Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"



Dr Mohan Z Mani,
Professor & Head,
Department of Dermatolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Original article / research
Year : 2022 | Month : August | Volume : 16 | Issue : 8 | Page : LC27 - LC31 Full Version

Quarantine of Travellers during the Initial Phase of the COVID-19 Pandemic- Experience from a Rural Setting in Kerala, India


Published: August 1, 2022 | DOI: https://doi.org/10.7860/JCDR/2022/57784.16793
Carol Pinheiro, Lakshmi Rajeev Thuruthiyath, Sairu Philip, Anuja Munduvadackal Viswabhadran, Amrutha Mudikunnath Sivadasan

1. Assistant Professor, Department of Community Medicine, Government TD Medical College, Alappuzha, Kerala, India. 2. Senior Resident, Department of Community Medicine, Government TD Medical College, Alappuzha, Kerala, India. 3. Professor, Department of Community Medicine, Government TD Medical College, Alappuzha, Kerala, India. 4. Junior Resident, Department of Community Medicine, Government TD Medical College, Alappuzha, Kerala, India. 5. Junior Resident, Department of Community Medicine, Government TD Medical College, Alappuzha, Kerala, India.

Correspondence Address :
Carol Pinheiro,
S-1 Staff Quarters, Government TD Medical College Campus, Vandanam, Alappuzha-688005, Kerala, India.
E-mail: carolcardoz@gmail.com

Abstract

Introduction: Quarantine of travellers was one of the major public health strategies enforced by the state to curb the transmission of the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) in the initial phases. Proper quarantine requires commitment from the person, support, and monitoring from the public health system.

Aim: To understand the process, practices, perceptions, and difficulties of quarantined persons during the initial phase of the Coronavirus Disease-2019 (COVID-19) in a panchayat in Alappuzha, Kerala, India.

Materials and Methods: A cross-sectional study was conducted from May to September 2020 using a semi-structured questionnaire through telephonic interview among quarantined individuals in a panchayat in Alappuzha, Kerala. Quarantine practices, the process of quarantine, perceptions, and difficulties faced were explored to understand their viewpoint. The perceptions of the healthcare providers were also enquired qualitatively. The data collected was entered in Microsoft Excel and statistical analysis was done using the Statistical Package for the Social Sciences (SPSS) version 27 (SPSS Inc, Chicago, USA).

Results: Out of the 182 quarantined individuals, 152 were in home quarantine of which 89 (58.6%) observed strict room quarantine and 132 (72.5%) had a quarantine period of more than 14 days which was the guideline then. Majority were contacted by the health staff during the period; however, 28% were not satisfied with the information that was conveyed to them. Majority adhered to infection control guidelines during quarantine. Almost half (46.7%) of them reported emotional problems during quarantine of which the major issues were loneliness and lack of social contact. Almost one-third of them had experienced stigma and rejection from people in the neighbourhood.

Conclusion: Quarantine to be used effectively as a public health measure requires that the concerns and problems should also be taken care of. Adequate information regarding the need and process of quarantine should be provided and there should be a system to cater to the emotional concerns of the persons. Awareness regarding the purpose and role of quarantine among the general public will enable quarantine to be used as a powerful tool for disease control in the future.

Keywords

Coronavirus disease, Perceptions, Severe acute respiratory syndrome coronavirus-2

The Coronavirus Disease-2019 (COVID-19) pandemic had imposed several challenges on the health system and cautioned a wind of change in all infectious disease prevention and control strategies worldwide. Various measures like physical distancing, contact tracing, quarantine, and personal protective measures were used as effective strategies to hinder the spread of the disease (1),(2). Quarantine policies were constantly changing from time to time and this had in fact raised doubts on the utility of the public health measure.

Quarantine is the term that refers to the policy that separates and restricts the movement of people who are exposed to a communicable disease to detect the development of symptoms and thus prevent transmission of disease from those potentially incubating it (3). The World Health Organisation (WHO) has recommended a strategy of 14-day quarantine either as a consequence of travel or following exposure to an infected person for effective control of COVID-19 (4). India had been using quarantine effectively as a tool to fight the disease ever since the first case was detected in the country on 30th January 2020. Quarantine is combined with entry and exit testing and a positive test demands isolation of the affected person till recovery. The recommended 14-day quarantine period although caused tremendous strain on the physical and mental wellbeing and the economic stability of the person, it had been considered as the most important strategy to prevent transmission of the virus to an immunologically naive community.

The state of Kerala had used many innovative approaches and put up a timely and comprehensive response to the outbreak (5). There was a system in place for screening and follow-up of every individual who arrived by air, sea, rail or road from other parts of India or abroad. The symptomatic passengers were taken directly to COVID treatment centres, tested and treated appropriately. The asymptomatic passengers were advised to follow strict home quarantine, avoid non-essential travel, and avoid social contact for the period of the quarantine (6),(7).

The concept of good quality home quarantine requires awareness and commitment from the person and the family and a robust system to monitor the process. This was ensured by the frontline health workers with the help of volunteers and local panchayat leaders in the field. The field workers of the health system were responsible for the initial counselling, education, and timely support to those in quarantine as and when needed. There was also a system in place to address the medical, nonmedical, and psychological needs of the persons under quarantine through reassurance phone calls (8). The details of the persons arriving in the state could be obtained from the COVID-19 Jagratha portal and the health staff promptly enquired about quarantine facilities at their homes much before they reached their homes (9). People without quarantine facilities at their residence, those without exclusive bath attached rooms or those who had vulnerable individuals at home were offered quarantine facilities at institutions. Self-help groups, volunteers, the panchayat, and the local police were involved with the health workers in monitoring quarantine violations in the area.

However, compliance with quarantine is not uniform and predictable and non-compliance with the instructions and inability to enforce quarantine along with other control measures had resulted in clusters of outbreaks at many places (10). This study attempted to understand the processes, perceptions, and practices followed by people during quarantine and the difficulties faced during the initial phase of the COVID-19 pandemic in a panchayat in Alappuzha district, Kerala. The experience gained could be used for guiding policy decisions regarding quarantine in the public health system.

Material and Methods

This was a cross-sectional questionnaire-based study through telephonic interview among natives of Kerala who returned from abroad or other states and were in quarantine in the district of Alappuzha, Kerala, India. The study was initiated after obtaining Institutional Review Board and Ethics Committee approval (IEC 56/2020). The study period was five months from May to September 2020. The study participants were routinely contacted by the health staff of the health institution in the area and all necessary instructions were given and follow-up of their health status was performed. Some of them were tested for the SARS-CoV-2 using real time or quantitative RT-PCR (q RT-PCR) or Rapid Antigen Tests (RAT) and if tested positive, their contacts were put on quarantine and followed up for another 14 days.

Study Procedure

Information was collected from those under quarantine at the end of their quarantine period using the questionnaire by telephonic interview by the investigators. Multiple conversations with the same person during the quarantine period helped in creating rapport with the persons in quarantine and helped in collecting the information on quarantine practices followed during the period of quarantine. A self prepared semi structured questionnaire was used to collect information on the demographic profile, country or state from which they arrived, the place and period of quarantine, the practices during quarantine, any problems faced and the kind of support received and their perceptions about quarantine. The perceptions of the medical teams regarding quarantine issues were also explored qualitatively through short personal interviews. These inputs gave useful insights from their viewpoint and can be considered as feedback for improvement and preparedness in the future.

Statistical Analysis

The data collected was entered in Microsoft Excel and statistical analysis was performed using the Statistical Package for the Social Sciences (SPSS) version 27 (SPSS Inc, Chicago, USA). The results obtained were described using appropriate measures of central tendency or proportions. Informed verbal consent was recorded for telephonic interviews, confidentiality was maintained during all stages of the study and the data collected was used for the purpose of this study only.

Results

Quarantine of travellers to the state was the main area of focus during the initial phase of the COVID-19 pandemic in Kerala and this strategy was well co-ordinated by the health systems with the active involvement of the local self-government and voluntary organisations in the community. The record of returnees to the state from COVID-19 affected countries and states was maintained at the health centres which helped in ensuring quarantine of all returnees and their contacts.

A total of 182 persons who returned to their home town in the district of Alappuzha and were in quarantine were studied, of whom 142 (78%) were men. The mean age (SD) of the study population was 35.92 (11.54) years. A majority 126 (69.2%) of the study population belonged to 18-to-40-year age group. One half i.e. 93 (51.1%) individuals under quarantine were international travellers and the rest were domestic travellers from other states in the country (Table/Fig 1).

A majority 128 (70.3%) were graduates and post-graduates in qualification and 122 (67%) were employed in the engineering and business sectors. A majority of them 126 (69.3%) had returned to Kerala immediately after the nationwide lockdown was lifted in the months of May and June 2020. The major reason for their return to Kerala was loss of job due to COVID-19 in 64 (35.2%) and the fear of COVID-19 as cases were increasing in 30 (16.5%). More than half of the study participants i.e. 104 (57.1%) were tested for COVID-19 by qRTPCR or RAT of which 23 (22.11%) were positive (Table/Fig 1).

A total of 30 participants (16.5%) were in institutional quarantine at COVID 19 care centres for the entire quarantine period, whereas 32 (17.5%) were in institutional quarantine for 7-14 days and then in home quarantine for the rest of the period. Out of the 152 study participants who were advised home quarantine, 89 practiced strict room quarantine, whereas 63 stayed at home along with the family members and not in strict room quarantine. A majority 132 (72.5%) had a quarantine period of more than 14 days and 50 (27.5%) were in quarantine for 14 days only (Table/Fig 2).

About one half 92 (50.5%) of the study participants were contacted before the quarantine period by the healthcare staff, majority 178 (97.8%) were contacted during their quarantine period, and 68.1% (n=124) were contacted by the staff even after completion of their quarantine period. Majority 106 (58.2%) were contacted by only phone calls at least once a day during the quarantine period. Overall, 100 (54.9%) were contacted by officials from the district level (District Nodal Officers, Collectorate control room, Mental Health Counsellors) during their quarantine (Table/Fig 3).

Majority of the people in quarantine 131 (72%) were satisfied that all information regarding quarantine was conveyed to them by the healthcare staff though some of the study participants 34 (18.7%) felt that all information, except quarantine certificate, was informed to them and 17 (9.3%) felt that information in many areas was inadequate. The most common information not shared was about the details and process of quarantine certificate, which was vital for those in employment (Table/Fig 3), (Table/Fig 4).

Persons in quarantine were instructed to use masks, practice hand hygiene measures, and stay separated from others. One-half of the study participants 90 (49.5%) used mask occasionally during quarantine, although they were advised to use them throughout. Majority of them 166 (91.2%) practiced hand hygiene measures always. Majority of the persons in quarantine 64 (35.2%) used cloth masks and 55 (30.2%) used triple layer surgical masks. The practice of double masking was followed by 21.4% (39) of the study population. About three quarter of the persons in quarantine 133 (73.1%) were in the habit of washing and reusing their masks (Table/Fig 5), (Table/Fig 6).

Almost 85 (46.7%) had emotional concerns during their quarantine, of which loneliness and lack of social contact were the most frequent. They had also encountered lack of sleep, sadness, and grief on being alone and lack of good food. A major proportion of the study participants 176 (96.7%) had access to things happening around through phone calls and social media. Majority 137 (75.3%)were of the opinion that being able to communicate with others and being aware of things happening around had a positive impact on them during the period. A small proportion 23 (12.6%) said they were concerned about misinformation circulating regarding the disease (Table/Fig 7), (Table/Fig 8).

Among the 182 respondents, 84 (46.2%) thought they would get SARS-CoV-2 infection if they had remained in that country or state. A large proportion of them 151 (83%) considered Kerala a safe zone in this pandemic. Almost all of them 181 (99.5%) were convinced that quarantine was a public health measure to protect their families, whereas 161 (88.5%) of them thought that they were asked to remain in quarantine as they were infected with the virus. A small proportion of them i.e. 63 (34%) feared stigma and rejection from people in the neighborhood. All of them were convinced that quarantine would stop the spread of the pandemic (Table/Fig 9).

Discussion

Quarantine as a public health measure to control the spread of an infectious disease was evident during the SARS outbreak (11). During the initial phase of COVID-19 in the state, it was important to follow the principles of quarantine and physical distancing to control the spread of the disease. Strict enforcement of home quarantine or institutional quarantine is possible only with good rapport with the health system and the local self-government (12). Communication with the health staff is essential to disseminate instructions to them, to spread awareness regarding quarantine, and to ensure adherence to the quarantine guidelines.

Quarantine of international and domestic travellers was a major public health measure initiated by the state to control the spread of the pandemic. This was of utmost importance as one of the main challenges Kerala had to face in the initial phase was the inflow of expatriates returning to their homeland due to several reasons and the large number of foreign tourists visiting the state (8). Evidence suggests that the disease is transmitted more by pre-symptomatic and asymptomatic individuals and hence, quarantine enforced in people with high risk, like travellers coming from high burden countries had a definite advantage (13). This strategy had prevented the spread of the disease to family members and close contacts in the state (14). The study brings to light that almost one half of the people in quarantine were international travellers and the major reason for the travel had been the loss of jobs due to COVID and fear of contracting the disease in a distant land. There was a good system to monitor and guide the people in home quarantine through the field staff, community health volunteers, and the local self-government. The persons in quarantine need to be informed about the maintenance of strict quarantine, the symptoms, whom to contact and when, the restrictions to be continued and about the quarantine certificate. Lack of clarity regarding the guidelines and inadequate information had created difficulty in complying with the instructions (15). Majority of the quarantined persons had a quarantine period of more than 14 days in the initial phase and the duration of quarantine is a reason for stress among them. Restricting the duration of quarantine to the most reasonable one and not adopting an over precautionary approach will be beneficial (15). Hand hygiene and face masks are considered powerful precautionary weapons in the fight against the disease (16). The persons in quarantine need to strictly follow the guidelines regarding the use of mask, hand hygiene, cough etiquette, and physical distancing as these measures reduce transmission to others (17).

Quarantine is an unpleasant experience for most people and mental wellbeing of the quarantined persons is an important factor to be considered during the quarantine period. Many studies have reported cases of anxiety and depression during the previous outbreaks also (18),(19). The communication channels with the health system need to be smooth to detect any aberration in their mental status or any concern that needs to be addressed, as loneliness and lack of social contact have disturbed many persons during quarantine (20). Frequent telephone calls from the higher levels like the district administration and the mental health programme may be strengthened to help quarantined persons in distress. The ability to communicate with one’s family and friends and the role of social media in helping people to update their loved ones about their situation and reassure them has to be emphasised. Being separated from family, the fear of contracting the disease, and the stigma associated with quarantine in the early days could be reduced by maintaining clear lines of communication with the quarantined persons and by spreading awareness about quarantine and its role in disease control to the general public. Successful use of quarantine as a public health measure in future requires policymakers to understand the psychological impact of quarantine and provide clear rationale for quarantine and the experience gained so far can guide policy decisions in future public health emergencies.

Limitation(s)

As the study participants were on quarantine, the information could be collected by telephonic interview only. The information from all travellers could not be enquired due to technical reasons like wrong phone number entered in portal.

Conclusion

Quarantine to be used effectively as a public health measure requires that the concerns and problems should also be taken care of. Adequate information regarding the need and process of quarantine should be provided and there should be a system to cater to the emotional concerns of the persons. Awareness regarding the purpose and role of quarantine among the general public will enable quarantine to be used as a powerful tool for disease control in the future.

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DOI and Others

DOI: 10.7860/JCDR/2022/57784.16793

Date of Submission: May 16, 2022
Date of Peer Review: Jun 18, 2022
Date of Acceptance: Jul 21, 2022
Date of Publishing: Aug 01, 2022

AUTHOR DECLARATION:
• Financial or Other Competing Interests: No
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA

PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: May 17, 2022
• Manual Googling: Jul 04, 2022
• iThenticate Software: Jul 26, 2022 (8%)

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