate the existence of such support measures to help individuals feel prepared should they need to isolate. Some countries provide this information through Web applications (apps) that utilise conditional logic. Such apps enable people to identify the social and financial supports that are both available and applicable to their specific situation. Research shows that individuals cope better with changes in lifestyle when they plan for said changes; this has also been shown to enable better compliance with public health guidance. 116 In a study conducted in Ireland, researchers hypothesised that, individuals would have increased confidence in their ability to isolate if they used an online tool (or decision aids) to help them make a plan and develop a routine for isolation. 117 The study, which was uncontrolled, conducted in April 2020 (n = 500 individuals), tested three interventions to help individuals first decide whether they need to isolate, second be confident in their ability to isolate should they need to and third manage a household in which an individual needs to isolate. 117 The authors reported that the behaviourally informed decision aids were associated with statistically significant, positive outcomes and can be used to support isolation during the Covid-19 pandemic. As such, the findings from the study have been incorporated into social media campaigns in Ireland. 117 In July 2020, a follow-up study was conducted in 1000 individuals living in Ireland; the aim of which was to understand an individual's willingness to isolate. 118 The results showed that less than 40% of individuals with one of the main Covid-19 symptoms (fever, cough, shortness of breath, change and or loss of taste and or smell) would isolate immediately and 50% would contact their GP. 118 The factors that independently increased the likelihood of isolating immediately were being female, having a degree and being an Irish national. 118 In the same sample, there was a lack of awareness around how to access a Covid-19 test, and that such tests were available free of charge. 119 Researchers recommended that test and trace staff should be utilised to direct individuals to available resources should they have to isolate or quarantine. Likewise, human resources departments should also be utilised to direct employees to available resources should they need to isolate or quarantine. 119 This review has a number of limitations. First, although official national and international agency and or government websites were reviewed to identify measures to support those in isolation or quarantine, there is a possibility that some measures may be in place, but are not documented on the websites reviewed. Second, this review did not evaluate if there was a relationship between the range and or intensity of measures offered and the burden of disease experienced in that country. Third, this review is limited by the type of review conducted for the effectiveness element of the question (i.e., a 'rapid literature review'). This was limited by the time constraints associated with the review, and the biases considered likely to be present in the primary research studies included.

This rapid review identified five categories of measures available to support individuals in isolation or quarantine. At a country level, there appears to be variation in the range and intensity of supports or quarantine. In addition, signposting to available resources is key to helping individuals plan for isolation and be confident in their ability to do so effectively.

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The authors would like to thank the Library and Information Services at the Health Service Executive, Ireland