A sign on a truck warns people to stay home in Melbourne on 5 August.
Photographer: William West / AFP via Getty Images
Photographer: William West / AFP via Getty Images
Flare-ups from Australia to Japan show that the world has not learned an early lesson from the coronavirus crisis: to stop the spread, those with mild or asymptomatic coronavirus infections must be forced to isolate themselves from their communities and family.
In Australia, where Victoria State has reported register dead, about 3,000 checks last month on people who should have been isolated at home were found 800 were out and about. In Japan, where the virus raged, people remain at home but are not in isolation: 40% of elderly patients become ill from family members in the same apartments.
Failure to effectively manage infected people with mild to no symptoms is a driving factor behind some of the worst resurgenes in the world. 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 out transmission: they move out of their homes to centralized facilities while overcoming their infections, which normally takes no longer than a few weeks.
“A laissez-faire approach that naively believes that everyone is responsible has been shown to be ineffective, because there will always be a share that will break the conditions of isolation,” said Jeremy Lim, adjunct professor at the Saw Swee of the National University of Singapore Hock School of Public Health.
Dealing with a new cluster this week after 102 days without a locally transferred case, New Zealand has quickly implemented this strategy, placing 17 people – including two children under the age of 10 – in centralized quarantine.
But other countries dealing with persistent proliferation such as Australia and the US do not pursue the policy broadly, despite their proven track record. Their unwillingness – as inability – to do so underscores the challenges facing liberal democracies, whose populations are less likely to tolerate measures that require individual sacrifice for the greater good.
Not at home
The existence of a large group of carriers that barely to feel disease is a unique feature of the coronavirus crisis, and an important factor that has driven its rapid spread throughout the world. Unlike previous outbreaks such as the 2003 SARS epidemic, many infected people do not to feel sick enough to stay home, and so the pathogen spreads widely as they go about their daily lives.
The US Centers for Disease Control and Prevention has It is estimated that 40% of Covid-19 infections are asymptomatic.
In Wuhan, the Chinese city where the coronavirus first appeared last year, mildly ill patients were initially rejected from hospitals and told to rest at home, given that the overwhelming health care system was needed to tackle the most severe cases. But health experts soon found that these people would infect their family members and others if they ran into the community, preventing a fallout from occurring.
Bringing mild asymptomatic patients to designated facilities – re-targeted convention centers, hotels and stadiums – for basic medical care marked a turning point in the city’s fight against the coronavirus. By simply separating them from healthy people, the silent spread of the pathogen through the community stopped.
The strategy has since been used in Italy, Singapore and South Korea following their own outbreaks of coronavirus earlier this year. Available with a resume last month, Hong Kong converted an exhibition center for bright Covid-19 patients and is building more such facilities.
In New Zealand, the government is putting “a lot of thought” into implementing the policy, and is asking family members of confirmed cases to go with them in central quarantine if they need care, said Health Director General Ashley Bloomfield.
Finishing touches will be applied to a ward in a special Covid Health Center at the Bandra Kurla Complex exhibition grounds in Mumbai, India on May 17th.
Photographer: Dhiraj Singh / Bloomberg
The approach is effective in the first place because it prevents people from infecting family members in the same household – more than 80% of cluster infections in cities in China were in households after mild patients were allowed to stay at home, a Lancet said to study. In Europe, the the increase in domestic infections forced Milan from Italy to put such cases in hotels, allowing the country to gain control of its outbreak in early May.
In addition to spreading households, the strategy is necessitated by a facet of human nature that has been seen time and time again in countries and cultures: left to their own devices, some people simply do not follow the rules.
In Australia and Japan, infected people who have been told to stay at home have left for various reasons – some are unable to work from home and need income, while others want to pick up groceries and suppliers. One woman in Tokyo traveled the country by bus after confirming their infection.
“It’s much better to be more aggressive in the short term with even mild cases than it is to slip such cases under the radar,” said Nicholas Thomas, associate professor of health safety at City University of Hong Kong.
Locked up
But with forced relocation mild asymptomatic patients to centralized facilities has been met with backwardness in some countries where citizens do not so accept government guidelines. Some people may lose their jobs if they disappear for two weeks, or if they have responsibilities for young children or older parents, where it is impossible to get divorced.
“People are wondering what on earth are they doing locked up in a hospital,” said Stephen Leeder, Emeritus Professor of Public Health and Community Medicine at the University of Sydney. “From what I know about the Australian psyche, I do not think it would go that well.”
In places like Venezuela and India where conditions in quarantine facilities are poor, the prospect of declining has caused some to be tested or lied to by contacts for fear of finding positive, making the work of health officials more challenging.
In an email response to questions from Bloomberg News, the Department of Health and Human Services in Victoria said the government offers alternative accommodation for quarantine, but that these are for health workers “who may not be able to live safely at their normal address” and other vulnerable groups.
Instead of forcing the isolation of mild cases, authorities have locked up 5 million residents in Melbourne and imposed restrictions until new cases come under control.
An information sign informs all customers that they must wear a protective mask at a shopping center in Melbourne on 23 July.
Photographer: Carla Gottgens / Bloomberg
Officials use a combination of stepped-up checks and fines of A $ 4 957 ($ 3,550) to persuade infected people to stay at home, while repeat offenders risk an A $ 20,000 fine in court. More than 500 military personnel help the police carry out checks on 4,000 households every day to ensure that those who should have to stay at home.
To be sure, aggressive and in-depth contact tracing and case follow-up have successfully contained outbreaks in countries such as Germany without a centralized quarantine strategy. But these places relied on an army of efficient workers chasing every transmission chain, a resource that not many governments had time to build.
“The classic practice in public health is identification, tracing and quarantine,” said Yang Gonghuan, former deputy director of the Chinese Center for Disease Control and Prevention. “But how that is done depends on popular sentiment and the country’s resources.”
– With the help of Sharon Chen, Dong Lyu, Angus Whitley, and Lisa Du
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