There is still room for improvement in the isolation measures and guidelines for COVID-19 patients
There has been little discussion of the importance of quarantine and isolation measures in the official COVID-19 communications in Finland. According to Juha Tuominen, CEO of Helsinki University Hospital (HUS), at a press conference on November 25, half of the COVID-19 infections occurred in the household settings, so it is also worth striving for isolation-like conditions at home whenever a COVID-19 infection is suspected or officially diagnosed.
In everyday language, quarantine and isolation are used as if synonymous, but there is a crucial difference between these two measures in managing the outbreak. Quarantined individuals must avoid contacts outside the household due to exposure and possible infection. The isolated patient avoids all contacts, including those within the same household, because one or more household members are infected.
There is little public information on compliance with quarantine and containment measures in Finland. Still, there have been anecdotal indications that recommendations and regulations for standards are not adequately followed throughout the autumn. We also have confirmed reports of this being true allover the world. It may be a lack of information, a false sense of security, and false beliefs (for example, the impression that an asymptomatic patient is not infectious is wrong). Still, we don’t know about compliance level and depth because there is little discussion about it publicly and very limited scientific research.
Traditionally, in Finland, isolation is thought to be mandated as a legally compulsory precautionary measure prescribed by an infectious disease specialist in a hospital. In the current phase of a large-scale COVID-19 outbreak, it is difficult to imagine hospital beds being used only to isolate COVID-19 patients. However, this does not mean that controlled and safe isolation of an infectious COVID-19 patient is somehow unnecessary.
In many countries, detailed and straightforward guidelines have been given to implement COVID-19 isolation in a household setting. Besides, some organizations, such as NECSI, have published their own simplified instructions for anyone to take a look at and implement if possible. The patient needs to have their separate room where other family members do not unnecessarily spend their time. Contacts are kept to a minimum, and precautions with masks and gloves are followed. Ventilation is well taken care of, instructions are given for monitoring everyone’s health status, and potentially infected people living in the same household stay inside as long as possible until there is no more risk of further infections.
Of course, there are differences in whether the patient to be isolated, is a child in need of care or an adult in need of special care, or a self-sufficient adult, and the means must be applied appropriately.
In many countries, separate COVID-19 hospitals, field hospitals, and “COVID-19 hotels” have been established to isolate COVID-19 patients. Otherwise, the utilization of vacant accommodation in the Uusimaa region to isolate COVID-19 patients with adequate infection control precautions should be re-evaluated. Such arrangements could also be used for infected homeless people and extended families, whose effective isolation and health monitoring can otherwise be difficult to arrange.
The importance and means of isolation inside the single household must be communicated accurately to citizens and residents. Also, isolation outside the household is an outbreak control measure that should not be forgotten in the Finnish public discussion to reduce the burden on health care, increase other control measures' efficiency, and stop the ongoing outbreak quickly.
Henri Lampikoski is the co-founder of the End COVID-19 Finland Working Group (Eroon koronasta) and a specialist physician in otolaryngology. Thomas Brand acts as the community engagement and outreach coordinator with the End COVID-19 Finland Working Group.
The views and opinions expressed in this article are those of the authors and do not necessarily reflect the position or opinion of any organization the authors might be associated with
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A slightly simplified version of this article was originally published in Finnish in Helsingin Sanomat as an opinion piece on 14 December 2020.