The 7SEF: Stage 5 - Isolate

This is Stage 5 of ICAN's 7 Stage Elimination Framework. You can read the Introduction here.

Goal: To isolate the virus and remove it from the population.

Timeframe: Isolation and quarantine facilities become operational at initiation of the plan and remain functional beyond Stage 7 – Reopen.

A mass testing program will lead to a short-term spike in the number of new cases detected. These cases will need to be isolated, and their close contacts (of which there should be very few) quarantined. It is essential that we have sufficient capacity to meet the demand for these services, including the staff needed to manage the facilities effectively. This capacity is separate to other health care capacity, including hospitals and ICUs, which would be reserved for high-risk cases.

Ensuring that the virus does not transmit within these facilities presents a challenge, as was demonstrated in Victoria, Australia. We can minimise the risk of an outbreak within a facility by using smaller, more local venues as our isolation and quarantine locations. Smaller venues also allow individuals to receive a higher level of care and attention, for example through better food and more opportunities to leave their rooms and exercise outside.

Implementation | Home Isolation

If individuals live alone, the priority should be to enable them to isolate in their homes. Self-isolation does not require additional capital investment, and there is less risk of accidental transmission. However, self-isolators would need daily monitoring and that may require the use of GPS devices, or employing volunteers to make regular (at least daily) physical house calls. These control mechanisms are essential. Isolation must be actively and consistently verified to ensure the effectiveness of the elimination protocol.

Implementation | Isolation and Quarantine Facilities

The facilities must be able to house the isolating individuals, plus the public health workers needed to administer tests and other medical treatment, and the security needed to ensure that individuals cannot ‘walk-off’. Isolation capacity can be sourced through hotels, guest houses, and Airbnbs. The government pays for their use and funds all investments needed to meet the requisite outbreak control and safety standards. Smaller and more local facilities are preferred as they present a lower systemic risk. Individuals are less likely to pick up or transmit an infection in a smaller venue. In contrast, a large hotel with several hundred rooms would warehouse the virus, risking a more serious community outbreak.

Implementation | Transportation

Local taxi drivers can be incentivised to offer their services to transfer individuals to and from these facilities, as well as to and from testing centres, hospitals, and other medical facilities. Owners of private transport services, such as minibuses belonging to sports clubs and other community organisations, could also be encouraged to donate their vehicles for the duration of the protocol. Ambulances and other health service vehicles should be reserved for high-risk cases and other emergencies. The more private sector resources that can be built into the plan, the less demand there will be on the public sector infrastructure.