Isolation and Quarantine Policies During the COVID-19 Pandemic: A Narrative Review on Global Challenges, Implementation Barriers, and Lessons Learned

Abstract

Isolation, quarantine, and contact tracing are some of the most critical and commonly employed non-pharmaceutical interventions used to control the spread of COVID-19. However, the effectiveness of these strategies and their implementation depends on many factors, including a country’s population, the availability of resources to diagnose and effectively isolate infected individuals, culture and societal beliefs, family dynamics, and the feasibility and acceptability of isolation and quarantine policies among the public. This narrative review aims to appraise the evidence on the implementation strategies and shortcomings of isolation and quarantine strategies adopted during the COVID-19 pandemic. Previous evidence has found that early quarantine and isolation of COVID-19 patients were more effective than late adoption (5-fold vs. 2.6-fold). Approximately 90% of outbreaks could have been managed if 80% of contacts were monitored, traced, and isolated within four days of the index case being identified. For each new case of COVID-19, around thirty-six individuals should be traced. When the percentage of asymptomatic individuals is greater than 30%, isolation and contact tracing alone cannot contain the infection. The delay between symptom onset and isolation was the most important factor in determining infection control. Symptom-based isolation strategies should not be considered the sole criterion for isolation, as many asymptomatic individuals escaped isolation and increased the risk of disease transmission. Digital contact tracing, telemedicine, and artificial intelligence (AI)-based surveillance systems are potential adjuncts to support isolation and quarantine measures. Changes in societal behaviors and cultural norms, fear of stigma, psychological issues, economic burden, poverty, poor literacy rates, lack of public trust in government, and language were identified as challenges and barriers associated with the effective implementation of isolation and quarantine measures during the COVID-19 pandemic.