6 reasons why institutional quarantine may be bad idea going forward

Most states in India are mandating institutional quarantine for anyone arriving from outside the state.

However multiple reports have emerged about sorry state of affairs at quarantine centres and even paid hotels. People are feeling cheated and also fear their health is at risk due to unsafe and unhygienic conditions at quarantine centres.

While asking people to stay in institutional quarantine had a genuine purpose of ensuring potentially infected persons stay safe, with ever increasing number of cases the model is suffering.

1. Quarantine facilities are limited.
Stage Government authorities have commandeered schools, marriage halls and various buildings to accommodate inbound travelers who need to be quarantined. But there's a limit to how many buildings are available and how many people can be accommodated. With train and flight service resuming, it may be impossible to find a spot for everyone.

Assume Bengaluru city gets 10 trains per day, with 1000 people per train and 20 flights per day with 150 passengers per flight. That is 13000 people per day. Plus probably another 2000 by road. So how to create 15000 quarantine rooms per day for whole of June? (15000 per day * 30 days = 450000 beds, assume each person stays for 14 days, Bengaluru city will need 2.25 lakh quarantine rooms per month)

Officials and staff responsible for ensuring quarantine is enforced are also overworked and a kind of lethargy might be kicking in, not taking things seriously, trying to make some money on the side etc. They are also feared of their own life as risk of infection is very high.

You can read this, this , this and this media report on conditions of Quarantine Centres.

2. Schools need to reopen
Schools have been shut for months. Sooner or later schools need to reopen, to conduct exams, to resume classes. All those schools being used as quarantine facilities need to be freed from its occupants, sanitized, cleaned and readied for academic purposes.

Even for other buildings (like marriage halls)- if the virus situation is likely to continue for years then we will need a better plan. How long can govt keep control of private properties?

3. Monsoon
Most states will get monsoon rain from June. This would make matters worse- leaking roofs, flooded surroundings create a much worse risk. With heavy rain supplying food, providing medical service everything will get much more complex. Best to send home those who are healthy after one final testing.

4. Hotels fleecing customers
Most hotels are not honoring government mandated rates. They are not providing required levels of service either. Thus it is a double rip off for those forced to stay in paid quarantine facilities. Only if demand is less and supply is more hotels will maintain some standard. Else people will continue to be cheated.

5. Awareness is high
Compared to March, most Indians are now aware of the Corona virus risk. If sent home it is very unlikely that they will endanger themselves or their family by violating social distancing norms. Authorities need to weigh the risk of one infected person infecting hundreds others in a quarantine centre vs one person possibly infecting 2-3 family members.

6. Fear of quarantine is discouraging travel and will affect economy
If on a round trip one has to spend 14 days quarantine at his destination and again another 14 days upon return, then it means loss of 28 working days and lots of money spent on quarantine centre. This kind of makes entire trip unviable. Right now people are holding back unnecessary travel due to fear of quarantine, risk and cost. But at some point of time people will have to travel for work, family purposes- the 14+14 day quarantine policy is not sustainable in long run- both from availability of quarantine facilities and loss of time, money, manpower wasted in the process. If you've anyway decided to open up by allowing trains and flights, then let people home quarantine.

The way forward:

  • Faster test results: If we can get faster test results- like few hours- then incoming passengers can be tested and sent home if result is negative.
  • Home quarantine with self declaration: Those who do not have elders at home, or those who have large enough homes to be able to maintain good social distancing, those who are not comfortable with forced quarantine should be sent home with adequate instructions and tracking. 
  • Use more technology: Arogya Sethu is already there. Instead of assuming everyone is infected unless proven otherwise, use technology to track and test relevant people

Main risk with home quarantine is that people won't stay indoor, go out and spread the virus. While this is a risk, it can be contained with quarantine stamp, alerting neighbors, app based tracking and other measures. A proximity sensor activated non-removable wrist band is also a good idea if we can procure and implement it.

Institutional Quarantine was a good idea during early days of lockdown. But now seems increasingly impractical given that we're opening up railways, flights and road travel. The volume of arriving passengers will be in thousands every day and find space for them, trying to control all of them against their comfort level will be a gigantic task. With poor state of quarantine centres in most places, I doubt if the whole process helps reduce the cases or spread the virus. What do you think?

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