Forced isolation camps ‘are not only unethical but will do no good’
Plans to force people into quarantine camps are not in keeping with public health goals, says medical ethicist
Plans to isolate people who test positive for Covid-19 in government camps have been challenged by one of SA’s leading medical ethicists.
In a critique published in the SA Medical Journal on Thursday, Dr Jerome Singh, of the Centre for the Aids Programme of Research in South Africa (Caprisa), questions the decision by the KwaZulu-Natal government to forcibly quarantine people who test positive for Covid-19 at such camps, even in cases where they have the means to self isolate.
Singh, who teaches health law and ethics at the University of KwaZulu-Natal (UKZN), said mandatory isolation should be based on a demonstrable threat to public health.
“In this regard, the KZN government has provided no corroborating evidence to demonstrate that the spread of Covid-19 in the province is attributable to defaulting self-isolators,” he said.
Singh said the KZN government’s strategy of putting everyone who tests positive for the virus at government quarantine centres unduly burdens those able to responsibly self isolate and could potentially deprive more needy patients of beds. Thus, it fails the test of distributive justice.
“If our public health goals are to prevent the spread of Covid-19 by those who are self isolating, and to preserve beds for those patients who need them, officials should pursue the least restrictive means to achieve these ends,” he said.
It has emerged that Gauteng, the Western Cape and KwaZulu-Natal shoulder the highest burdens of Covid-19 cases in the country, with several Covid-19 “hotspots” in these provinces emerging.
Singh said since community transmission of Covid-19 became established in SA, individuals who test positive for Covid-19 and do not require hospitalisation are permitted to self isolate in their homes to reduce the burden on the health system.
He described KZN’s policy as “heavy-handed”, adding that the provincial government has not clarified how it plans to manage the social implications of mandatory isolation.
He argued that the rationale behind forcing people into government camps is flawed, as premier Sihle Zikalala’s stance is premised on suspicions about self-isolating defaulters.
“In relevant circumstances, it is undeniably necessary and in the interests of public health to remove an infected individual from their dwelling to safeguard the health of others residing there — say, for example, where all members of the household live in a single-room informal dwelling.
“However, where an individual is able to self isolate and does so responsibly, they pose little or no infection risk to others. In such instances, mandatory institutional isolation would be unreasonable and ineffective in containing the spread of Covid-19.”
Singh said by April 19, KZN had 587 cases of Covid-19, of whom 54% were in self isolation.
“If KZN’s new policy applies retrospectively, 317 people who are currently in self isolation theoretically face mandatory isolation in state facilities. If Covid-19 cases in KZN continue to rise, the province’s health system will be overwhelmed, as has been the experience in other settings that have experienced ‘surge’ scenarios.”
He said in preparation, the emphasis should be on reserving hospital beds for Covid-19 patients with severe or advanced symptoms and respiratory complications.
Less restrictive measures, including intensified counselling, random checks on the self-isolating individual and the levying of penalties for non-compliance, could be introduced to discourage defaulting, Singh said.
He suggested that mandatory hospital isolation should be decided on a case-by-case basis, be evidence-based and be reserved for those with the highest probability of poor outcomes.
“Mandatory isolation also risks stigmatising those infected with Covid-19 and could drive the disease underground. We cannot afford to score own goals at this critical juncture in our response to the Covid-19 pandemic.”
The scientific opinion comes as lobby group AfriForum on Wednesday asked minister of co-operative governance and traditional affairs (Cogta) Nkosazana Dlamini-Zuma to overturn a directive forcing people who test positive for Covid-19 to be held in government quarantine camps.
The lobby group has given the government 48 hours to do so, or face legal action.
In a letter by lawyer Daniël Eloff, of Hurter Spies, AfriForum said it is concerned that people who test positive for Covid-19, or are suspected of having contracted the virus, “will not be entitled to self isolate to stop the spread of the disease and will instead be forcibly placed into quarantine at state facilities”.
It also empowers the state to forcibly quarantine people in government camps, even in cases where these people have the means to self isolate and intend to do so.Afriforum
AfriForum said amendments to regulations to prevent an escalation of the national state of disaster, announced on March 15, empower the state to prosecute anyone who tests positive for Covid-19, but refuses to be taken to a government-run quarantine camp.
“It also empowers the state to forcibly quarantine people in government camps, even in cases where these people have the means to self isolate and intend to do so.”
The letter to the minister came after KZN health MEC Nomagugu Simelane-Zulu said on Sunday that the provincial government has resolved to discard the policy of self isolation for people who test positive for Covid-19.
Simelane-Zulu said, effective from Sunday, anyone testing positive will be kept and monitored at state-identified quarantine sites.
The declaration came as Zikalala announced a stricter enforcement of lockdown legislation after it emerged that the province had, at that stage, the highest Covid-19 death toll in the country. He also said newly diagnosed positive patients will be “taken” to government-approved isolation sites for treatment.
This policy change, Singh said, marks a dangerous departure from the country’s prevailing position on home-based self isolation and “should not be replicated elsewhere”.
World Health Organisation (WHO) governance on self isolation emphasises the prioritisation of those with the highest probability of poor outcomes.
“If all mild Covid-19 cases cannot be isolated in health facilities, the WHO recommends that those with mild illness and no risk factors be isolated in non-traditional facilities, such as repurposed hotels, stadiums or gymnasiums, where they can remain until their symptoms resolve and laboratory tests for Covid-19 virus are negative.”
Alternatively, the WHO recommends that patients with mild disease and no risk factors be managed at home. To that end, the WHO recommends that if there are patients with only mild illness, providing care at home may be considered, as long as they can be followed up and cared for by family members.
National Cogta spokesperson Lungi Mtshali on Wednesday said the department had not received the correspondence from AfriForum. Efforts to reach him on Thursday were unsuccessful.