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Half of people with COVID-19 symptoms leaving emergency departments did not self-isolate as instructed

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Almost half of people with COVID-19–like symptoms who were awaiting test results did not self-isolate as instructed, according to new CHÉOS-led research.

“Despite a relatively strong understanding of self-isolation rules, we found that only 56 per cent of patients discharged from Metro Vancouver emergency departments actually adhered to those rules,” explained CHÉOS Scientist Dr. Andrew Kestler, the senior author of the study, published as a letter to the editor in the Canadian Journal of Emergency Medicine.

Dr. Lulu Yang

According to Dr. Lulu Yang, lead author and emergency medicine resident at UBC, the results show how challenging self-isolation can be as a public health requirement, even though it remains a very important tool in controlling the pandemic.

“Self-isolation protects the public and those close to us from COVID-19 and is key to reducing the spread of infection,” said Dr. Yang, “However, self-isolation is difficult, and its success requires that individuals isolating have an established social support network and financial resources to meet their needs during the isolation period.”

Assessing adherence to COVID-19 self-isolation rules

During an emergency department visit, if COVID-19 is suspected, patients are provided with verbal instructions from a health care provider to self-isolate, as well as a public health guidance handout with self-isolation instructions.

To understand how well symptomatic individuals were able to self-isolate after leaving the hospital, the researchers surveyed people discharged from St. Paul’s, Lions Gate, and Mount St. Joseph’s Hospitals from May to June of 2020.

Of the 342 patients with confirmed or suspected COVID-19 during the study period, 65 people met the criteria and completed the survey. Eight per cent of participants ultimately tested positive for COVID-19.

Study participants were asked about their adherence to self-isolation guidance and their reasons for non-adherence. Just over half of participants reported adherence to self-isolation guidelines.

“The most common reasons given for non-adherence were access to food, medication, and fresh air,” said Dr. Yang. “In addition, most participants shared their homes with others, and more than two-thirds found it difficult to practice self-isolation within their homes.”

“We anticipated that there would be some voluntary lack of adherence, but the frequency of barriers to self-isolation that were out of people’s control was higher than expected,” added Dr. Kestler.

Participants were also asked several questions to test their understanding of self-isolation rules, scoring a mean of 80 per cent.

“Our results show that most people understood public health guidelines, but that knowledge didn’t predict their willingness or ability to adhere to those guidelines,” noted Dr. Kestler.

How do we improve adherence to public health guidelines?

The research raises concerns about the ability of people with COVID-19 symptoms to avoid exposing others in their communities. But, explains Dr. Yang, people need to be supported during the isolation period in order to follow the guidelines.

“Our results demonstrate that lack of access to essential supplies can lead to decreased adherence,” she said. “Also, having limited space was the most often cited reason for non-adherence — most urban residents do not have access to a private outdoor space and may find it difficult remaining indoors during self-isolation.”

“Current public health efforts and future pandemic planning should focus on sustainable methods to support people in self-isolation with basic necessities,” Dr. Yang added.

“It’s worth considering what has been accomplished elsewhere,” said Dr. Kestler, “Some jurisdictions have set up systems to deliver basic necessities to people in self-isolation. Other areas have established COVID hotels, where those with COVID-19 can stay during their isolation period, and have their basic needs provided.”

CHÉOS Scientists Drs. Skye Barbic, Eric Grafstein, and Frank Scheuermeyer are co-authors on the study, along with representatives from UBC, St. Paul’s Hospital, and Vancouver General Hospital.

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