Note: Isolation is for confirmed COVID-19 cases; Quarantine is for contacts of cases i.e. unconfirmed but suspected cases.
Various countries have adopted the guidance to quarantine suspected cases and isolate confirmed cases at their homes. However, this ignores critical evidence from the Chinese experience in Wuhan, which initially included home quarantine/isolation; on realization that 78-85% of new cases occurred in families, they instituted centralized quarantine/isolation whereby cases were placed in facilities rather than remaining at home (Wang et al. 2020, WHO 2020). Together with existing measures this resulted in extinguishing the COVID-19 outbreak in Wuhan. An investigation of the contribution of various outbreak measures in Wuhan suggests that measures taken before centralized quarantine/isolation (2nd February 2020) did slow the outbreak but not reverse it (Wang et al. 2020). Reversal was only achieved following this critical measure.
Understandably such a measure may not be acceptable in different populations, but can be
locally adapted. In Lebanon, centralized isolation and voluntary centralized quarantine for
persons may be offered, preferably incentivized with monetary benefit. It is expected that many
persons would accept centralized pathways, especially for the safety of their own household
members. Every person who accepts centralized placement will likely count to decreasing the
number of new cases, and even more so in countries where households are not small.
“[The] most likely person to become a case is someone who’s been a significant contact of
another case, and at the moment, in most parts of the world due to lockdown, most of the
transmission […] is happening in the household at family level. In some senses, transmission
has been taken off the streets and pushed back into family units.”
– Dr. Michael Ryan, Executive Director, Health Emergencies Program, WHO
This would concern confirmed cases (centralized isolation), suspected cases and symptomatic
persons (centralized/home quarantine), and close contacts (home quarantine). Placement may
be in hotels, dormitories, stadiums, gymnasiums or similar facilities that have been adequately
set up and staffed by qualified healthcare personnel. Importantly, no intermixing among
persons in the latter three categories should occur, to avoid transmission by true cases. COVID-
19 positive children should be allowed to isolate at home, and other exceptions may be
considered on a case-by-case basis particularly for highly vulnerable persons.
The advantages of centralized quarantine/isolation include earlier identification of new cases
and earlier treatment for cases progressing from mild towards severe/critical status (WHO 2020). For
persons declining centralized quarantine, such measures may be taken at home. However, this
would be accompanied by obligatory monitoring through local authorities (municipal or
otherwise), which benefits both the individuals and their household contacts (to detect disease
progression and treatment referral) as well the wider community in preventing new cases.