Thu | Apr 2, 2020

Morais Guy | The case for state quarantine

Published:Wednesday | March 25, 2020 | 12:10 AM
Dr. Morais Guy
Dr. Morais Guy

One of the topical debates in the fight against the COVID-19 disease in Jamaica is the matter of state quarantine as opposed to home quarantine.

There are many reasons for having home quarantine, and in an ordered and orderly society, it can work, and work effectively.

In Jamaica, unfortunately, this is not the case. The experience of this in the COVID-19 fight over the past three-four weeks has in the main been shown to be less than effective. Many persons who requested to self-quarantine have blatantly ignored that directive. They have been seen and reported to be around others in the community openly, and possibly clandestinely, without really understanding that they are putting their neighbours and their friends and other family members at risk. Ignorance sometimes intervenes, as they have no clue, nor have they a full understanding of the what and the why of being quarantined.

Of course, economics come into play here as many of our people struggle on the margins to eke out a daily living, if not a meal-to-meal existence, so instituting a home quarantine deprives them of this ability to stay alive.

Even with the State providing food packages in the community or to the household, there is still the resistance to this, and the need to ‘seek for themselves’ supersedes every other need. There are also logistical problems associated with taking food to persons who are self-quarantined, and when there is a delay the misery index gets high.

There are also those who from a public-health perspective require quarantine, who feel that they are or have not been exposed, and hence see no reason why they should be in self-quarantine.

The case also is that when you home quarantine as a family, there is stigma associated with it, and very soon the entire community starts to treat the entire clan as pariahs, making social reintegration after the requisite period very difficult and inhospitable for the individuals.

REASONS FOR STATE QUARANTINE

For these reasons, and possibly more, it is my view that quarantine in a state facility offers us the best option of preventing the spread of the coronavirus in Jamaica.

1. First, state quarantine facilities are manned by security personnel and the individuals are less likely to abscond, so we have absolute confinement for the requisite period.

2. Second, the State provides meals for these persons catered to the facility, so there should not be any complaints of food shortage.

3. Third, there is virtual isolation from outside persons, and if the proper quarantine protocols are observed, then there is little likelihood that they will run the risk of transmitting the disease to others outside of the facility. This goes a far way in reducing the community transmission.

4. Fourth, it would obviate the need to have community lockdown, as has happened in the communities of Seven and Eight Miles, Bull Bay, and Corn Piece in Hayes, Clarendon.

The reason why there is the need to quarantine the community in most instances is that there is supposed widespread contact by infected persons, or persons who would have been under home quarantine but who failed to stay home, and hence continue to mingle with the other community members, adding to the risk.

Consider this: the community of Bull Bay has a population of thousands of persons. These persons are all under community lockdown. Life has been hellish for them. The dynamics would have been different if you had removed those affected householders and contact persons from the community, house them in a state facility, adding to fewer than the current 100 now in designated state quarantine facilities, and allow the community to continue their usual way of life while still continue the investigations by contact tracing. People’s livelihoods would have been safeguarded and maintained.

5. Fifth, it would also require fewer security personnel when you have state-run facilities, as opposed to having the Jamaica Defence Force and the Jamaica Constabulary Force deployed in significant numbers in the communities to man checkpoints and patrol boundaries.

If another case is attributed to another community, will you lock down just as well? How soon will you run out of security personnel if you keep adding communities? Remember, our security forces are below required numbers right now, and numbers are finite.

6. Sixth, it would prevent the public outcry about food shortage, as has been publicised in the media of people complaining about hunger. Reports have surfaced in both lockdown communities of food shortage and people venting their anger.

HOTELS AND SCHOOL DORMITORIES

The question now arises: where would you house all these persons? Because as the disease progresses, the numbers will most definitely rise.

The country has closed all schools and colleges. Many with dormitory facilities will be closed for some time, as there doesn’t seem to be any likelihood of early reopening. Some hotels have closed and laid off their workers.

Why not use these facilities for housing the quarantined persons? The dorms are in many instances self-contained rooms, some with shared bathrooms. The hotel rooms are all self-contained.

The Government could enter into some arrangements with the hotel operators to pay for the facilities at a reduced rate, and in doing so would safeguard some of the workers’ employment, as they would be required to cook and cater for the ‘guests’ under the strict quarantine rules so that they themselves are not endangered. A similar arrangement could be made for the colleges and schools with dormitories and their workers.

I would think that between both modalities, every parish would be catered to with a combination of one or both of the above outlined.

Yes, there will be a cost to the State but at the end of the day, it might be cheaper to go this route than the community lockdowns.

More important, however, it will go a far way in ensuring that fewer Jamaicans would be infected by those who might be carriers of the virus, and hence the health burden with increased hospitalisation would be reduced.

Simply, a lower front-end spend to reduce the higher back-end spend with increased complications and prolonged expensive hospital care.

The ‘containment’ of these persons could also provide a better opportunity for the testing of all these persons as the logistic challenges outside of this setting would be averted.

These are suggestions that the Government may need to consider. We are down the wicket, but it is not too late to make changes in this ever-evolving medical emergency.

Urgent and creative action is required if we are not to fall victims of a wait-and-see approach, as has been the experience of others.

Dr Morais Guy is the shadow minister of health and the People’s National Party member of parliament for Central St Mary. Email feedback to columns@gleanerjm.com