Helping people to self isolate after testing positive for covid-19 must now be a top priority for the UK government, argue experts in The BMJ today.
Dr Muge Cevik at the University of St Andrews and colleagues say the focus should be on those working in high exposure occupations, living in overcrowded housing, or without a home, and should include free and safe accommodation alongside adequate income support, job protection, and help with caring responsibilities.
Most countries have used testing as a tool to interrupt transmission chains by encouraging isolation of contacts, they explain. However, the ability to quarantine until test results are available, and to isolate if positive, depends on people having the space and resources to do so.
They point to UK survey data suggesting that less than one in five people are able to adhere to isolation protocols. Notably, lower rates of adherence have been reported among men, younger people, key workers, those living with dependent children, and those in lower socioeconomic groups.
Although willingness to self-isolate was high across all respondents, the self-reported ability to isolate was three times lower among those earning less than £20,000 a year or who had less than £100 saved. This finding is consistent with reports that lost wages are the primary reason for not following isolation guidelines.
However, several well described models have been shown to enhance compliance with quarantine and isolation, they write.
For example, in the United States schemes offer people with positive results a menu of supportive services, including free deliveries of food and medicines, transport, and even dog walking, to help them quarantine either at home or in free hotel accommodation.
"These interventions have led to high rates of test uptake, number of contacts identified, and adherence to self-isolation, contributing to reducing total household and community transmission," say the authors.
As vaccines are rolled out, even small improvements in people's ability to quarantine and isolate can have an important effect on slowing transmission, hospital admission, and death, especially among those most at risk of covid-19, they add.
"The next phase of the public health response must align testing strategies with people's lived realities," they argue. "Ultimately, people need to be able to isolate without fear of a substantial damage to their work, income, family, or caring responsibilities."
And they conclude: "We can't wait for vaccine mediated decreases in morbidity and mortality to manifest. Too many lives have been lost or destroyed. Integrating equitable support services for those most at risk for covid-19 is a national emergency and governments should act accordingly."
Dr Fiona Godlee, Editor in Chief of The BMJ said: "The UK's political leaders seem to have their heads in the sand while waiting for the vaccine to rescue us. Unless they take other effective action to control the spread of the virus, they will be judged to have been fatally negligent."
She added: "Huge sums have been spent on test and trace, but even if this were being well managed, it works only if those who test positive are able to self isolate. Action is urgently needed to support people to self isolate, to break the chain of infection, move us safely out of lockdown, ease the strain on the NHS, and prevent more avoidable illness and death."
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Peer reviewed? No
Evidence type: Data Analysis; Opinion
Subjects: People
Journal
The BMJ