The UK government is considering plans to increase compensation for those who have to self-isolate because they have been exposed to coronavirus, as it looks at ways to keep those who may be infected at home to halt the spread of Covid-19.
Anyone in the UK who either tests positive for Covid-19, or comes into contact with somebody who has tested positive, must self-isolate for 10 days. But studies used by the government’s Scientific Advisory Group for Emergencies (Sage) estimate levels of compliance are between 18 and 25 per cent. Crucially, people who earned less than £20,000 per year or had less than £100 in savings, were three times less likely to self-isolate.
The UK government has one of the highest testing rates per capita in the world, and has set aside £22bn for its testing and contact-tracing strategy. But to date there has been extremely limited provision for those required to self-isolate, who must do so in their own home, at their own expense.
“Why, when we have very high testing capacity, have we ended up with worst-in-class outcomes in terms of prevalence and mortality,” said one person working for the UK government’s test and trace programme. “Understanding the success of ‘isolation’ is a key part of answering that I think”.
Governments around the world have taken different approaches to getting their populations to quarantine themselves when they are at high risk of spreading the virus, with some offering benefits while imposing punitive sanctions. The marked absence of support for self-isolation in the UK has sparked frustration among public health experts.
“Without isolation what’s the point?,” said Martin McKee, professor of European public health at the London School of Hygiene and Tropical Medicine. “The reason most people don’t isolate is because they can’t and we haven’t been providing anything like the degree of support we should be.”
Late last year, after public pressure, the UK government began offering £500 one-off payments to those who were unable to work from home. But people were only eligible if they already received benefits. Even then, only one in three who applied when asked to self-isolate by NHS Test and Trace were successful, according to official figures.
Nor does the government offer food or other necessities to those it says must stay at home. Instead, it advises them to “ask friends, family or neighbours who are well to go out and get food and other essentials for you”.
Dr Muge Cevik, clinical fellow at the University of St Andrews, pointed to statistics that show a clear link between deprivation and poor outcomes from the virus.
“For many, [coronavirus] is a mild illness and if you have to decide between earning money and staying home when you feel OK, it’s a difficult choice,” she said. “The solution to compliance is financial support rather than enforcement.”
In South Korea, where the infection rate is 72 times lower than the UK, the authorities give Won454,900 ($411) to isolating individuals who are unemployed, self-employed or employed, regardless of their income. They also send a stay-at-home kit, with food, drink and medical supplies and regularly check in with individuals through an app.
Several local authorities also offered temporary accommodation to South Korean residents who tested positive for Covid-19 when self-isolation at home was difficult.
New York followed a similar model last year. Anyone who tested positive for Covid-19, along with their close contacts, was offered free hotel accommodation. By November, more than 2,500 had isolated in hotels, according to Ted Long, a physician and the executive director of the Test & Trace Corps. The city also offered food delivery, medicine, and protective equipment to anyone who requested it.
The limited data available on adherence to self-isolation rules points to the impact of these policies. Accommodation is particularly crucial for those living in cramped housing. The risk of transmission between residents rises from 18 per cent in a two-person household to 50 per cent when more than six people live together, according to the UK’s Office for National Statistics.
A recent study by researchers at University College London, found that while general compliance with rules around social distance and hygiene was remarkably high in the UK, nearly 40 per cent of people admitted to not remaining in quarantine for at least 10 days, and 13 per cent said they had not isolated at all.
In contrast, a recent study in South Korea found that the median rate of self-quarantine violations was 1.6 per 10,000 self-quarantined individuals, which equates to better than 99 per cent compliance. New York officials have presented data showing around 98 per cent compliance, based on the number of people who confirm by phone that they remain inside and alone.
Many governments have also dangled the threat of severe punishments to deter their populations from breaking quarantine rules.
In South Korea, anyone who tests positive for the virus must immediately download an app which tracks their movements and they are often subject to random home visits. Infractions result in fines of Won10m (£6,764), sentences of up to a year in prison, or both.
The UK, by contrast, has been criticised for taking a much more lax approach to penalties. People breaking most coronavirus rules receive a £200 fixed penalty, which is reduced to £100 if it is paid within 14 days. In September, fines for violating self-isolation rules were raised to £1,000 for a first offence.
In recent weeks, UK police forces have ramped up their rhetoric on enforcement, saying those who break the rules are “increasingly likely” to receive fines.
But several public health experts have warned that there is limited evidence that harsher penalties will work, particularly given the clear link between deprivation and lack of compliance.
“Behavioural theory has long held that positive reinforcement is more effective than negative reinforcement,” said Michael Hopkins, professor at the science policy research unit at Sussex university, who has been leading an international comparison of policies around test, trace and isolate.
“Isolation is difficult — or impossible — if you are precariously employed or self-employed, economically disadvantaged, live in crowded conditions or have competing commitments such as care duties.”