Quarantine hotels 'not enough' without better support for self-isolation

It is only now though, as the UK edges out of the second wave with more than 100,000 lives lost to Covid so far, that plans for quarantine hotels are finally on the table.

Under the scheme, all arrivals from 'red list' countries - mainly in Africa and South America, but including Portugal, Dubai and Mauritius - will be transported direct from the airport to hotels where they must remain in their rooms for 10 days at their own expense, expected to cost around £1500.

British nationals and UK residents returning from 'red list' countries will be required to self-isolate under supervision at quarantine hotels

The aim is to limit the import and spread of Covid variants, but critics argue that by not following the examples set by other island nations such as Taiwan, New Zealand and Australia - where 14-day supervised quarantine is a blanket requirement for all arrivals - we are not only leaving ourselves exposed, but the repeating mistakes of earlier in the pandemic.

READ MORE: UK quarantine proposals 'leave too many gaps', says Sturgeon 

Dr Thomas Christie Williams, a paediatrician, clinical lecturer, and researcher in evolutionary genetics at Edinburgh University, said: "The countries that have done best are Taiwan and New Zealand.

"They've had very low case rates and very low death rates, and they've been incredibly strict about how they implement their quarantine measures: it's 14 days, no exception, and lots of testing, and they've essentially eliminated community transmission.

"We know that it works if you do it strictly and you do it for everyone. But we don't know how well it works if you do it haphazardly, or half-heartedly."

First Minister Nicola Sturgeon is critical of the limited quarantine list set by the UK Government

Dr Williams added: "My concern about having special measures for some countries and not others is that the new variants appear and spread very quickly - it's pretty dizzying how fast they spread.

"By the time you discover it, it's in and it's spreading, so it's really hard to say that 'France is okay but not Portugal'.

"That's what blind-sided us in the Spring when we focused on China, but then the cases came from Italy because we weren't paying attention to it."

Nicola Sturgeon has made clear that the UK Government plan falls well short in her view, and intends to take tougher measures for Scotland.

If this includes setting our own, much lengthier list of quarantine hotel countries then it is difficult to see how it could work unless we also severely restrict travel to and from England.

Leo Varadkar said unless Northern Ireland took an equally tough stance on international travel the situation would be like 'soup in a sieve'

On Monday, Ireland's Tánaiste Leo Varardkar set out the parallel dilemma facing the Republic if it imposes sweeping travel bans but Northern Ireland does not.

He said: "For us to do it on our own, as the Republic of Ireland, it would not be effective.

"Not because of people flying into Belfast and travelling down to Dublin, but someone flying into Belfast, going to their home in Newry [on the Irish border] and infecting two people there, one of whom is a cross-border worker.

"It would be a bit like soup in a sieve: it would slow things down, but it wouldn't be fully effective."

READ MORE: Real test still to come for Scotland's vaccine rollout 

For many public health professionals, there is real frustration that Scotland came close to 'Zero Covid' last summer.

In early July, Scotland was detecting an average of just one case per 100,000 people per week, compared to 150 now.

That would have be the ideal moment - epidemiologically, if not politically - to impose hotel quarantine.

Genomic analysis shows that there were 46 "import events" between July 17 and August 30, including 28 new strains introduced from England, 13 from Europe, and four from Asia.

Research led by the Roslin Institute found that the first wave Covid-19 strains were virtually eliminated in the summer, with fresh imports in July and August helping to seed a second wave

Instead, Scotland - along with the rest of the UK - introduced quarantine-exempt 'travel corridors' while those who were required to quarantine were left to do so at home, with little monitoring other than a phonecall from contact tracers - but only one in five travellers even got that.

Contrast with Taiwan, where borders were closed early and all arrivals must quarantine for 14 days in a hotel or at home using 'digital quarantine' which tracks their movements.

Food and medicines are delivered, there are daily police checks, and anyone caught breaching isolation can be fined up to $33,000 (£24,000) - but they are also paid a $33 a day stipend.

With population density more than twice as high as the UK, the island has recorded just seven Covid deaths among its 24 million inhabitants.

Its economy is growing, schools are open, and bars, restaurants, gyms, sports stadiums, and concert venues are all packed - no social distancing required.

There are limited exceptions to quarantine currently, such as travel from Ireland, the Channel Islands, Isle of Man, or due to occupation, such as hauliers or essential work for BBC broadcasting. But travellers are currently asked to quarantine for 10 days at home

The problem for the UK right now, however, is less about international travel than it is community transmission.

In the week to January 24, 4,249 people arrived in Scotland who were expected to quarantine just in case they were incubating the virus compared to 9,868 living here who actually tested positive.

For Dr Muge Cevik, an expert in infectious diseases and medical virology at St Andrews University, self-isolation - where compliance is an estimated 18% - is our "weakest link".

She highlighted the issue last week in a paper published by the BMJ. 

Although £500 Covid support grants are available to those on benefits or low incomes, research in England has shown that rejection rates are high.

And while councils can fund self-isolation accommodation to those who would struggle to isolate from others in their home (for example because there is only one bathroom), this is not routinely offered.

READ MORE: Brexit was about taking back control - so why not of our borders in a pandemic?

In comparison, Norway compensates those required to self-isolate with 80% of their salary, while in New York City contact tracers automatically offer free hotel rooms to anyone testing positive.

"Generally they are picked up by a taxi and driven to their hotel, so they don't even have to worry about transport," said Dr Cevik, who is also a member of NERVTAG (New and Emerging Respiratory Virus Threats Advisory Group), which advises the UK Department of Health.

"Hotel quarantine is a good approach, but I think the same should also be provided to people who have tested positive in the country.

"Testing has been emphasised a lot since the beginning, but it's not an intervention. If there are resources triggered by the test, they need to come at the same time.

"You can't just expect people to sit at home with no money, no income, and then get £500 two weeks later, or four months later.

"The majority of people with Covid have mild symptoms and they will continue going to work if the alternative is that they lose their income.

"The amount of budget that's been allocated for isolation support is really small compared to testing, but without adequate and accessible support in place all that we're doing [with surveillance] is not actually reducing the onward transmission - it's just helping us to count numbers."

In New York people testing positive are offered hotel rooms for self-isolation, and you can even have your dog walked for you

She believes that the UK's disastrous death toll could have been partly prevented if low-paid key workers had been enabled to stay at home.

"One of the reasons our care home deaths have been so high is not just because there are elderly people, but because staff with symptoms couldn't afford to isolate.

"You see the same pattern with outbreaks in prisons and meat-packing factories.

"If we want to prevent deaths at this point, the people who are exposed are out there - they're working in unsafe workplaces, and they continue to work while they're sick."