Dr Om Kurmi
The main purpose of quarantines during the current pandemic is to keep away a person or group of people who are asymptomatic but are believed to be exposed to the SARS-CoV2 from healthy people. Many researches suggest that the median incubation period is estimated to be around five days, and approximately 97.5% of those who develop symptoms will develop so in about 11.5 days. This broadly means that the majority of the people in quarantine, if had an infection, will show symptoms within 14 days. WHO recommends a quarantine of 14 days. Based on the WHO recommendation, many governments around the world, including the Nepalese government, have decided to quarantine people coming from abroad for 14 days before allowing them to go to their homes.
The Nepalese government provided the first quarantine facilities for those who initially returned mainly from Wuhan, China, where the virus is believed to be transmitted to humans. Nowadays, many provincial governments bordering with India have these facilities for Nepalese citizens returning from India through land routes. The best approach would be to quarantine and test everyone coming from a high-risk zone, such as migrant workers coming to Nepal from some of the Indian states such as Maharashtra, Gujarat, Delhi, Uttar Pradesh as the infection rate in these states are high or from other countries including the Middle East where the likelihood of workers getting infected is high. There have been several complaints about the inadequate facilities, including not proper hygiene, toilets facilities and poor quality of food in quarantine facilities established in the neighbouring region of Nepal and India.
I believe the government should have at least basic facilities. Some of them that are important to make the quarantine effective are: (i) Stay in the quarantine facility for the 14 days unless you develop a symptom and are tested positive. If you are tested positive, you should be moved to an isolation facility. (ii) Provide individuals staying in quarantine with specific basic requirements such as clothes, towels, bedding, cups and plates, utensils etc. and they should be asked not to share it with anyone during the quarantine period (iii) Maintenance of proper hygiene: Here handwashing with shop should be adhered to strictly as this is the first line of defense. Always sneeze into your elbows or piece of clothes or tissue if available. Need to have proper toilet facilities which are found to have been lacking in individual quarantine facilities and people are forced to go out in the open field. Provide and advise individuals staying in quarantine to use paper or piece of clothes or disposable gloves to open the door handle or knob of the room or toilet, which either can be discarded or cleaned. It would be advisable to provide individual small hand sanitizer bottle to each one staying in the quarantine (iv)Always maintain social distancing of at least 2 metres from other individuals in the quarantine, and (v) Always wear cloth masks while staying in quarantine
Isolation of sick and vulnerable population
Isolation is a type of quarantine but reserved for individuals with symptoms of COVID-19 or for those who have tested positive. Most of the isolation facilities are provided in healthcare facilities reserved for individuals with moderate to severe symptoms where there is the availability of urgent medical care if needed. In many countries, individuals with mild symptoms or those elderly in long term care homes who are the most vulnerable groups are advised to isolate them in their room so that the healthcare facilities are not overburdened and are available for extremely sick individuals. During the isolation period, the COVID-19 positive cases are closely monitored by healthcare workers so that they are kept away from healthy people and hence prevent the spread of the virus.
Wearing face masks
The use of masks by the public has been very widely discussed. Many organizations, including the WHO and US CDC, who in the past had issued guidelines against wearing a mask in public has now changed their earlier recommendation. Now many organizations, including the WHO, advises to leave the medical mask for the healthcare workers and use clothes mask while in public and where a minimum of 2 metres of social distancing cannot be maintained. The main purpose of wearing clothes mask in a public place is to prevent the spread of the virus to other healthy individuals. The overall summary of using masks has been summarised below:
• We should avoid indiscriminate public wearing of medical masks as this may result in additional critical shortages of masks needed to protect front-line healthcare workers. It is recommended to keep physical distancing and proper hygiene, including frequent handwashing with soap as they are found to have more potential benefits compared to mask-wearing.
• There is now a broad consensus that the public mask-wearing is potentially beneficial as source control for individuals with respiratory symptoms who cannot avoid travelling to public spaces and cannot maintain a minimum of 2 metres of physical distancing at all times (e.g. travelling for medical care). The role in preventing the spread of the virus from asymptomatic or pre-symptomatic individuals is unknown, and so far, it is only theoretical.
• The effectiveness of homemade and cloth masks varies and depends upon the material used. One should understand these homemade or cloth masks are to protect others, and if everyone wears it, then this in the current condition is an excellent public health measure. The efficacy of surgical masks and N95 respirators compared to handmade clothes mask is greater; however, if everyone wears a cloth face mask while in a public place, there is a likelihood of having some protection, but it is not clear the degree of protection.
• The effectiveness of masks also depends upon good wearing and removal techniques. Wearing masks in isolation will not be very helpful unless it is combined with proper hygiene techniques, including handwashing with soap and also washing the mask that is made of clothes with detergent after its every use in a public place. We should always discard disposable masks after wearing them in public places.
(The author is Asst. Professor, Respiratory Epidemiology, at the Department of Medicine, McMaster University, Hamilton, Canada)