In some countries national governments may be using a range of other terms that relate to physical distancing and reducing COVID-19 transmission. There is no standard definition for any of these terms as regulatory measures are normally defined differently by each national government. Therefore, if you are unsure about whether these terms are relevant in your context, consult national guidelines. Below we provide broad explanations of what is meant by each term.
Lockdown: Lockdowns are government enforced restrictions that are put in place to reduce population movement and therefore reduce the spread of COVID-19. Lockdown restrictions vary in each country, but can include some of the following limitations:
Requiring that people stay at home and work from home if possible, but normally limited movements for essential needs (e.g. grocery shopping or medical appointments).
Limiting the amount of time any individual can spend outside of the home per day (including for exercise) and the geographical region in which a person can travel.
Stopping or limiting travel on railways, flights and other forms of public transport.
Closing restaurants, non-essential shops, entertainment and sports venues and religious gatherings.
Closing schools and educational institutions.
Limiting the number of people who can gather in a location.
Monitoring the movement of people.
These measures can have substantial social and economic consequences for populations and need to be carefully assessed before putting them in place. These consequences may disproportionately affect people in low or middle income nations, since in these regions of the world a quarter of the population lives on less than $3 a day and these individuals are less likely to be supported by social or financial safety nets.
Self-isolation: This applies to households where one or more members of the household has had symptoms of COVID-19 or if one or more people have tested positive to a COVID-19 test. Self isolation measures require the individual and all members of the household to stay at home for 14 days. If symptoms become severe, then health services should be called to assess whether that individual needs to be admitted to a hospital. The 14 day time period is based on cautious estimates of the incubation period of COVID-19 (the time it takes for an infected person to show symptoms) but the duration for self-isolation varies by country. Self-isolation periods get extended if other household members also develop symptoms. Self-isolating families need support from others in their community to get shopping or other urgent items since they should not be leaving the house. In many countries, volunteer community groups or government programmes have been set up to meet this need. Self-isolation is also sometimes used to describe people who are staying at home to protect themselves or a vulnerable member of their household. These individuals may choose to be self-isolated in their homes for the duration of the outbreak but such a decision is normally voluntary.
Quarantine: Typically quarantine applies to any individual who has travelled across countries or internal borders during the period of the COVID-19 pandemic. As a precaution, governments may request these individuals to isolate for up to 14 days by requiring them to stay in their home or a hotel. Quarantine normally applies to all arrivals, irrespective of whether you are showing symptoms. It is a measure designed to protect the public, should a traveler have become infected prior to or during their journey. Quarantine durations sometimes get extended if the person does develop symptoms or tests positive to a COVID-19 test. People in quarantine need support from others in their community to go shopping or other urgent items since they should not be leaving the house. In many countries, volunteer community groups or government programmes have been set up to meet this need.
Shielding: Shielding measures limit contact between high-risk and lower-risk individuals. Those who are at highest risk of developing severe illness if they catch COVID-19 include older people or people who have pre-existing medical conditions. Shielding is designed to reduce the number of severe cases of COVID-19 and therefore reduce pressure on the public health system. This is done by housing high-risk individuals in ‘green zones’ which may involve vulnerable individuals self-isolating in their own homes or community level interventions to create isolation centres for these high risk individuals. Shielding is often considered in settings where other physical distancing measures may be difficult to enforce such as camps or informal settlements. It is also being considered in some low and middle income countries because other physical distancing measures would have too severe an effect on people’s social and economic lives. This document outlines three options for implementing shielding in low and middle income settings. The approach is also explained in this webinar. Shielding approaches could easily be met with resistance from communities, so therefore it is important that different shielding options are explained and that communities have the opportunity to select options that are appropriate for their context. Community engagement is key throughout the process.
The utilisation of any of the above approaches in low and middle income countries is a decision that needs to be made by national and regional governments and should be based on epidemiological data, understanding of the local economy and social safety nets and with flexible and phased implementation.
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Author: Eva Manzano and Sam Gil (CAWST)