Friday, February 7, 2025

Study reveals how home quarantine breaches propelled Botswana’s Covid-19

A professional study suggests that Botswana could have contained the spread of COVID-19 had it not been for a breach in home quarantine regulations resulting in the initial eight local transmissions in the country.  

The study paper titled “Shortfalls in home quarantine for COVID-19 Prevention: a case report” was commissioned by the Pan African Medical Journal. It was conducted by seven medical health professionals: Chidzani Catherine Mbenge, Lebapotswe Tlale, Lisani Ntoni, Naledi Mokgethi, Sidney Otlaadisa Kololo, Rinett Pharatlhatlhe and Tuduetso Molefi.

The study paper which is the work of the operational Botswana´s COVID-19 national contact tracing subcommittee that produces case reports as part of contact tracing analysed a Covid- 19 imported case placed under home quarantine that resulted in eight local transmissions at the beginning of the Covid-19 epidemic in Botswana.

Giving a background of how local transmission came about, the report says a young male XY returned to Botswana from overseas on the 22 March 2020. He was screened at Botswana’s largest air point of entry, Sir Seretse Khama International Airport, using a screening questionnaire and temperature check. He was found to be asymptomatic and advised to go under home quarantine. 

The study revealed that “as he did not have his own transport from the airport, he was picked up by a group of friends who then held a welcome home session for him at a residence in Gaborone. After 2 days XY travelled to a village 50km from Gaborone where he quarantined with his friend, XX, without reporting to the local health team.” 

The study further revealed that, “he then developed flu-like symptoms on 28th March 2020 and called the local health team who upon learning that he arrived from a COVID-19 highly affected country, came prepared in full personal protective equipment and admitted him to the local isolation centre.” 

His friend was also put into isolation the following day. They both tested positive for SARS-COV-2 by polymerase chain reaction (PCR) and were Botswana’s COVID-19 cases number 5 and 6 and his friend was the first local transmission case in Botswana. 

“XY and XX contacts were all line listed and all close contacts were home quarantined and tested. 2 other XY’s friends who worked at the same workplace of 105 employees became confirmed cases on 8th April 2020. The employees and immediate families of the 2 friends were quarantined and tested where 5 more employees became confirmed cases. No further cases were discovered from their contacts,” the study paper says. 

The authors pointed out that, “this case report highlights that home quarantine if not well managed can lead to a surge in local cases and drawing from the literature we propose recommendations of strengthening home quarantine.”

The study states that the shortfalls identified from this case was that the index (suspected COVID-19 patient) was given verbal instructions at the airport, had improper transport arrangement, mingled with many people and there was no active follow in quarantine. 

“It is our argument that this was a preventable situation had there been proper quarantine measures in place. As countries like Botswana are considering lifting travel bans and resuming international travel amidst the COVID-19 pandemic, quarantine of travellers from highly affected countries might still be necessary,” they noted. 

The authors said it is not only returning travellers and close contacts of cases that are monitored at home but confirmed COVID-19 cases not requiring hospitalization can be placed under home isolation. 

“There is need for best practices to be in place so that this high-risk groups monitored at home do not spread the COVID-19 infection defeating countries efforts of epidemic control,” reads the paper. It says some factors associated with adherence to quarantine include perceived risk of disease, perceived benefit of quarantine, shortage of essential supplies and financial implications.  Therefore, whenever home quarantine is utilized it needs to be well organized and highly monitored to be effective. 

They noted that legally binding agreements signed by clients going under quarantine are one way of ensuring compliance. 

They revealed that during the SARS outbreak in 2003 Singapore ensured compliance to home quarantine by serving clients with the Home Quarantine Orders (HQO) and fining those who breach it in addition to surveillance, enforcement, health education, transport, and financial support to those losing income by being in quarantine. Only 26 out of 7863 contacts of SARS cases served with an HQO breached the rules and were penalized.

The authors said community structures can be mobilized to support home quarantine.

“An example is Shenzhen, China that controlled COVID-19 transmissions through effective management of home quarantine using the “Three in One” Task Force comprised of community work stations, community health centres and community police where community workers ordered and delivered necessities for those in quarantine and actively monitored them twice a day. This organized home quarantine had good results as only three out of 2,004 persons on home quarantine had confirmed COVID-19 infection,” the study says.

The authors said African countries like Botswana can also use community structures such as village leadership, village development committees and community volunteers to monitor compliance of people on home quarantine. 

They suggested that neighbourhood watch program (community policing) successfully used against crime can be extended to report neighbours breaking quarantine rules. A high volume of people on home quarantine require a lot of manpower to follow up clients daily. 

“However, in the case of Singapore they outsourced the service to a security agency and used auxiliary police officers instead of health officers in serving the HQO at homes and the officers made random checks by calling the clients twice daily to ensure that they stay home. This is a stringent measure that can be adopted by countries to ensure compliance,” the study says. 

The authors concluded that well organized home quarantines are a feasible alternative to facility quarantine for the control of communicable diseases like COVID-19. 

“If not well managed, breaches in home quarantines can lead to the spread of local transmissions in the community. Home quarantine should be reinforced through legal binding quarantine orders, home assessments, health education, use of community structures, provision of support services in quarantines, use of technology for surveillance and taking legal action against those who break rules,” the authors observed.

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