With a third of the world said to be on some form of lockdown, scientists have investigated the factors that encourage people to stick to a quarantine.
The coronavirus is said to have emerged at a seafood and live animal market in the Chinese city Wuhan, capital of Hubei province, at the end of last year.
It has since spread into more than 170 countries across every inhabited continent, with over 787,000 confirmed cases since the outbreak was identified. In severe incidences, the virus can lead to a respiratory disease called COVID-19.
To stem the spread of transmission, officials around the world have introduced enforcements that only allow residents to leave their home to buy essentials or for exercise, with socialising and non-essential travel as good as banned.
Concerned many may struggle to stick to the draconian measures, scientists from King’s College London analysed 14 studies on adherence to quarantines during an infectious outbreak.
They found people were more likely to stick to a lockdown if they had “knowledge” about the infection, understood the benefits of quarantining and had the supplies required for a prolonged stay indoors.
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Boris Johnson has introduced unprecedented enforcements that only allow Britons to leave their home for “very limited purposes”, like “shopping for basic necessities as infrequently as possible”.
Anyone with the virus’s tell-tale fever or cough has been told to isolate entirely for seven days, with other members of their household doing the same for two weeks.
Letters have also gone out to 1.5 million vulnerable Britons, like those with severe asthma or blood cancer, telling them to stay indoors for the next three months.
Latest coronavirus news, updates and advice
While officials are confident these extreme measures will stem the spread of the pandemic, the King’s scientists stress “quarantine does not work if people do not adhere to it”.
“Officially-sanctioning” lockdowns in the form of fines or other punishments can “lead to legal dispute, chaotic scenes of confrontation and poor mental health”.
“Many nations are understandably nervous of these outcomes, especially given that confrontation can now result in harrowing mobile phone footage making its way to social and mainstream media,” the scientists wrote in the journal Public Health.
Officials therefore tend to rely on “a combination of inducements and appeals to civic duty in order to encourage people to adhere”.
To better understand the effectiveness of this approach, the scientists analysed 14 studies, where adherence ranged from 0% to 93%.
Results suggest people are more likely to stick to a quarantine if they understand its “procedure” and the risks of the infection it is protecting them from.
When five schools in Australia were closed during a flu outbreak, a lack of clear quarantine instructions led to some “inventing their own rules” based on what they deemed an “acceptable degree of contact”.
A village affected by Ebola in west Africa became more compliant when they began to notice the spread of the infection was slowing.
Residents of several Senegalese villages also stuck to a quarantine against Ebola when they learnt asymptomatic patients can spread the disease.
Making quarantine a “social norm” was also found to be effective.
For example, people quarantined in parts of Canada during the outbreak of fellow coronavirus strain severe acute respiratory syndrome (Sars) in 2002/3 were more likely to adhere to it if they were pressured to do so by their peers.
Practical issues were also found to be important, for example people tend to stick to a quarantine if they know it will not leave them financially vulnerable if unable to go to work.
Britons have long been urged to work from home if they can.
With closed pubs, bars and restaurants leaving many out of pocket, chancellor Rishi Sunak has introduced “unprecedented” financial measures to help protect workers and jobs, including paying up to 80% of wages.
Coronavirus: ‘who would want to be a decision-maker right now?’
Experts have welcomed the “timely” research.
“This new review is very welcome and reinforces the viewpoint that there can be very different levels of compliance with quarantine interventions such as social distancing, varying from zero to almost 100%”, said Dr Michael Head, from the University of Southampton.
“These differences in the behavioural response highlight the difficulty of making decisions around when to recommend quarantines, to what level, and importantly when to relieve any lockdown measures.
“Who would want to be a decision-maker right now?”
While the measures brought in are extreme, the public seem to have accepted then.
“It is clear from our empty streets and public spaces that the vast majority of people have got the message that we must all avoid social contact so we can slow down the spread of coronavirus and prevent the health system being overwhelmed”, said Professor Lucy Yardley also from the University of Southampton.
“Although there have been a few examples of a few people who have not yet understood or have not followed the public health advice on social distancing these only make the headlines because they are so rare”.
One expert worries, however, the financial support put in place by the government may not do enough to ensure everyone sticks to the lockdown.
“These findings suggest key steps to enabling adherence to the current social isolation advice are to ensure financial security for all, for example ensuring that five million self-employed people are provided financial security now, rather than in June”, said Professor Susan Michie from University College London.
Sunak announced on Thursday a special package of support for the self-employed, promising to pay them up to £2,500 ($3,000) a month during the coronavirus shutdown.
He went on to say the new scheme would likely only be up and running by June, leaving the self-employed with a wait of almost three months before cash comes through.
Those who cannot wait until June can apply for a loan under the coronavirus business interruption loan scheme or apply for universal credit.
Ministers have yet to rule out more severe measures
While the government has not ruled out more extreme measures to combat the coronavirus outbreak, not all are convinced these are necessary.
“[The] government should consider more of a focus on the objectives of quarantine than on the precise means and trust people to devise their own solutions within a broader framework of guidance,” said Professor Robert Dingwall, from Nottingham Trent University.
“Police harassment of citizens sitting on park benches or lonely beaches is not helpful.”
While many are no doubt finding “lockdown” difficult, experts stress now is not the time for complacency.
“These are difficult times but we should be proud in the UK that we are doing a great job of working together to stop transmission of the coronavirus,” said Dr Tom Wingfield, from the Liverpool School of Tropical Medicine.
“Despite the encouraging signs, the social distancing measures and other restrictions to our daily lives will be needed for some weeks and possibly months to come and, by continuing to observe them, we are all contributing to controlling coronavirus in the UK.
“Let’s keep at it.”
What is the coronavirus?
The coronavirus is one of seven strains of a virus class that are known to infect humans. Others include the common cold and Sars.
Symptoms tend to be flu-like, including fever, cough and slight breathlessness. Early research suggests four out of five cases are mild.
In severe incidences, pneumonia may come about if the infection spreads to the air sacs in the lungs, causing them to become inflamed and filled with fluid or pus.
The lungs then struggle to draw in air, resulting in reduced oxygen in the bloodstream and a build-up of carbon dioxide.
The coronavirus has no “set” treatment, with most patients naturally fighting off the infection.
Those requiring hospitalisation are offered “supportive care”, like ventilation, while their immune system gets to work.
Globally, the death toll has exceeded 37,800, according to Johns Hopkins University.
More than 166,200 people are known to have “recovered” to date.