Home quarantine

How many people have contracted COVID-19 at home?

Too many, as far as the Department of the Interior and Local Government is concerned. So with support from the National Task Force Against COVID-19, the DILG is pushing for a near-total ban on home quarantine even for mild and asymptomatic cases.

The only ones who may be exempted are people needing special care by household members, such as the infirm elderly, pregnant women, or those with debilitating comorbidities or physical disabilities.

DILG officials partly blamed the home quarantine policy for the surge in COVID cases before President Duterte grudgingly agreed to a two-week “timeout” suggested by medical groups.

The Department of Health has opposed a sweeping ban on home quarantine for mild and asymptomatic cases. Last Thursday, Health Undersecretary Maria Rosario Vergeire explained to “The Chiefs” on OneNews / TV5 that the DOH is opposing the ban because the government lacks facilities and health personnel for all asymptomatics.

From a purely health standpoint, complete isolation from the rest of the household is the ideal policy.

A basic problem, however, is the quality of quarantine facilities. People with mild or no symptoms generally don’t want 14-day confinement in any room that is less comfortable than home.

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Some local government units such as San Juan offer private rooms with their own toilet / bath, free food throughout the quarantine plus free WiFi. The rooms have windows so the lack of air conditioning is no problem.

But the more common government-run facility is a gym-size structure featuring a network of beds with flimsy dividers as walls, with a curtain for a door and no ceiling.  Toilets and baths are communal – one of the biggest turnoffs for people who prefer home quarantine.

Those who want privacy can opt for accommodations in one of the hotels, several of them five-star, that are participating in the quarantine program. But how many people can afford five-star quarantine for two weeks, even if at pandemic-discounted rates?

The accommodation expenses must be added to the cost of swab testing, currently ranging from P2,000 (only in Marikina) to P12,000. Even for asymptomatics, two to three swab tests are needed before they can be cleared to return to work. Health insurance firms refuse to cover testing for asymptomatics, because of the possibility of frivolous testing.

Mild and asymptomatic cases used to check into hospitals for the 14-day quarantine. But with the continuing increase in COVID cases, many hospitals now refuse to allow this. They explain that their COVID bed allotments are reserved for the more serious cases, especially those needing ventilators and intubation, while the rest of the beds in the hospital are reserved for patients with non-COVID afflictions – and there are still a lot of them.

Some hospitals had problems telling asymptomatic paying patients that they had to make room for the more serious COVID cases.

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It’s easier to make a case for transmission under home quarantine in cramped households. Mayor Toby Tiangco of Navotas, for example, does not allow home quarantine. The city has many informal settlements and even the average household size outside the slums makes physical distancing a challenge.

So how does the local government persuade the mild and asymptomatic patients that they must transfer to city-run quarantine facilities? Tiangco told The Chiefs last week that city personnel talk to the patients, and sometimes he himself does the talking – and even then, the task isn’t easy.

Tiangco had earlier told us that there was resistance among city residents even to free swab testing, with priority given to mass transport drivers and low-income wage earners. One theory was that people feared that a positive result would put them out of work for at least two weeks.

It’s a challenge to persuade people with no symptoms of illness that they must isolate themselves and stop working for at least 14 days. Even mild cases prefer to work from home where possible.

The government will have to come up with a clear definition of mild and asymptomatic cases. Is a COVID-positive person who runs a fever that disappears after a day classified as mild or asymptomatic? What about if the person has a dry cough that vanishes after three days, or suffers a few days’ loss of the senses of taste and smell?

I’ve read about COVID survivors who have not regained their sense of smell. Are they classified as mild cases? Called anosmia, the affliction is not as harmless as it seems. Those with the affliction lament that they miss the smell of their babies, their pets, their gardens. The joy of eating is lost.

Yet those with anosmia, dysgeusia (change in the taste of food) and other COVID symptoms are not disabled and can still work from home – which many of them do. The home office is not easily transferred to government-run isolation centers – another reason why people with en suite facilities prefer home quarantine.

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DILG officials, on the other hand, argue that based on their experience in enforcing quarantine rules, even when there are facilities for home isolation, COVID transmission has been recorded within the household.

In fact I personally know two persons with mild COVID symptoms who opted for home quarantine and infected their parents, and a third who infected her daughter.

But I also know a lot more people who are prepared to risk home transmission rather than go to a government-run quarantine facility. Asymptomatics fear that their afflictions could worsen with exposure to other infected people. It’s a fear that cannot be easily dispelled, in the absence of definitive studies on the issue.

One possible remedy for this problem is the provision of quarantine facilities that offer upgraded accommodations – not the five-star or even four-star hotel rooms, but similar to a private room in a mid-priced hospital – even if it involves reasonable fees from those who refuse the existing quarantine services.

To complement this effort, the government must speed up the procurement (or local development) of saliva tests, which provide instant results with greater accuracy than the “gold standard” swab polymerase chain reaction test. Those with no symptoms but are compelled to take a swab PCR test after being exposed to COVID cases tend to continue mingling with other people while waiting for the test result, which takes two to five days.

If the government wants to end home quarantine, it must provide palatable alternatives.