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31 March 2020

Adherence to quarantine during COVID-19 pandemic

Information, social influence, the practicalities of isolation and a clear understanding of the benefits of quarantine are key to people adhering to this measure to contain infectious disease outbreaks, according to new research from King’s College London.

Adherence to quarantine during COVID-19 pandemic

Entire cities have already gone into quarantine during the current COVID-19 outbreak and more are likely to follow.

However, quarantine will not work if people do not adhere to it. To provide guidance on how to ensure quarantine measures are effective during the current COVID-19 outbreak, researchers from the NIHR Health Protection Research Unit in Emergency Preparedness and Response at King’s College London analysed previous research investigating the factors associated with adherence to quarantine during previous disease outbreaks.

Published online in the journal Public Health, the research identified 14 studies that looked at the adherence of different groups to quarantine protocol during a range of disease outbreaks, including Ebola, SARS, swine flu and Mumps. Analysis showed that people vary in their adherence to quarantine and from the eight studies that reported on this, adherence rates of quarantined individuals ranged from 0 to 92.8%.

One of the major factors affecting adherence to quarantine is knowledge about the infection and the quarantine protocol, according to the study. If instructions or language are unclear then people tend to make up their own rules. Social pressure from others to comply with quarantine is also important.

Cultural factors also played a role, according to the researchers, and when caring for others is inherent in a culture this could mean people might break quarantine in order to follow this cultural norm.

Our study shows that people vary in their adherence to quarantine during infectious disease outbreaks and to improve this public health officials should provide a timely, clear rationale for quarantine and information about protocols and emphasise social norms to encourage this altruistic behaviour.

Lead author Dr Rebecca Webster, the Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King’s College London

'Our research also showed that messaging around the benefit that engaging in quarantine will have on public health could be influential as well as ensuring that sufficient supplies of food, medication and other essentials are provided.' Rebecca said.

If people believed that quarantine was beneficial in controlling the outbreak then adherence was better, particularly if it could be observed in a slowing in the spread of the outbreak. In addition, when the disease itself is believed to be more risky, adherence to quarantine was better.

Practical issues were also influential with fear of running out of supplies and loss income both affecting whether people broke quarantine.

The effectiveness of quarantine depends on how many people do it so it is important to know what makes people more likely to comply. Our research shows that information and knowledge around the quarantine are central to its effectiveness.

Contributing author Professor Sir Simon Wessely, IoPPN

He continued, 'In the era of ‘fake news’ consistent messaging is difficult but leaving the information needs of the public unmet can be dangerous. Public health teams should provide clear, authoritative information where needed, and then check the messages are getting through. This is happening in this country, but needs to be worldwide.'


The paper is still undergoing formatting and copy-editing and may be subject to slight changes.

Reference: Webster, R.K et al. (2020) How to improve adherence with quarantine: Rapid review of the evidence. Public Health DOI: 10.1016/j.puhe.2020.03.007


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