People arriving in the UK from Covid hotspots will soon be required to quarantine in hotels – but it’s something scientists have been calling for since the outbreak of the pandemic .
Arrivals from 30 countries, including Portugal, South Africa and parts of South America, will have to self-isolate in government-run hotels for 10 days.
The announcement comes after government figures released on Tuesday showed more than 100,000 people in the UK have died within 28 days of testing positive for coronavirus since the pandemic began.
In countries including Australia, New Zealand, China, India, Singapore, the Philippines, Taiwan, Qatar and Thailand, mandatory hotel quarantine has long played a key part in public health response.
Here are all the times it has been suggested here in the UK.
On April 8 two infectious disease specialists stood as witnesses in front of the House of Commons Science and Technology Committee: Dr Gabriel Leung, chair of public health medicine at Hong Kong University, and Dr Seon Kui Lee, a director at the Republic of Korea’s Center for Disease Control and Prevention (KCDC).
Just days before, South Korea had introduced mandatory quarantine to all international travellers to prevent the spread of Covid-19. Passengers – including South Koreans – were required to self-isolate at home or at government-designated facilities. Those who refused were deported.
In Hong Kong, which introduced a mandatory 14-day quarantine for all arrivals from March 19, hotels saw a spike in occupancy rates from the tens of thousands of citizens and students returning from abroad. To date, Hong Kong (with a population of 7.5 million) has recorded 175 deaths and South Korea (almost 52 million, about 15 million fewer than the UK) 1,378 deaths.
Leung and Lee were asked by members of the Commons committee to share their respective countries’ quarantine and isolation policies. Lee said: “Both the border restrictions and the quarantine and isolation are fairly targeted or precision public health interventions because, although they may be very taxing on the public health system, they generally involve a fraction of the total population at risk.
“Whereas the third category of interventions, physical distancing, involves the entire population.”
A month later on May 13, Professor Phil Blythe, chief scientific adviser at the Department for Transport, told the same committee that officials were “looking at practice from around the world”, including from New Zealand – which introduced mandatory quarantine on March 14 and has had a total of 25 Covid-19 deaths.
“I was on the telephone to the chief scientific adviser to the Ministry of Transport in New Zealand this morning, because it has implemented quarantine as well,” Blythe said.
“Initially, it was implemented as a voluntary quarantine if you were not showing symptoms; it has now been changed to compulsory quarantine in hotels, because it was found that a number of backpackers and holidaymakers were breaking the quarantine. So we are trying to learn from different practices from around the world.”
A former government chief scientific adviser, Sir David King, assembled a group of 12 independent scientific experts and set up a shadow version of the government’s Scientific Advisory Group for Emergencies (Sage).
The Independent Sage committee, or Indy Sage, published its first official recommendations for the government on May 12. “We need to make sure that visitors to the UK and Ireland are not importing the virus; we should do this by testing (and possibly quarantining) all arrivals,” the report read.
“This might require using hotels or other facilities to help house people while they are quarantining.”
Dr Gabriel Scally, president of epidemiology and public health at the Royal Society of Medicine and a member of Indy Sage, explained to HuffPost UK why hotel quarantine should have been introduced from the very start of the pandemic.
“We know that the virus came to the UK through our ports and airports, so our original view was that quarantine was the right thing to do to stop cases from coming into and seeding around the country,” he says.
Quarantine use to prevent the spread of an infectious disease is a centuries-old public health approach that has been employed across the globe, although it is particularly effective for island nations. “Britain and Ireland have used it in the past to keep out disease, so the question was never why should there be a quarantine, but why not? Why did the government not use one of the major tools in the public health toolbox for handling this outbreak?”
A week after the recommendations by Indy Sage, MPs published a 19-page report which called on Boris Johnson to provide isolation and quarantine facilities including “requisitioned hotel accommodation”.
On June 8, Professor Lucy Yardley, professor of health psychology at the University of Bristol and a member of the government’s Sage committee, said she had seen evidence that people with Covid-19 symptoms were not, or could not, self-isolate.
Speaking to the House of Lords science and technology committee, Yardley said: “We have never managed to accomplish good adherence to self-isolation, not even in the earliest stages. We have data that when people thought or said they were adhering they were leaving the home while symptomatic. We have to understand better the various reasons why people are doing that, despite good intentions.”
She added: ” We know that a lot of that is to do with not having sufficient support, not enough income and so on. Despite the policies that are in place, a lot of people fall through gaps. We have to solve this problem of why people are not yet self-isolating as much as they need to.”
At the same session, Professor Susan Michie, a health psychology expert at University College London and an Indy Sage member, told the committee: ”[Not] many people have accommodation where they can isolate themselves. Other countries provide accommodation for people, so that they can isolate themselves when they need to.
On August 5, the Home Office published its “preparedness for Covid-19: management of borders” in which it quoted Professor Teo Yik Ying, dean of public health at the National University of Singapore, on his country’s self-isolation and hotel quarantine measures. From March 28, all arrivals from the UK and US were placed in hotel rooms the Singaporean government had booked. (To date, Singapore has seen 29 Covid-19 deaths out of a population of 5.7million)
Professor Teo, who had given evidence to the Home Office earlier, told MPs: “In Singapore it is a very clear situation that until the rest of the world has its situation contained, we will not be rushing to release the border control measures and to allow for mass-market travel at the moment.”
The report went on to reference the case of Hong Kong again, where a “14-day compulsory quarantine order was imposed to be served either at home or a hotel, with mobile phone tracking used to enforce the order”.
Professor Annelies Wilder-Smith, professor of emerging infectious diseases at the London School of Hygiene and Tropical Medicine, explained the former British colony’s “test and hold policy”: “That is that no one can come in, regardless of who you may be, until you have been tested at the port and then you go straight either into isolation as a confirmed patient or into quarantine as a potentially infectious individual for 14 days. Once you do that, you make sure that quarantine is enforced and enforceable.”
“We are concerned that the UK’s approach to border measures in the period from 13 March to 8 June was very different from countries in similar circumstances,” the report concluded. “This should have raised serious questions within the government about whether it was taking the correct decisions.”
Would it have made a difference?
Scally, who co-authored Indy Sage’s recommendations in May which called for the government to use hotels as a way of quarantining visitors into the UK, says the government’s decision not to do so could have cost “tens of thousands of lives”.
“We could have ended up in the kind of position Japan has ended up (5,252 recorded deaths out of a population of 126 million) – that’s the difference it could have made if the government had handled this properly.
“Right from the beginning [the UK government] was late in doing everything: they didn’t stop mass gatherings, they allowed thousands of people from Madrid to attend a football match at Anfield, Liverpool, and didn’t put in any social restrictions. All the way along, the government has delayed and deterred, and then done things in a half-hearted way.”
Instead, Boris Johnson consistently over-promised on expectations. From a failure of a test and trace programme to a quickly-forgotten Operation Moonshot, Johnson and his ministers kept pledging silver bullets when in reality, there never really was one.
As Scally points out, the only thing that will bring Britain out of this pandemic is an integrated effort across a whole range of public health measures – of which hotel quarantine is just one small, albeit important, part.
“The point is no one thing works and we need a whole basket of public health action” he stresses. “You need a really good test, trace and isolate support system, you need to have local public health teams across England well-resourced and supported, you need local authorities and communities involved – particularly BAME communities and in deprived places with a high proportion of people living in overcrowded housing.
“The problem is the government has really disinvested from public health and the entire system of handling public health issues and large-scale emergencies have been dramatically degraded over the last 10 years.”