‘Out-of-home quarantine’ measures in China helped limit spread of COVID-19, epidemiologists say

Open this photo in gallery:

Ten days after locking down the city of Wuhan, Chinese authorities took another dramatic step to curtail a viral outbreak – and civil liberties: Beginning Feb. 2, officials forced into “centralized quarantine” anyone with a fever and people who had been in close contact with someone believed to be infected by the novel coronavirus.

In the weeks that followed, thousands of people were taken from their homes and forcibly placed in hotels, dormitories, convention centres and even converted classrooms at Communist Party schools.

The idea was to keep the virus from spreading at home, as well.

It’s the exact opposite of what is taking place in many other parts of the world, where authorities have sought to keep people out of hospitals unless their cases are severe. The government of Canada’s official advice to those with mild symptoms is to “isolate yourself at home,” although it counsels staying in a separate room.

What are the coronavirus rules in my province? A quick guide to what’s allowed and open, or closed and banned

Coronavirus guide: Updates and essential resources about the COVID-19 pandemic

How many coronavirus cases are there in Canada, by province, and worldwide? The latest maps and charts

Open this photo in gallery:

British Columbia tells people with fevers, coughs and sore throats – all symptoms of COVID-19, the illness caused by the coronavirus – to self-isolate, which “means staying home.” Ontario’s instructions for self-isolation include keeping away from others and using “a separate bathroom if you have one.”

According to the Public Health Agency of Canada, 71 per cent of the country’s cases have come from community transmission rather than travel-related exposure to an outbreak hot spot such as Wuhan.

But epidemiologists say China demonstrated the importance of taking infected family members – even those not seriously ill – out of the home as a way to halt the formation of small clusters of cases among those living in close quarters.

“Mild people are spreading it just as much as severe cases, in fact probably more so. And the world – except for Hong Kong, Taiwan, Singapore, South Korea and China – the rest of the world sends their mild people home and says, ‘Please, home quarantine,’ ” said Dale Fisher, a professor of medicine at the National University of Singapore, who was among the 25 delegates in a World Health Organization mission to China in February.

Open this photo in gallery:

“And I think it’s a big mistake. It’s like they’re all just lemmings, walking off a cliff, not learning from countries that have succeeded.”

Chinese researchers who have pored through the numbers point to centralized quarantine as a key reason Wuhan, which will end its travel lockdown Wednesday after officially reporting only two new cases in the past two weeks, was able to limit the spread of the virus. Numerous questions have been raised about the accuracy of the Chinese statistics, in particular the number of reported deaths in Wuhan.

But the closing of temporary hospitals built to combat the virus and a broader easing of pressure on the health-care system in Wuhan have buttressed the official argument that the worst of the virus has, for the moment, been kept in check in the city that was the original epicentre of the outbreak.

In the initial stages of the pandemic, the rate of spread among family members in China was 10 per cent. Forced isolation dropped that figure to 3 per cent, Wu Zunyou, the chief epidemiologist with the Chinese Centers for Disease Control and Prevention, said in mid-March. At one point in early February, officials in Hubei province, where Wuhan is the capital, had more than 75,000 people under medical observation.

“This quarantine measure did a great job in helping prevent domestic infection. It’s brilliant,” said Wu Tangchun, a public-health expert at Huazhong University of Science and Technology in Wuhan. “There’s no doubt that it was a crucial factor in Wuhan’s victory.”

Open this photo in gallery:

He dismissed concerns about the human-rights implications of separating families. “Would you rather get your children and elderly parents infected or are you willing to wait and stay away from them for 14 days? This is a choice between short-term and long-term happiness. I don’t think that’s hard to understand.”

Even after official declarations that China has put the worst of the outbreak behind it, centralized quarantine remains a central pillar of the country’s pandemic measures, as officials seek to fend off the emergence of a second wave.

People flying into the country must spend 14 days in government-selected facilities, primarily hotels that have been temporarily repurposed for quarantine measures, with people 15 and older in separate rooms – even if that means splitting up couples or keeping parents and children apart. On Tuesday, officials in Beijing said they had gone two weeks without a new case of community transmission.

The policy has forced huge numbers of people into hotels across the country – an ancillary economic benefit for a hospitality industry brought to its knees by the outbreak.

Open this photo in gallery:

“There’s billions of dollars in stimulus money being spent by government – here’s something that aligns directly with pandemic control,” a measure that’s good for both the economy and public health, said Craig Dalton, a public-health expert at the University of Newcastle who has promoted “pre-emptive, low-cost hygiene enhancement and social distancing,” including eating lunch alone and placing a sign on the front door that says: “Welcome if you are well.”

Dr. Dalton dislikes the term “centralized quarantine” because of its authoritarian connotations. He prefers “out-of-home quarantine,” a practice some jurisdictions in Australia have begun to adopt, he says. In some cases, people who are vulnerable to COVID-19 because of their age or underlying health conditions have been taken out of their homes and placed in hotels. In other cases, people with just mild symptoms have been isolated.

Either way, Dr. Dalton says, it’s a crucial measure. In China, “about 80 per cent of transmission happened in the homes, because that’s where the people were and that’s where they were most face to face with others.” In the midst of the outbreak, people are “probably most at risk inside the house,” he said.

Open this photo in gallery:

For countries seeking to contain COVID-19, “out-of-home quarantine needs to be really pushed,” he said.

In China, doctors point out that the tough measure is necessary to overcome a key obstacle to pandemic control: human nature.

“Home quarantine is a challenge to people’s sensibilities. Some people can’t follow quarantine orders set by virus prevention departments, and that’s likely to create risks for their families,” said Lin Ming, a pediatrician at Xiehe Hospital, one of the most important health-care facilities in Wuhan.

With no vaccine yet available, strict enforcement of isolation, even if it separates family members, “is definitely the best way for us to cut off the spread of the virus,” he said. In a pandemic, he argued, “the needs of individuals are subservient to those of the group. Making a small personal sacrifice, including enduring discomfort, is what we have to do.”

With reporting by Alexandra Li

Sign up for the Coronavirus Update newsletter to read the day’s essential coronavirus news, features and explainers written by Globe reporters.