Who Broke Quarantine?

Almost two years ago, the world was shocked by news reports emerging from Wuhan, China. The international community did not yet believe that SARS-CoV-2 (COVID-19) would spread beyond China’s borders. Even then, the images of people dying alone in field hospitals were horrifying. The world continued with normal life for a few months, quarantining any community (or cruise ship) that had the misfortune of suffering a COVID-19 outbreak.

Quarantine was re-introduced as a modern tool for containing the spread of COVID-19. Facing international pressure to contain the spread of COVID-19, Chinese officials quickly implemented a “sealed management” policy that prevented Wuhan residents from leaving their home. Meanwhile, many developed countries were concerned about the unmitigated spread of COVID-19.  There was broad international consensus to identify and isolate COVID-19 at that time. 

The “age of quarantine” was marked by social changes unseen for at least a century. European nations implemented some of the strictest control measures. Meanwhile, within Canada, provinces engaged in a ‘quasi-quarantine’ strategy. Many restaurants, retail establishments and shopping malls closed for months. Supermarkets became a new type of general store, although toilet paper and most essential goods were stripped from the shelves.  Some people went months without a haircut while working from home.  It’s important to consider these images, which comprise a shared experience of this pivotal time in human history.

So, who broke quarantine?
By March 2020, thousands of university students made their annual journey to Florida for spring break. It marked a significant change in sentiment towards people not adhering to COVID-19 restrictions.

The ideals of quarantine were sustainable, until they weren’t. Missing from the public conversation were highly personal stories of suffering. People in quarantine often suffered alone, with few friends or family to support their care needs.  Mothers of children clung to protect their kids from an unknown threat.  Thousands of Canadians faced food insecurity, while food banks quickly became depleted. Meanwhile, small business owners worried about bankruptcy or paying their rent. 

By March 2020, the news media published scandalous images of young adults partying for spring break.  The average person was outraged by this, harkening the beginning of a blame culture for the spread of COVID-19. These powerful images – or relational frames – shaped the development of early health beliefs related to COVID-19. 

Othering and blame.  Shortages of basic supplies.  Government orders without equivalent support to access nutritious food, home care or shelter.  Upon becoming infected with COVID-19, some patients with no friends or family were ordered to confine themselves in their home.  The result was a health care system that was overwhelmed with calls for support and testing. People facing distress felt disconnected from a health care system that encouraged self-isolation, without appropriate home support or assessments.

When a Patient Dies… Alone

Quarantine orders meant that many otherwise healthy individuals died alone at home from COVID-19 without any symptom assessment in their home.  The health care system began to respond poorly to acute care demands. People lacked access to health care, and prevention of death became their personal responsibility while adhering to self-isolation requirements. For example, faced with breathlessness, the patient would be responsible for deciding when to call 911.  Family physicians quickly became overwhelmed with unmet health demands.

Collectively, health care systems overlooked symptom distress in the community. We responded later in the process of distress, sometimes after the secondary complications of COVID-19 had severe impacts on a person’s survival. Vulnerable patients became anxious, unsure they could independently manage the demands of living at home. Health anxiety soared, as people easily recalled instances where they felt alone and unsupported during a personal health crisis.

By 2021, it was clear that the process of quarantine was broken… flawed even. Governments began to abandon the practice. This resulted in a healthcare system that would continue to manage population health, while simultaneously withdrawing support available to the individual. The experience of quarantine was punctuated by a lack of advocacy for paid sick time, home health care and isolation support. EMS and emergency rooms became the default assessment centers of the pandemic.

In this post-pandemic environment, it is important we talk about these experiences openly. How did patients experience quarantine when experiencing symptom distress at home? Were patients supported in post-COVID recovery at work, or did their symptom experience threaten their livelihood?  More importantly, how did COVID-19 impact their overall health? 

As health care professionals, we must first seek to understand the patient’s experience.  Only then can we improve the use of quarantine for future epidemics and outbreaks.

Published by Adam Henley

Adam is a Registered Nurse with experience in chronic disease management, symptom measurement, hematology/oncology, primary care behavioural health and geriatrics. He combines counselling, nutrition & exercise with traditional home nursing care. Adam cares to live health together with clients in a manner consistent with Parse’s Theory of Human Becoming. At the heart of his care, Adam offers evidence-based strategies to transform health together.

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