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 Table of Contents  
ORIGINAL ARTICLE
Year : 2022  |  Volume : 15  |  Issue : 1  |  Page : 92-98

Quarantine during COVID-19 pandemic: A cross-sectional study to investigate its compliance and psychological impact among health care professionals in Southern Haryana


1 Department of Community Medicine, SHKM Government Medical College, Nalhar, Haryana, India
2 Department of Community Medicine, Government Medical College, Shahdol, Madhya Pradesh, India

Date of Submission05-Jul-2021
Date of Decision08-Dec-2021
Date of Acceptance11-Dec-2021
Date of Web Publication24-Jan-2022

Correspondence Address:
Dr. Vikas Gupta
Department of Community Medicine, Government Medical College, Shahdol, Madhya Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/kleuhsj.kleuhsj_182_21

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  Abstract 

BACKGROUND: COVID-19 has caused a pandemic during 2019–2020 that has resulted in illnesses ranging from the usual flu to serious respiratory problems, even leading to mortality. Recent literature has suggested that the health (psychological) impact of quarantine is wide-ranging, substantial, and can be long-lasting.
OBJECTIVES: The purpose of this study was to assess the mental health status (psychological distress) of those who experienced quarantine and their compliance with quarantine during the outbreak of COVID-19 among health care professionals.
MATERIALS AND METHODS: The study included 217 health care staff (doctors and nurses) working in COVID-19 outpatient and wards, sent on quarantine at home or state-run facilities. The psychological impact was assessed using the Kessler Psychological Distress Scale (K10). Categorical data were presented as percentages (%), and the Chi-square test was used to determine the association, with a P < 0.05 considered statistically significant.
RESULTS: Out of 217 participants, only 206 gave their consent to be part of the study, and only 10.2% (21/206) of quarantined subjects were compliant with all protective measures. It has a significant association with the participant's understanding of all the rationale for quarantine and with the Kessler Psychological Distress Scale (P < 0.05). The mean score obtained on Kessler Psychological Distress Scale (K10) subjects was 18.91 ± 5.16, whereas 63 subjects out of 206 (30.6%) had a score of 20 or more.
CONCLUSION: Given the developing situation with the coronavirus, policymakers urgently need evidence synthesis to produce guidance for the public. Thus, the outcomes of this study will definitely help authorities, administrators, and policymakers to put quarantine measures in a better way.

Keywords: Compliance, health care worker, Kessler Psychological Distress Scale (K10), quarantine


How to cite this article:
Singh A, Gupta V, Goel PK. Quarantine during COVID-19 pandemic: A cross-sectional study to investigate its compliance and psychological impact among health care professionals in Southern Haryana. Indian J Health Sci Biomed Res 2022;15:92-8

How to cite this URL:
Singh A, Gupta V, Goel PK. Quarantine during COVID-19 pandemic: A cross-sectional study to investigate its compliance and psychological impact among health care professionals in Southern Haryana. Indian J Health Sci Biomed Res [serial online] 2022 [cited 2022 May 22];15:92-8. Available from: https://www.ijournalhs.org/text.asp?2022/15/1/92/336297




  Introduction Top


COVID-19 has caused a pandemic during 2019–2020 that has resulted in illnesses ranging from the usual flu to serious respiratory problems, even leading to mortality.[1] The origin of COVID-19 is zoonotic, yet the transmission from animals to humans or humans to humans is observed either through droplets or direct contact, and the period of incubation ranges from 2 to 14 days.[2],[3] History has recorded the occurrence of plenty of pandemics, including severe acute respiratory syndrome (SARS) (2002), resulting in 800 mortality; and Middle East respiratory syndrome coronavirus (MERS-CoV) (2012), resulting in 860 mortality; and just after 8 years of MERS-CoV, COVID-19 gave its worldwide representation.[3],[4]

The index case was reported from Wuhan (China) during December 2019, and afterward, its dissemination speeded up in a very rapid manner and reached several countries in a short period of time, causing a lot of fatalities. After such a disastrous situation, the World Health Organization (WHO) came into action, realized its impact, and decided to declare COVID-19 as a public health emergency of international concern on January 30, 2020.[5] Startlingly, there was global reporting of catastrophic counts of newer cases during the start of March, so subsequently, on March 11, 2020, the WHO declared COVID-19 to be a pandemic. On March 24, 2020, the Government of India took a strong initiative to contain the spread of this virus and, from March 25, 2020, onward, the closure of nearly all offices, industries, hotels, commercial and private establishments, shops, malls, and others was ordered.[6]

As of December 6, 2021, there had been more than 265,713,467 COVID-19 cases reported across 213 countries and territories, resulting in approximately 5,260,888 deaths, whereas in India, the total case count was 34,656,822 and 473,592 deaths.[2],[7] Haryana's Nuh district was the worst affected district among all 22 districts of Haryana state with the maximum number of positive cases. A large number of people were sent into quarantine.[8] Many countries ask people who have potentially come into contact with the infection to isolate themselves at home or in a dedicated quarantine facility. This outbreak has seen a large number of people placed under quarantine, either self-isolated at home or in state-run facilities. Asymptomatic people with travel or contact history visiting the COVID 19 Screening health center, or “Flu Corner,” were advised to home quarantine. Doctors and health care staff discharging duties in close contact with COVID-19 positive patients were placed under quarantine at home/hostel, or in state-run facilities. The district administration had taken over certain colleges as quarantine centers in the district.[9]

Recent literature has suggested that the health (psychological) impact of quarantine is wide-ranging, substantial, and can be long-lasting.[10],[11],[12],[13] We need to know the psychological impact of quarantine as well as the factors influencing its compliance during the COVID-19 pandemic. Nuh was among the worst affected districts among all 22 districts of Haryana State with the maximum number of positive cases. A large number of people were sent on quarantine, including health care professionals. Hence, this study was conducted with the objective of assessing the mental health status (psychological distress) of those who experienced quarantine and barriers and facilitators for compliance with quarantine among health care professionals during the outbreak of COVID-19 in Nuh district.


  Materials and Methods Top


Study setting and design

The present quantitative study was cross-sectional in design and conducted at SHKM Government Medical College, Nalhar, situated in district Nuh, Haryana, for 2 months during April and May 2020. Nuh was among the worst affected districts among all 22 districts of Haryana State with the maximum number of positive cases. A large number of people were sent on quarantine, including health care professionals. Furthermore, 351 patients were home quarantined during that time period.

Study population and sample size

The study subjects included health care personnel, including doctors and nurses, placed under quarantine at home, hotels, or state-run facilities after discharging duties in close contact with COVID-19-positive patients. The list of those quarantined health care professionals was obtained from the Office of Medical Superintendent along with their contact details, which tallied to around 217 eligible participants.

Study tool

A 19-element structured questionnaire with both open and closed-end responses was developed, which covered the domains of subject's characteristics; understanding the rationale, compliance, and difficulties associated with quarantine; psychological impact; and barriers and facilitators among COVID-19 quarantine study subjects. A pilot study was conducted randomly among 15 health care professionals, and it took an average of 20 min to complete the questionnaire. The questionnaire was made precise, relevant, valid, and acceptable by presenting it to 10 randomly selected faculty members. The questionnaire was refined and organized to make it more comprehensible prior to distribution to the study subjects. The questionnaire had four divisions and consisted of a total of 19 elements. Division one consisted of three elements and gathered information regarding subject characteristics such as age, gender, occupation, and place of quarantine. Division Two was comprised of four elements and aimed to gather the subjects' understanding of the rationale, compliance with all community and household protective measures, and difficulties associated with quarantine. Division three was comprised of 10 elements and aimed to measure the psychological impact using the Kessler Psychological Distress Scale (K10) which was modified to 14 days from 30 days and included statements such as “tired out for no good reason, nervous, so nervous that nothing could calm you down, hopeless, restless or fidgety, so restless you could not sit still, depressed, that everything was an effort, so sad that nothing could cheer you up and worthless” and the response to each element was based on a 5-point Likert scale pattern (all of the time = 5, most of the time = 4, some of the time = 3, a little of the time = 2 and none of the time = 1).[14] The score ranged from 10 (minimum) to 50 (maximum). A score of 20 or more was considered to have a serious psychological impact on subjects during the 14-day quarantine period. Division four was comprised of two elements and aimed to extract the barriers and facilitators among COVID-19 quarantine study subjects.

Data collection

Participation in this survey was voluntary and was not compensated. Informed consent was obtained from each participant prior to participation, and the anonymity and confidentiality of the participants were maintained. Just after the completion of their 14-day quarantine period, they were contacted telephonically to confirm their availability to conduct this study. They were explained the purpose of this study and were requested to participate. Out of 217 subjects, only 206 subjects provided their written consent after understanding the study objectives and were included in the study using a convenient sampling method. The questionnaire for subjects was administered by the investigator himself, using a face-to-face interview technique. In addition, the filled questionnaires were then checked for completeness. The subjects suspected of serious psychological impact on the Kessler Psychological Distress Scale (K10) were directed to the nearest health facility. The study was initiated after obtaining the ethical approval from the Institutional Ethical Committee (IEC), SHKM GMC, Nalhar (Letter No. SHKM/IEC/2020/40, Date: 24 April, 2020).

Data analysis

Collected data were entered into the MS Excel spreadsheet, coded appropriately, and later cleaned for any possible errors. Analysis was carried out using IBM SPSS Statistics for Windows, Version 22.0 (IBM Corp. Armonk, NY, USA). During data cleaning, more variables were created so as to facilitate the association of variables. Clear values for various outcomes were determined before running frequency tests. Categorical data were presented as percentages (%), whereas continuous data were presented as mean and standard deviation. Independent t-test and a Chi-Square test were applied to find out the strength of the association between the dependent variable and independent variables. All tests were performed at a 5% level of significance; thus, an association was significant if the P < 0.05.

Ethical clearance

The study was initiated after obtaining the ethical approval from the Institutional Ethical Committee (IEC), SHKM GMC, Nalhar (Letter No. SHKM/IEC/2020/40, Date: 24 April, 2020).


  Results Top


A total of 206 subjects were involved in the present study, including doctors and nursing staff. The mean age group of the study subjects was 32.05 ± 6.49 years, and around one-tenth of the study subjects (14.1%, 29/206) were over the age of 40 years. The female subjects made up around two-thirds (62.6%) of the total subjects. Home quarantine was mostly adopted among quarantine types, as more than half of the study subjects (52.9%) were sent for home quarantine.

[Figure 1] shows that the rationale for quarantine was completely and correctly understood by only 22.3% of subjects, whereas 54.4% of subjects believed that quarantine was mainly for the benefit of the community. The most common difficulty faced by subjects during quarantine was the inability to leave the house “to socialize (70.4%) or on errands (72.8%).” In [Figure 2], astonishingly, only 10.2% of quarantine subjects were compliant with all protective measures, whereas compliance with all community and household protective measures was 35.0% and 20.4%, respectively.
Figure 1: Distribution of understanding the rationale and difficulties associated with quarantine among study subjects (n = 206)

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Figure 2: Distribution of compliance among COVID-19 study subjects (n = 206)

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[Table 1] shows the mean score obtained on the Kessler Psychological Distress Scale (K10) to evaluate the psychological impact associated with quarantine among COVID-19 study subjects was 18.91 ± 5.16, whereas 63 subjects (30.6%) had a score of 20 or more, which predicts the likely psychological impact or distress among subjects during 14 days of quarantine. [Table 2] shows that the mean score of K10 was significantly higher among participants being quarantined at hostels or state-run facilities when compared to participants quarantined at home (P < 0.05)
Table 1: Psychological impact using Kessler Psychological Distress Scale (K10) associated with quarantine among COVID-19 study subjects (n=206)

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Table 2: Distribution of Kessler Psychological Distress Scale (K10) score (mean±standard deviation) among study participants (n=206)

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When subjects were asked about the barriers to noncompliance with quarantine using open-ended questions, the major barriers were duration of quarantine (68.4%), fear of infection (67.0%), and inadequate supply (76.2%). Similarly, the opined facilitators to make quarantine more compliant included keeping it as short as possible, giving people as much information as possible, providing adequate supplies, and assessing preexisting poor mental health [Figure 3].
Figure 3: Distribution of barriers and facilitators among COVID-19 quarantine study subjects (n = 206)

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[Table 3] shows Chi-square test analysis to determine the association between dependent variables and compliance, and it was revealed that a higher K10 score (20 or more) and an inability to understand all the rationale for quarantine had a statistically significant association with noncompliance with all protective measures (P < 0.05).
Table 3: Independent association of variables and compliance among study participants (n=206)

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  Discussion Top


Quarantine is often an unpleasant experience for those who undergo it. Separation from loved ones, the loss of freedom, uncertainty over disease status, and boredom can, on occasion, create dramatic effects. People are facing several problems during lockdown that include basic survival and fake and endless information on the COVID-19 pandemic period.

The present study has made an attempt to evaluate the psychological impact on quarantined subjects, and it was observed that during the quarantine period, 13.1% of subjects felt nervous all the time, 1.9% felt so nervous that nothing could calm them down all the time, and 5.8% of subjects felt depressed all the time.

According to the Upadhyay et al.'s study, 6.1% of individuals experienced severe depression, 10.0% experienced severe anxiety, and 16.5% experienced severe stress.[15] Jeong et al. compared psychological outcomes during quarantine with later outcomes and found that during quarantine, 7% showed anxiety symptoms and 17% showed feelings of anger, whereas 4–6 months after quarantine, these symptoms had reduced to 3% (anxiety) and 6% (anger).[16]

Sprang and Silman compared posttraumatic stress symptoms in quarantined subjects with those not quarantined and found that 28% of subjects quarantined in this study reported sufficient symptoms to warrant a diagnosis of a trauma-related mental health disorder, compared with 6% of subjects who were not quarantined.[17] Zhu et al. conducted studies among groups quarantined versus nonquarantined and revealed that SRQ-20, GAD-7 and PHQ-9 scores were significantly higher among quarantined subjects when compared to nonquarantined ones. Furthermore, it was observed that psychological impact was higher among home quarantined subjects (24.5%) when compared to facility-based quarantined subjects (12.6%), which was in contrast to the present study, where psychological impact (K10 score) was higher among facility-based quarantined subjects (20.16 ± 5.54) when compared to home quarantined subjects (17.79 ± 4.54).[18]

The present study has raised concern as the psychological impact (K10 score) was higher among nurses (19.27 ± 5.52) as compared to doctors (18.61 ± 4.86). Liu et al. studied hospital staff and examined symptoms of depression 3 years after quarantine and found that 9% of the whole sample reported high depressive symptoms. In the group with high depressive symptoms, nearly 60% had been quarantined, but only 15% of the group with low depressive symptoms had been quarantined.[19]

In a study by Bia et al. among hospital staff who might have come into contact with SARS, it was found that being quarantined for 9 days was the most predictive factor for the acute stress disorder symptoms among subjects post-quarantine. In the same study, quarantined staff were significantly more likely to report exhaustion, detachment from others, anxiety when dealing with febrile patients, irritability, insomnia, poor concentration and indecisiveness, deteriorating work performance, reluctance to work, or consideration of resignation.[20]

Confinement, loss of usual routine, and reduced social and physical contact with others were frequently shown to cause boredom, frustration, and a sense of isolation from the rest of the world, which was distressing to subjects. This frustration was exacerbated by not being able to take part in usual day-to-day activities, such as shopping for basic necessities or taking part in social networking activities through the telephone or internet.[21],[22]

The study revealed that only 10.2% of quarantined subjects were compliant with all protective measures, whereas compliance with all community and household protective measures was 35.0% and 20.4%, respectively. Soud et al. in the United States during 2009 showed that students with suspected mumps were instructed to stay isolated and 75% stayed isolated for the recommended number of days.[23] During the swine flu outbreak (2011) in Australia, compliance was observed in various studies by McVernon et al., Kavanagh et al., and Teh et al., with much variation, as among parents from households with children who were placed in quarantine during the outbreak, 84.5% reported full adherence at the household level, while parents who were employed from households with children who were placed in quarantine during the outbreak, half of all households fully adhered to quarantine recommendations, and among subjects tested for H1N1 and who were prescribed home quarantine for 7 days, 92.8% reported adherence to quarantine measures.[24],[25],[26] The Hsu et al.'s study showed that health care workers in charge of SARS epidemic control at health centers in Taiwan were advised to home quarantine for 10–14 days, and all nurses reported poor adherence from quarantined individuals.[27]

The present study also attempted to obtain an opinion about the barriers to noncompliance with quarantine using open-ended questions. The major barriers were duration of quarantine (68.4%), fear of infection (67.0%), and inadequate supply (76.2%). The studies by DiGiovanni et al., and Pellecchia et al., also cited the barriers for adherence to the quarantine as length of quarantine, fear of infection, practical issues like loss of income and need to work, need to attend important events, and need to seek medical care.[28],[29]

If the quarantine experience is negative, there can be long-term consequences that affect not just the people quarantined but also the health-care system that administered the quarantine and the politicians and public health officials who mandated it. Ever since the plague of Justinian, imposed quarantine has rightly remained part of our public health arsenal. But as with every medical intervention, there are side effects that must be weighed in the balance and alternatives that must be considered. Voluntary quarantine, for example, may be associated with good compliance and less psychological impact, particularly when explained well and promoted as altruistic. Whether the uncertain epidemiological benefits of this new form of mandatory mass quarantine outweigh the uncertain psychological costs is a judgment that should not be made lightly.[30]


  Conclusion Top


Given the developing situation with the coronavirus, policymakers urgently need evidence synthesis to produce guidance for the public. Thus, the outcomes of this study will definitely help authorities, administrators, and policymakers to put quarantine measures in a better way. It will also provide input to the healthcare system administrators that enforce the quarantine and the public health officials who have mandated it.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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    Figures

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