key: cord-0879591-1ncsfy51
authors: Raveendran, A.V.; Jayadevan, Rajeev
title: Reverse quarantine and COVID-19
date: 2020-07-19
journal: Diabetes Metab Syndr
DOI: 10.1016/j.dsx.2020.07.029
sha: d19e0e1804644978c1e42dd9f5e09d16bb4c7dcd
doc_id: 879591
cord_uid: 1ncsfy51

BACKGROUND: COVID-19 is a pandemic, resulting in large number of deaths all over the world. Lack of effective antiviral agents and vaccines pose a major challenge to control this pandemic. METHODS: Review the role of reverse quarantine in the control of COVID-19. RESULTS: Public health measures like social distancing, wearing face mask and hand hygiene along with quarantine measures form important steps to control the disease. Reverses quarantine is a useful strategy to reduce morbidity and mortality associated with COVID-19. CONCLUSIONS: Reverse quarantine is a promising public health measure to reduce the morbidity and mortality associated with COVID-19.

Abstract Background COVID-19 is a pandemic, resulting in large number of deaths all over the world. Lack of effective antiviral agents and vaccines pose a major challenge to control this pandemic. Methods Review the role of reverse quarantine in the control of COVID-19. Results Public health measures like social distancing, wearing face mask and hand hygiene along with quarantine measures form important steps to control the disease. Reverses quarantine is a useful strategy to reduce morbidity and mortality associated with COVID-19. Conclusions Reverse quarantine is a promising public health measure to reduce the morbidity and mortality associated with COVID-19.

Key words: Quarantine, Reverse quarantine, COVID-19.

• Quarantine and Reverse quarantine are common preventive measures in COVID-19 pandemic. • Separating those who are exposed to an infectious disease is called quarantine. • Separating those who are likely to develop severe illness from the public is Reverse quarantine. • It is a promising strategy to reduce the morbidity and mortality associated with COVID-19. Reverse quarantine and COVID-19 Quarantine and Reverse quarantine are commonly used terms in connection with pandemic COVID-19.

In simple terms, quarantine means a period of time during which a person who might have a disease is kept away from other people in order to prevent the spread of the illness. Dorland's Illustrated Medical Dictionary defines quarantine as "restriction of freedom of movement of apparently well individuals who have been exposed to infectious disease, imposed for the usual maximal incubation period of the illness". Separating those who are exposed to an infectious disease in order to stop the spread of infection is called quarantine, whereas separating those with the disease is called isolation [1] .(see figure 1 ) Quarantine practice started long ago from 14 century, when ships coming from plague infected areas were not allowed to dock, and were made to wait for 40 days in order to prevent the spread of the disease. The word quarantine comes from the Italian words "quaranta giorni" which means 40 days [2,3].

The common diseases for which quarantine is implemented include cholera, diphtheria, infectious tuberculosis, plague, smallpox, yellow fever, viral hemorrhagic fevers (such as Marburg, Ebola, and Congo-Crimean), and severe acute respiratory syndromes in addition to COVID-19. Quarantine is found to reduce the risk of COVID-19 disease by 44-81% and mortality by 31-63% [4] . Proper timing and duration of quarantine and the ability of the people and health care providers to adhere to the quarantine procedures determine the success rate of quarantine.

During this COVID-19 pandemic, it has been observed that older people, individuals with diabetes, hypertension, lung disease, kidney disease and immuno-compromised individuals are at risk of severe illness and considerably greater mortality with SARS-CoV-2 infection [5] . Reverse quarantine involves separating those who are likely to develop severe illness (vulnerable population), from the general public who are at the risk of the disease during an outbreak of an infectious disease, so that the associated mortality and morbidity could be reduced (Table 1 ) [6] . Vulnerable individuals should not be allowed to attend public gatherings and wherever possible, should be separated even from their family members, who have high risk of exposure (Table 2) . Younger adults in the household, who have substantial contact with sick people on a regular basis as part of their profession, might consider living in a separate dwelling until the risk is lowered.

Prolonged "lockdown" is not a feasible long-term solution due to its adverse economic implications. In COVID-19, there are large numbers of asymptomatic individuals and pre symptomatic individuals who can transmit the disease. Also pertinent here is the relative shortage of hospital facilities that cannot cope with a large influx of patients at a time; denial of care being inevitable in such an eventuality. Hence in the absence of effective treatment or vaccine, reverse quarantine is a promising and inexpensive solution.

The secondary attack rate (the percentage of close contacts that acquire the infection from a contact) of the SARS-CoV-2 virus ranges from 10.5 to 83, in various studies from multiple countries. The wide range is due to variation in living conditions and behaviour of the people involved. Experience from the diamond princess cruise ship has shown that the R-0 (ability of an infected person to infect other people) can be reduced from 7 to <1 by adhering to quarantine measures even in relatively small living spaces [7] . It follows that implementation of such measures can protect the vulnerable segment of the population to a significant degree.

However, implementing reverse quarantine in a populous country like India with a large number multigenerational family is a challenge. A substantial part of the population lives in cramped living conditions where social distancing is not feasible. Younger adults might not have the financial reserve to afford a second dwelling. If a vulnerable individual is the only earning member of the family, reverse quarantine is not a practical option.

To conclude, although there are limitations, reverse quarantine is promising strategy to reduce the morbidity and mortality associated with COVID-19. Figure 1 : Isolation, quarantine and reverse quarantine

The Origin of Quarantine

Quarantine alone or in combination with other public health measures to control COVID-19: a rapid review

Prevalence of comorbidities and their association with mortality in patients with COVID -19: A Systematic Review and Meta-analysis

Reverse quarantine: Management of COVID-19 by Kerala with its higher number of aged population

Transmission potential of the novel coronavirus (COVID-19) onboard the Diamond Princess Cruises Ship, 2020, Infectious Disease Modelling