Rethinking quarantine rules

Published October 27, 2021, 12:02 AM

by Raymundo W. Lo, MD, FPSP

UNDER THE MICROSCOPE

Dr. Raymund W. Lo

In a pandemic, quarantines are an important tool in controlling the spread of disease. The practice originated in Venice in the 14th century to protect the city from the plague epidemic if the ship came from infected ports. The term is derived from the Italian words quorantagiorni which means 40 days which is how long the ships stayed at sea before docking at port.

Note that quarantine aims to prevent entry of the disease into an area. It means that area has no cases or has relatively low numbers of cases, otherwise, quarantine will not serve its purpose.

In the Philippines, entry into the country is based on color coding countries based on their respective COVID-19 incidence rates and case counts. Green countries can skip quarantine with a negative RT-PCR result within 72 hours of arrival. Yellow countries arrivals are required to have a five day quarantine for fully vaccinated persons and 10 day quarantine for unvaccinated/partially vaccinated persons and will have to undergo RT-PCR tests before leaving quarantine. Red countries are banned from traveling to the Philippines.

But why base the categories solely on incidence rates and case counts? We are not admitting entire populations but individual travelers. There is a bias in this thinking since many countries in the green list actually may not be testing enough to land in the yellow or red category. It prejudices countries with high testing rates which of course will detect more cases thus landing them in the yellow category even if a majority of their populations are fully/partially vaccinated. The more you test, the more cases you find. In fact, this color coding system is simply not well thought out.

Let’s take Thailand for example. It has very high case counts (9810 as this is being written) but has announced it will accept tourists who are fully vaccinated without quarantine from certain low risk countries including the USA which is on the yellow list and the UK which has now been put on the red list due to the detection of a delta variant mutation of no clinical significance as of the moment. These two countries have high vaccination rates and yet our government is restricting travelers from these countries from entering just because of the incidence rates and case counts. The USA and UK are also countries with high numbers of Filipinos who are very likely to come home for the Christmas holidays, thus,  the quarantine requirement will definitely deter a majority of them from coming over since they will probably spend half their vacation time in quarantine making it not worth their while.

This is bound to further impede our economic recovery as most businesses get their income from the last quarter of the year with holiday spending making up for poor sales in previous quarters. That will spell doom for many struggling small and medium enterprises which will lead to economic collapse due to a spiral down effect on employment and consumer spending.

Why not base quarantine restrictions on incoming travelers’ vaccination status? Fully vaccinated persons are very much less likely to be infected. Even if infected, they have lower viral loads and therefore will not pass it on to others. The delta variant has put a damper on the last item with some researchers claiming breakthrough infections (of fully vaccinated persons) still have high viral loads (though its clinical significance still has to be resolved). Nonetheless, breakthrough infections are uncommon thus, the risks are lower with vaccinated persons overall.

It shouldn’t matter where a person comes from as long as he/she is fully vaccinated. In the strictest sense of the word quarantine, it is the separation and confinement of suspected transmitters of disease. But if fully vaccinated persons are the least likely to be infected and to transmit the disease, is it right to quarantine them at all? They are actually more likely to get infected by the unvaccinated in our general population, especially their family and friends they will get to meet in the course of their stay here, with the low vaccination rates and high community transmission prevalent in the Philippines. Coupled with a negative  RT-PCR testing on arrival, these travelers are about as fully protected as can be.

Imagine the hundreds of millions of pesos in savings the government will have by not having to provide hotel accommodations for thousands of OFWs and the similar savings of returning residents and tourists/businessmen who can then spend it on other stuff. Think of the economic boost more balikbayans and tourists will do.

Lastly, think of the thousands of days lost in quarantine that will never be recovered. Money may come around again. Time lost is forever

It’s time to scrap the country color coding system, not only because of its flaws but also because it’s actually more of a window dressing. Quoting from “Lessons from the history of quarantine, from plague to influenza A” (Emerging Infectious Diseases, ncbi.nim.noh.gov), “Decisions made by health authorities often seem focused more on reassuring the public about efforts being made to stop transmission of the virus rather than on actually stopping transmission of the virus.”

Time to scrap quarantine for fully vaccinated travelers. Instead, just require RT-PCR on arrival and have them quarantine themselves away from family and friends while awaiting the results. If positive, isolate them right away. If negative, a reminder on symptom awareness and reporting will suffice. Let’s start to trust people to do the right thing, for themselves, their family and the public.

 
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