Empathy and use of evidence in handling travellers coming from COVID-19 high-risk countries

Empathy and use of evidence in handling travellers coming from COVID-19 high-risk countries

Richard Makurumidze^1,2,3,&

¹University of Zimbabwe College of Health Sciences Department of Community Medicine, Harare, Zimbabwe, ²Institute of Tropical Medicine, Antwerp, Belgium, ³Faculty of Medicine & Pharmacy, Free University of Brussels (VUB), Brussels, Belgium

^&Corresponding author
Richard Makurumidze, University of Zimbabwe College of Health Sciences Department of Community Medicine, Harare, Zimbabwe

Perspective    

Most African countries have implemented the recommendation to quarantine travellers coming from COVID-19 high-risk countries. Though the World Health Organisation recommends 14 days of quarantine [1], some countries have extended the period to 21-days due to the variability of the incubation period [2]. This is a noble public health intervention which has been shown to reduce new infections and mortality [3]. There have been reports of hostility towards travellers returning from COVID-19 high-risk countries regarding quarantine especially in developing countries [4]. No person in their normal mindset will travel and put themself at risk under the prevailing situation. Some are students, employees or other vulnerable groups whose residence or stay has been terminated and asked to go back to their countries [5]. Some travellers have been asked to foot their accommodation and living expenses. Others have been housed in squalid conditions with no running water or shared ablution facilities and other amenities [6]. The purpose of quarantine is to create a “household” for the affected individual and sharing amenities defeats the whole purpose. By sharing amenities, a “single household” of travellers with different risks of harbouring COVID- 19 is created thereby putting others who were initially safe at risk.

Moreover, quarantine has been associated with mental and psychological consequences. Often the majority of the travellers will be coming from a prolonged isolation environment due to lockdowns which most of the high-risk countries started implementing earlier on. The longer the duration of the isolation or quarantine period the higher the risk of the consequences. The observed consequences include post-traumatic stress symptoms, confusion, anger, stigma, infection fears, frustration, boredom among others with some of these having a possibility of long term sequelae [7]. Based on these complications, blanket quarantine without some criteria to assess which traveller is at risk of initiating community transmission should be avoided at all cost. With the developments in the rapid antibody diagnostic tests, a better understanding of the immunopathogenesis and progression of COVID-19 there might be a need to implement screening algorithms so that only travellers that pose a danger to the community are quarantined. The screening algorithms can also be used to quarantine or isolate the travellers in cohorts according to their risk of harbouring COVID-19. All the countries classified as high-risk already have COVID-19 community transmission ongoing. Many of the travellers from these high-risk countries might have already had symptomatic or asymptomatic COVID-19 infection [8].

Current evidence has shown the formation of antibodies post COVID-19 infection, though there is a paucity of evidence on their ability to protect against future infections. These antibodies have been shown to start to appear around a week after infection [9,10]. On the other hand, viral shedding can start before symptoms appear and can continue beyond the incubation period [11,12]. As rapid antibody diagnostic tests with better performance (specificity and sensitivity) come on the market, there might need to screen all travellers to identify those already infected [13]. This can be done concurrently with the gold standard of reverse transcription reverse polymerase chain reaction (PCR) test for diagnosis or to assess infectiousness among those already infected [8]. The decision to whether quarantine or not can then be tailored according to baseline symptoms, results of the rapid antibody and PCR tests. Those with a similar risk of being infected with COVID-19 can be quarantined together, while those with evidence of prior infection and no longer infectious can be considered for home monitoring and follow-up.

In the event of quarantine, authorities should provide essential health care; financial, social and psychosocial support; and basic needs, including food, water, and other essentials. The needs of the vulnerable populations who cannot afford should be prioritized [1]. The quarantine should be done in a manner that minimises the risk of transmission among travellers. If resources permit, the issue of maintaining each traveller in their own “household” should be prioritised. If that cannot be achieved, the minimum that should be implemented is at least quarantine travellers according to cohorts based on their risk. Considering the likely development of psychological and mental complications, assessment and provision of counselling services by professionals should be considered at baseline and periodically. Other countries have implemented entertainment activities which include unlimited access to the internet, movies channels like Netflix among other initiatives [14]. In some countries reports of travellers resorting to sexual escapades have surfaced [15,16]. To minimise the consequences of these casual sexual relationships, stricter measures supported by the availability of preventive measures such as condoms, post exposures prophylaxis for HIV, sexually transmitted infections and pregnancy should be implemented.

In conclusion, it is of paramount importance for quarantining of travellers from COVID-19 high-risk countries to implemented with empathy and human rights considerations. Measures should be put in place to minimise infections, psychological, mental, and sexually related complications. Advances in the development of rapid antibody diagnostic test kits should be considered to tailor quarantining.

Competing interests     

The author declares no competing interests.

Authors' contributions     

The author have read and agreed to the final manuscript.

References     

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