Quarantine and Isolation: an Outdated Intervention or an Effective Epidemic Control Measure

Dear editor
The new corona virus reported in Wuhan, China, which was then named as COVID19, now is spreading around the world. According to the 57th World Health Organization (WHO) Situation Report, as of 17 March, 179111 confirmed cases of COVID19 in over 159 countries and territories around the world have been infected and 7426 people died. WHO declared the COVID19 as a Public Health Emergency of International Concern (PHEIC) event on January 30¹ and the risk level of COVID19 was raised to “very high”. 
The Chinese government took extreme measures to contain the disease abruptly. The Wuhan city, the epicenter of the outbreak in China, was quarantined and curfew measures were followed. According to WHO, highest numbers of confirmed cases in European region are seen in Italy as of 17 March, 27980 confirmed cases has been reported. In attempt to control the disease Italy quarantined the country to control coronavirus.
The first cases of COVID19 in Iran were confirmed on 19 February. The epicenter of the disease in Iran was Qom province and the disease was then seen all-around the country very soon especially in the Guilan province in the North, Isfahan, and Teheran, the capital city. As of 19 March, total number of confirmed cases of COVID19 in Iran was reported as 17361 patients and 1135 people died including health care providers. Despite the rapid transmission of the disease, quarantine of the epicenters of the disease was not supported and home isolation was encouraged. All kindergartens, schools, universities, tourist attraction sites and mosques were closed and extensive health promotion and health education messages were issued in media and virtual spaces.
Although many efforts were conducted to convince the people to remain at home, some people neglected the risk of corona infection and used the time for travel and leisure. Tourist attraction provinces authorities issued several messages that they could not host the tourists and in some cases local restrictions were established. However the lack of strong political will to quarantine the most affected provinces and travel to and from the most affected regions of the country contributed the spread of disease and endangering less affected places.
Some authorities believed that quarantine for infectious diseases is outdated and is no longer accepted. They argued that convincing the people to remain at home could stop the disease spread. Minimizing the transmission of infectious diseases is a core function of public health law. Quarantine is mentioned 14 times in International Health Regulation (IHR) especially in Article 30, 31, and 32². Based on public health law, “isolation of individuals and groups who may have been exposed to an infectious disease, as well as the closure of businesses and premises and the confiscation of property” are authorized. However there are important issues to be addressed before considering the quarantine. These include “appropriate quarantine setting and adequate provisions for quarantine period, minimum infection control (IPC) measures, and minimum requirements for health monitoring of quarantined persons during the quarantine period”³. Looking at nonconformity of some people to health messages during COVID19 pandemic which endangers others health need to be legally confronted. It seems that quarantine and strict measures to contain the disease are inevitable in such situations and should not be considered as an outdated measure.
Conflict of interest
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Authors' contribution
All authors contributed to this project and article equally. All authors read and approved the final manuscript.
 

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