#TalkingCOVID-19WithDrGrant: Removal Of Mandatory Institutional Quarantine For Returning Residents A Noble Move

Dr Grant Marewanhema

FROM the beginning of the COVID-19 pandemic in Zimbabwe in March 2020, returning residents were mandated to go into quarantine in designated institutions, initially for 21 days, then for 14 and this was reduced in the past few weeks to 8 days. Recently a cabinet pronouncement was made that returning residents who test negative at points of entry no longer need to go into mandatory quarantine.

By Dr Grant Murewanhema

Before we critique this decision we have to go into the dynamics of transmission. Initially, the majority of confirmed cases of COVID-19 were diagnosed among returning residents. South Africa contributed over 90% of these cases. This is not surprising given our relationship with South Africa, and some porous borders at all. The WHO defines three patterns of local transmission; namely sporadic, clustering and community transmission. While the words seem straightforward they do carry important epidemiological definitions, and use of each may mean a certain type of action.

In sporadic transmission, cases occur at random, have no geospatial relationships and are very few. Clustering means infection of groups of people who are geospatially linked; in most cases these are linked and the source of infection can be tracked to one of them, or to an imported case. Community transmission implies many cases occurring in the community, or multiple clusters of cases in different communities; which may not be linked to imported cases.”

When the returning residents were being mandatorily quarantined, a number of them who had been negative at ports of entry would subsequently test positive in quarantine, and the contentious issue was whether they were coming in infected, or obtained the infection from the quarantine centres. It seemed at some point that whatever was happening, quarantine centres were not serving their purpose, and in some instances were becoming the hotspot drivers for transmission.

This was compounded by reports of inhumane conditions in the quarantine centre, leading to illegal escape of many returnees. In any case, there were multiple reports of returning residents overstaying in the quarantine centres owing to delays in accessing testing and results. There were also multiple reports of condoms and other consumables running short in the quarantine centres, signifying that it was quarantine from the rest of the country but not from fellow returnees.

There were reports of different cohorts being mixed in the quarantine centres, and of security and healthcare personnel also acquiring infections from the quarantine centres. These centres are expensive to run in terms of human resources and provision of basic necessities. It wasnt surprising that there were multiple reports of food shortages and riots in some quarantine centres.

 The biggest question though remains; did the quarantine centres really serve the purpose they were created for?

In the long run, such centres can start posing other hazards, especially to girls and women. Amnesty International reported that during previous ebola viral disease outbreaks in West Africa security forces sexually abused young girls and women in quarantine, resulting in many unintended pregancies and infections as victims failed to access essential care timeously.

The pattern of transmission has changed, and the balance now weighs heavily in favour of community transmission. The situation reports from the MOHCC over the past few weeks show that the over 95% of cases are now diagnosed among locals.

Because of limitations in testing the actual burden of COVID-19 in Zimbabwe is unknown, but the increasing numbers of community deaths maybe telling a tale of widespread undetected community transmission.

Its unfortunate that the hospitals are debilitated and dilapidated, healthcare workers are incapacitated and the population has nowhere to obtain timeous services from. Sadly, many are succumbing to this disease quietly in their communities.

Back to the decision on removing the need for mandatory institutional quarantine, I would argue and say this is a welcome move. Resources need to be channeled and prioritised for containing COVID-19 in the community, and testing, treating and isolated infected cases. It would be noble to turn some of the pre-existing quarantine facilities into isolation facilities, which the country badly needs. Returnees have to do the right and sensible thing, which is home quarantine until cleared by a repeat PCR testing. Sometimes, we have to assume responsibility as individuals for the well-being of the community.

As we move into the future we need to remain cognisant that COVID-19 is here for much longer than anticipated, and we replace fear with responsibility. Regulations and statutes can only do so much, but as individuals and communities we have a bigger role to play. Adjusting to the new normal is a continuous process which cannot happen overnight, and continuous education and communication is a must. Lets all continue working together to fight COVID-19.

(Dr Grant Murewanhema: an Independent Public Health Specialist and Epidemiologist; who has main interests in Maternal, Sexual and Reproductive Health and Control of Infectious Diseases)

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