Background
Methods
Study area and population
Study design and sampling
Data collection
Data management and analysis
Ethical considerations
Results
Characteristics of study participants
Characteristics | Number |
---|---|
Sex | |
Female | 11 |
Male | 9 |
Age | |
29 to 40 | 8 |
41 to 50 | 6 |
51 to 65 | 6 |
Marital status | |
Single | 4 |
Married | 16 |
Occupation | |
Health professional | 7 |
Business & sales | 3 |
Student | 3 |
Other professional | 4 |
Other (fisherman, truck driver, retired) | 3 |
Had dependents | |
Yes | 19 |
No | 1 |
Country/ place participant was returning from | |
African | 9 |
European | 4 |
Middle East | 5 |
Other (India, within Uganda) | 2 |
Facility of quarantine | |
Public | 6 |
Private | 14 |
Days spent in quarantine | |
14 | 3 |
15 | 9 |
Above 15 | 8 |
Experiences in quarantine
Quarantine environment
“My hotel facility was okay. I could buy food and my room had a balcony so I could rest without much interruption. My food was brought to the room and when I was tired of the room, I used the balcony or walked around the hotel. So, for me the ambiance was okay, it was a functional hotel, small but homely and not crowded which is what I wanted. So, my experience was good.” (Female, 36 years, 15 days in private facility)
“My colleagues went to Kampala and had a good experience with excellent food and facilities. I regret choosing to stay in this place. At night there was a smell of sewage and I couldn’t open the windows and neither could I go to the veranda when I wanted to exercise. You don’t confine people in dark hotels for such a period of time. Hygiene was poor, they were not cleaning our rooms and they rarely changed our linen understandably. There was a smell of sewage which made me uncomfortable and extremely unhappy for the 14 days I was confined in this one facility.” (Female, 58 years, 15 days in private facility)
“On arriving at Entebbe Airport, they were just asking and telling us which hotels we were going to but then they put everyone in a single bus and those who arrived first had to wait almost for an hour to fill up with no physical distancing. Yes, a full board bus and I am like what? You know I have been maintaining physical distance and wearing my mask where I was for 3 months and now I am on this bus with people from all over the world and we were all being put on the bus with limited windows and aeration for almost two hours. They then start dropping off people going to their hotels as we wait for them to drop us.” (Female, 41 years, 17 days in private facility)
There were also suggestions of other quarantined individuals being given preferential treatment compared to others including them seeing their family or being allowed to go for self-quarantine which caused some dissatisfaction among participants.“Yes, it [quarantine experience] was good, the only worry we had about the government facilities, we thought they would put us like in a hall all together and you had to fight your own way of survival but we later found out that you are given your own room, the compound was big and you could physical distance. It was okay, the facilities were clean; they would clean them in the morning and in the evening.” (Female, 40 years, 17 days in public facility)
Quarantine management
“The quarantine costs were expensive but mine was not coming directly from my pocket but rather my employer. Generally speaking, compared to the rest of other places, this is expensive but the pain and burden of the costs rested with my employer.” (Male, 29 years, 15 days in private facility)
On the other hand, where participants paid the costs themselves, they were dissatisfied and others had to pay for other bills such as electricity on top of the full board accommodation costs. To cope, some of the participants reduced the number of meals they had in a day.“We never had financial issues because we were given food, we had breakfast, lunch and dinner. We were given tea, soap, mosquito nets, blankets even sanitary pads. We thus did not have financial challenges because we had the essentials unless someone wanted to drink wine that’s when you had to dig into your pocket.” (Female, 47 years, 17 days, public facility)
“The hotel was expensive charging us $105 per night and the meals were charged separately and still expensively. We thus resorted to eating breakfast and an early dinner because we were not doing anything and so we didn’t have all the meals. But it was expensive and at the end of my 16 days, the cost was $1860 which is a lot of money that I am trying to claim from my employer but I don’t know about other people.” (Female, 65 years, 16 days in private facility)
“They take off your samples expecting to get results … because they took our emails at the airport so I thought that maybe they would send results on email but what we got was a verbal communication. They were like ‘since none of you has been taken out of the facility by now, it means you are all okay’ (laughs) … This came after three days of asking for the results which had been promised in 24 hours. In fact, we did not get the first test result and only got the departure results from the hotel.” (Female, 34 years, 16 days in private facility)
“There was a delay of the results but the formal quarantine days were 14 so when we delayed we had an additional day and yet you have prepared your mind and already communicated to everyone that on the 14th day you are going home but you don’t go and so it brought with it anxiety to the family and myself but I later got over it.” (Male, 29 years, 15 days in private facility)
“Of course I was not happy because I expected to leave on Sunday. I even called my son and he drove to Entebbe but when I realised that it was coming to 4pm and the results had not been delivered, I had to tell him to return to Kampala because of the curfew. So, I was not happy as I had already spent several days in quarantine in another country before coming back to Uganda.” (Male, 58 years, 15 days in private facility)
Individual factors
“I did not feel bad or anything. Actually, I was glad that at least they are protecting Ugandans from this COVID-19 epidemic. Moreover, I would also want the same for my people to stay safe as we continue to bring back those stranded from outside the country and so the quarantine centers were a good idea.” (Female, 31 years, 16 days in quarantine in public facility)
The experience was however different for the participants who had not been prepared for the measure as they were taken into quarantine from attending to their activities such as the truck driver and the fisherman who later reported accepting the measure.“I already knew that people coming back had to be quarantined but we left our destination after testing for COVID-19 and we were negative and so it is a challenge coming back here and you are told that those results are not being considered and we needed to be quarantined for 14 days in a place with other people who did not know their status but since it was a government decision, we had nothing to do.” (Female, 40 years, 17 days in public facility)
“My major worry was that they brought new people in our quarantine centre daily whose status we did not know, and we were never separated. Everyone had their own room but we were mixed. They could not group us like this batch has already spent 7 days here and should occupy this space or the other. We were sharing the same facilities and we worried that if anyone was infected amongst us, we would all have to redo the quarantine yet we had already done several days. It brought anxiety and people were fearing each other. We tried to do all things such as distancing and washing hands with soap and water.” (Female, 40 years, 17 days in public facility)
“You do not control the people serving you, you do not know whether they are observing social distancing or washing their hands or wearing a face mask and they are serving all of you. You do not know whether they are staying in the hotel or coming from out, so it always brought the worry. Food is delivered to you but you have no idea how it was prepared and this is not in your control. You are in quarantine but there is a risk of you being exposed much as you are observing other measures well. Sometimes the person bringing food in the morning is different from that bringing the lunch, and dinner is also brought by a different person. At least they minimised cleaning the rooms and changing bed sheets which reduced chances of disease transmission.” (Female, 52 years, 14 days in private facility)
“I felt a bit stigmatised especially in the community but within Kampala, my sister received me very well but the problem now is that I want to head to the village. I called the local area chairperson because in that area when they see someone coming from outside the country, the community rejects you. The Chairperson told me he was going to make announcements in the community and then when I go, the leaders will receive me and take me home as I have my certificate.” (Female, 52 years, 14 days in private facility)
“Aaaah.,. you just have to adjust to the situation you are in and loosen up. You have to get up like in a boarding school, go to bathe and be ready for breakfast. After breakfast you do whatever you want with yourself, the social distance was there and you are not allowed to talk to people so much. We just adapted and found ways of living with it.” (Female 31 years, 16 years in public facility)
“During quarantine, we would gather around in the morning about 10 o’clock and share some scriptures and worship while observing social distance and everyone would put on a mask. We then repeated the routine in the evening.. We also created a WhatsApp group where we could encourage each one to be strong that we could get out of quarantine. The group is still active up to now, and people keep checking on each other asking ‘how are you? how is everyone? are you okay?’” (Male, 35 years, 15 days in public facility)
Linkage to other services
“Of course, on the second day of my arrival, they had to check on the heartbeat of the baby to feel whether the baby was doing well. The doctor came back to do a scan to confirm if the baby was still okay and check on those of us who were on medication to see if we needed refills and it was really all good. Personally, I am grateful.” (Female, 31 years, 16 days in public facility)
“I really needed medical care after an asthmatic attack as I had chest pain and I couldn’t even rotate in bed. When I requested for help, the health worker who comes here every morning to take our temperatures planned to take me to see a doctor but they refused him from doing so. The army officer, who I think is also a health worker, brought me some medication. (Female, 52 years, 14 days in private facility)
“After quarantine, it is absolutely annoying to be called by the Ministry of Health to tell you that ‘hello friends, this is to tell you that you are highly suspected to be … because you travelled’ that is stigma for me. If I am seated with my friends and I get such calls, they might be like ooh … you know. This is after 2 months you are still getting those annoying and embarrassing calls. Till today, even when I am seated with my friends, family, or in the supermarket, I pick up the call and they say “hello friends, you know … ” I switch it off and for me that is stigma and it is terrible (laughs)”. (Female, 58 years, 15 days in private facility)
Discussion
-
Manage the pre-quarantine process: The pre-quarantine process in this study involved being received at the airport, screening and testing for COVID-19 and transporting persons to quarantine facilities. This process should be well managed and follow the recommended standard operating procedures such as appropriate screenings, sufficient physical distancing and wearing of face masks as it is the first encounter of participants with the process to which they need to have confidence.
-
Share as much information as possible: Quarantined individuals need accurate and consistent information about the quarantine process, the duration of the quarantine including when such a period would need to be extended, and how they are expected to conduct themselves. Where testing is done, information should be clear on how they would obtain their results and relay them to reduce any anxieties associated with status uncertainty. Even when the quarantine period requires to be extended, there should be proper empathetic communication to the quarantined including information, education and communication materials in an understandable language and support to help them deal with anticipated effects. Sufficient information and support should also help the quarantined adopt a positive attitude towards the measure, deal with any fears they have and share coping mechanisms that can ensure a less stressful quarantine. A person’s knowledge about COVID-19 including its transmission and symptoms, and quarantine protocols increases their likelihood of compliance with quarantine [22]. A review of the psychological impact of quarantine in the US and UK found that people in quarantine with fear of infecting their loved ones coped easily when public health officials provided adequate information about the disease in question and the need for quarantine [23].
-
Keep quarantine duration short: In planning for quarantine, the quarantine duration should be kept as short as possible to minimise the impact of long periods of isolation. This should be consistent with the science and how it evolves and protocols should factor this as a principle in determining quarantine stays. It is also important to avoid extending quarantine days except when absolutely necessary. Other potential workarounds could be considered such as prescribing self-quarantine or using a blend of time in institutional quarantine followed by another in self-quarantine.
-
Support quarantine costs / minimise costs: Quarantine is a costly undertaking and where the costs are pushed on to the individual, they may lead to huge effects on their financial status from which they may not easily recover further impacting them psychologically. Where possible, governments should provide basic quarantine centres which meet standards that they can fund or offer a variety of low-cost facility options which participants can pay for without much strain. Loss of income and effect on work remains key concerns among quarantined individuals [10, 22].
-
Adequate preparation and monitoring of quarantine facilities: Before centres are used for quarantine, they should be inspected to ensure they meet basic standards that can support quarantine. The centres should be trained on how best to support the quarantine process and adhere to required prevention and control measures. Further information should be provided on services for quarantined persons such as appropriate and healthy meals and supplies, and the quarantine dos and don’ts among others to support them in dealing with boredom.
-
Ensure access to health care: While in quarantine, persons will continue to have other health needs that need to be broadly planned for including the procedures to be followed to obtain these services, provision of first aid facilities and any emergency needs. These should be considered in planning for institutional quarantine. Provisions for social and psychological support should also be incorporated to support individuals to cope better.
-
Address any potential for stigma: The authorities should be upfront to deal with any potential stigma that may be associated with being in quarantine as this is likely to influence compliance and willingness to undertake the measure and overall experience of quarantined individuals similar to recent research findings [22].