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Wondering What A Coronavirus Quarantine Is Really Like? (Part 1 of 2)

This piece by ACCESS Health Chair and President William A. Haseltine originally appeared in Forbes.

Quarantine is an often disquieting term. From the mid 1300s to today, the word has evoked images of the sick and defenseless being dragged from their homes and locked away with dozens if not hundreds of potentially infectious strangers.

The reality in the age of coronavirus though is far different. I had the opportunity this week to speak to a friend of mine who was forced into quarantine, along with his wife, in Shanghai. Many news outlets have reported on the Draconian measures introduced by China, describing   “hazmat suit-clad goons dragging people from their homes”. Yet for my friends, the picture they paint of life under quarantine is different. 

Their journey to quarantine started in late February, when they hopped a plane from Europe back to their home in Shanghai. The city they were traveling from had yet to report a single confirmed case of Covid-19 and Europe overall hadn’t yet been dubbed a hot spot of infection. Upon their arrival at the Shanghai airport, they were screened like all other travelers — they walked through an infrared temperature check, they filled out a form describing where they had traveled, then they grabbed their suitcases, hopped into a waiting car, and headed home to their apartment. 

The next day, when my friend went down to his lobby’s front desk, the clerk examined him with friendly suspicion. 

“He was asking me where I had been, since he hadn’t seen me or my wife around the apartment for a few weeks. Once I told him I’d been traveling, his whole attitude changed. The only thing he wanted to talk about from then on was self-isolation.”

In China, there are three levels of isolation and quarantine. The first is self-isolation, which means you stay home, monitor your temperature, and record it via a mobile app that helps the city monitor the health of people in isolation from afar. You can go out to buy groceries and for walks, but other than that you are meant to confine yourself to your home. The second level is home quarantine, where you’re still at home but cannot step outside your home. And the third is controlled quarantine, where you are taken out of your home and sent to a supervised quarantine facility. The government of Shanghai had asked all those traveling into the city from elsewhere to voluntarily self-isolate for two weeks to be sure they weren’t unknowingly spreading infections. There was no doubt that my friend and his wife would comply. 

“For the next three days, we stuck very close to home. We could leave to get groceries if we needed to, but mostly my wife and I ordered in. But even ordering food was different than it used to be before the outbreak. Instead of bringing the food to our apartment, the delivery people had to leave it on a set of tables and shelves that had been temporarily placed by the front gate. At least we could go down to pick it up, since we were only self-isolating. If you’re told to self-quarantine you can’t leave your apartment — someone from the building has to bring it up to you.”

“Then that Tuesday, three days after we’d arrived back in Shanghai, everything changed. Our phone rang incessantly that day — the police, the Shanghai Center for Disease Control, and the district CDC all called us to let us know that a passenger on our flight to Shanghai had tested positive for infection. But that isn’t really what shocked us — what alarmed us the most is when they told us we would have to finish out the rest of our fourteen day period of self-isolation in a controlled quarantine facility. They wanted to take us from our home.”

“The word quarantine was terrifying. I was thinking of quarantine as somehow a lot of very, very sick people locked up together. Not, you know, a rational thing. Sort of like solitary confinement — you are cut off in some sense from the rest of the world. I even checked with the American consulate to see if it was really necessary. But they told us there was no other option, we would have to accept the forced quarantine or risk the consequences of non-compliance.”

“That night we each packed a suitcase of our personal things and a bag with our laptops and tablets then the next morning we went downstairs at 11:00am, as they’d asked. A person comes in wearing a mask and some sort of surgical gown and walks us over to a van. Then he drove us over to a local hotel. Oddly enough, we looked it up later and found out it was actually a three star hotel when it was operational.”

Much like the quarantine motels set up in Washington State here in the United States, the Chinese government had taken over hundreds of hotels to use as quarantine facilities to help contain the spread of the disease.

“When we arrived, there was another person in a hazmat suit standing outside waiting for us. It was nothing like the usual hotel check in process. We walked inside and were greeted by a very nice woman in a surgical mask and gown sitting behind a card table with forms and instructions. She politely but firmly explained that we would have to stay in separate rooms. She gave me a form which included rules for the next eleven days of our stay. We couldn’t leave our rooms. We couldn’t receive guests. And when we received our three meals a day — at 8:30am, 12:00pm and 6:00pm — we would listen for a knock on our door then wait thirty seconds before opening the door, getting our food as quickly as possible, and shutting the door behind us.”

“It was all a bit unnerving at first. We asked if we could room together, but they said no — no exceptions. Even though I don’t speak Chinese, they assured me it wouldn’t be a problem. They did at least put us in two rooms on the same floor. They handed us each a thermometer, showed us how to use it, then told us that we would have to take our own temperature twice a day. We’d also have to submit to daily medical inspections and allow people to enter each day to clean and disinfect our rooms.” 

“There was one last set of directions before we went into our rooms. A hazmat-suited woman handed my wife and I a couple tiny bottles of shampoo and shower gel, and a couple bars of soap. Then she handed us each a big blue bucket and a jar of disinfectant tablets and said, ‘This is for toilets.’ My eyes grew wide in horror as I tried to figure out what she was asking me to do. Then she realized what I was thinking and burst into laughter. ‘No, no, no, no, no, no,’ she said. ‘I don’t want you to use the bucket as a toilet, I want you to dissolve the tablets in water in the bucket, then dump the mixture into the toilet before you flush. I was so relieved. They wanted us to dissolve six disinfectant tablets into one liter of water then pour it down the toilet after urinating. It was two liters of water and twelve tablets for other types of bathroom visit.”

“The first day was a bit disconcerting. The person in the room beside mine had a pretty nasty cough that sounded like a barking dog. But the next day was substantially better, as my wife and I figured out a routine. Internet bandwidth was good and we could connect an unlimited number of devices. So we started a video conferencing session which we left on all the time, so we could ‘share; the experience. We could still order food for delivery, which they’d drop off at meal times in front of our doors. And friends were allowed to send care packages as well: little bottles of Evian and Perrier, fresh fruit, wine and cheese, and chocolates all made it seem much less like the kind of experience I previously associated with the word ‘quarantine’.”

“The hotel staff was kind and friendly. I especially enjoyed the disinfectant guys in the hazmat suits who came to my room each day to clean out the room – they were my two minutes of same-room conversation each day. I could see them visit my wife’s room before mine each day, so I always knew when they were on their way. I never exchanged names with them but they were my best buddies, because they were really my only buddies. I suppose they were also my worst buddies too. They were everything.”

Thankfully, my friend and his wife were cleared and released at the end of their eleven days in controlled quarantine. Now, in Shanghai as in the rest of China, there have been no new infections due to local transmission. 

“What I would say now is that quarantine today, in the age of the internet with continuous video conferencing, is very different from what it probably used to be. With the care packages, and video conferencing and continuing to work remotely, I did not feel cut off from the world. I felt isolated in the sense that I was alone, but I did not feel cut off.”

In addition to bringing relief to any afraid of what quarantine may bring, my friend’s story highlights the steps we need to take in the United States as well to prepare ourselves for the inevitable onslaught of new cases. We need to be ready to test those who we suspect are infected, trace all those they came in contact with, and have a plan in place not just for medical care but also for selective isolation and quarantine. This is the only way to slow the spread of this disease and buy ourselves time for a medical solution. 

This story illustrates one other important aspect of our response, which we dare not lose sight of: maintaining a sense of dignity and humanity in how we care for each other. Even as he sat alone in his room, there were moments of kindness and compassion throughout my friend’s experience that he will not soon forget. He told me one story, from his third day of quarantine, when he received an unexpected package of kiwi fruit, coffee, and tea from the Shanghai Municipal Foreign Affairs Office. The package came with a note in poorly translated English that read, “My dear friend, the inconvenience for the time being, it is for the health of you, of me, and of everybody. So thank you for everything. Quarantine against virus is no isolation of warm hearts. We are right here with you.”