The UK government is considering increasing compensation for those who must self-isolate because they have been exposed to the coronavirus, as it seeks ways to keep those who may be infected at home to stop the spread of Covid-19 .
Anyone in the UK who either tests positive for Covid-19, or comes in contact with someone who has tested positive, must self-isolate for 10 days. But studies used by the government’s Scientific Advisory Group for Emergencies (Sage) estimate compliance levels to be between 18 and 25 percent. Importantly, people who earned less than £ 20,000 a year or had less than £ 100 in savings were three times less likely to self-isolate.
The UK government has one of the highest per capita testing rates in the world and has set aside £ 22bn for its testing and contact tracing strategy. But to date there have been extremely limited arrangements for those who have to self-isolate, who have to do so at home, at their own expense.
“Why, when we have a very high testing capacity, have we ended up with the worst results in our category in terms of prevalence and mortality,” said a person working for the UK government’s testing and tracing program . “Understanding the success of ‘isolation’ is a key part of responding to what I think.”
Governments around the world have taken different approaches to get their populations to self-quarantine when they are at high risk of spreading the virus, some offering benefits while imposing punitive penalties. The marked lack 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 themselves is because they can’t and we haven’t provided anything like the level of support we should be.”
Late last year, after public pressure, the UK government started offering one-off payments of £ 500 to those who couldn’t work from home. But people were only eligible if they were already receiving benefits. Even so, only one in three people who applied when asked to self-isolate through the NHS Test and Trace were successful, according to official figures.
The government also does not provide food or other basic necessities to those it says must stay at home. Instead, he advises them to “ask friends, family or neighbors who are doing well to go out and get you food and other essentials.”
Dr Muge Cevik, clinical researcher at the University of St Andrews, pointed to statistics which 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 making money and staying home when you feel well, it’s a tough choice, ”she says. “The solution to compliance is financial support rather than law enforcement.”
In South Korea, where the infection rate is 72 times lower than in the UK, authorities are giving 454,900 Won ($ 411) to isolate unemployed, self-employed or employed people, regardless of their income. They also send a stay-at-home kit, with food, drink, and medical supplies, and check in with people regularly through an app.
Several local authorities have 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 pattern last year. Anyone who tested positive for Covid-19, along with their close contacts, were offered free hotel accommodation. In November, more than 2,500 had isolated themselves in hotels, according to Ted Long, doctor and general manager of the Test & Trace Corps. The city also offered the delivery of food, medicine and protective equipment to anyone who requested it.
The limited data available on compliance with self-isolation rules show the impact of these policies. Housing is particularly crucial for those who live in cramped housing. The risk of transmission between residents drops from 18% in a two-person household to 50% when more than six people live together, according to the UK Office for National Statistics.
A recent study by researchers at University College London found that while general compliance with social distancing and hygiene rules was remarkably high in the UK, almost 40% of those admitted do not stay in quarantine for at least 10 days, and 13 percent said they had not isolated themselves 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 greater than 99% compliance. New York officials presented data showing around 98% compliance, based on the number of people who confirm over the phone that they are staying indoors and alone.
Many governments have also balanced the threat of severe penalties to deter their populations from breaking quarantine rules.
In South Korea, anyone who tests positive for the virus must immediately download an app that tracks their movements and they are often subjected to random home visits. Violations result in fines of 10 million won (£ 6,764), sentences of up to one year in prison, or both.
The UK, on the other hand, has been criticized for taking a much more lax approach to sanctions. People who break most of the coronavirus rules receive a flat penalty of £ 200, which is reduced to £ 100 if paid within 14 days. In September, fines for violating self-isolation rules were increased to £ 1,000 for a first offense.
In recent weeks, British police forces have stepped up their rhetoric on law enforcement, saying those who break the rules are “increasingly likely” to receive fines.
But several public health experts have warned that there is little evidence that tougher penalties will work, especially given the clear link between deprivation and non-compliance.
“Behavioral theory has long held that positive reinforcement is more effective than negative reinforcement,” said Michael Hopkins, professor in the science policy research unit at the University of Sussex, who led an international comparison of policies around testing, tracing and isolation.
“Isolation is difficult – if not impossible – if you are insecure or self-employed, economically disadvantaged, live in overcrowded conditions or have competing commitments such as care duties.”