Date: 24.3.2020

Dr Harsh Vardhan

Union Minister of Health and Family Welfare

Ministry of Health and Family Welfare

Nirman Bhawan

New Delhi

Re: Concern with regard to isolation and quarantine of patients suspected of or diagnosed with Coronavirus (COVID-19)

Dear Sir,

We, the undersigned persons/ organizations, are concerned with regard to the rights of persons suspected of or diagnosed with the COVID-19 virus, who are being quarantined or are kept in isolation. We are aware that COVID-19 is a public health crisis and measures need to be taken by the State to ensure its containment.  While, isolation and quarantining of persons suspected of or diagnosed of a contagious disease should usually be the last resort, as noted by the WHO, in the case of Covid-19, isolation and quarantine may be used in the early stages of an outbreak to prevent the introduction of the virus into new populations. However, these measures have to be an integral part of management or prevention of the infection, following certain procedures that are detailed later in this letter. Isolation and quarantine are therefore to be implemented with the utmost care, with cognizance of the rights and consent of those for whom this may be necessary. We are extremely concerned that measures that violate individuals’ rights during such processes of isolation and quarantine will be counterproductive and will not elicit long term support. Individuals who quarantine themselves are doing it not just for self protection, but also for a larger public cause. They must therefore be provided support in all forms when they are doing such public service.

There have been media reports of persons who have not abided by isolation or quarantine guidelines resulting in overly harsh measures being adopted by the government including stamping of hands, publication of names and marking of homes; we have addressed our serious concerns with these measures in a separate letter. Instead of adopting such ad-hoc and arbitrary measures, the government should scrutinize the root causes of these actions and address them. For instance, abysmal facilities at the quarantine centres have been reported. The reports state that these spaces are filthy and have blocked toilets and no proper drainage.  Use of such places to quarantine persons who are suspected to or diagnosed with COVID-19 is outrageous and must be discontinued. There appears to be no assessment of the ability of persons who may be working, whose homes may be far from points of entry into the country or too small for effective isolation or have no support systems to abide by orders for isolation. There have been reports that people sensationally “caught” trying to break isolation or quarantine were trying to reach their homes in trains and buses. Overall there appears to be no concerted effort by the government to provide proper information and counselling to those asked to isolate or be quarantined or to the general public to provide regular updates, assurances and ensure that there is no stigma, discrimination or violence against those in isolation or quarantine; publishing guidelines after guideline expecting people to read, understand and implement them is not sufficient.

The processes of isolation and quarantine must ensure that: 

  1. The basic rights of the person to food, water, clean sanitation, hygiene, electricity and good health care facilities should not be breached.
  2. All the places identified as isolation or quarantine centres should have the basic facilities, and the persons who are under observation must not be forced to stay in places that do not adhere to the basic standards of hygiene and health.  Such a situation may cause the person to take adverse steps such as leaving the facility which would consequently harm the person and may potentially expose others to the disease. We are alarmed at news reports that suggest a two-tier system of clean and comfortable isolation or quarantine facilities is being proposed in some States for those who can pay while those who can’t; all persons in isolation or quarantine facilities should have access to the same basic comfort and hygiene.
  3. Strict confidentiality should be maintained by all institutions or facilities being used as quarantine centres or isolation wards. The health workers, the health care providers, and the persons in authority should ensure that the rights of these persons and their families are not violated in any way.
  4. Assessment should be made of individuals who are being home quarantined, if they have all the basic facilities in their home, and it should be ensured that they are provided all the social support in terms of availability of groceries, food, and most importantly counseling for mental support. Proper information, education and counselling for persons who may be required to be in isolation or quarantine.
  5. For those who live in very small homes, shelter homes with many people, and home quarantine may lead to risk of transmission, other places designated by the government for quarantine could be used.  Local panchayats, ASHAs, and others may be involved to support their day to day needs. Needless to state that all those involved in such support should not be forced to do so and they along with all health care providers should be provided with the essential personal protective equipment to protect themselves.
  6.  At the airports, stamping persons does not serve the purpose of preventing the spread of the infection. Instead, it violates their privacy and stigmatizes them and should therefore be discontinued. It also makes them vulnerable to the violence when they are attempting to reach their homes
  7. People should be counseled and taught how to take complete precaution and the importance and reasons for staying isolated for a period of time. Further, passengers who are advised home quarantine, and stay in places far away from the airport where they have landed, it is essential that the designated health department vehicles take them to their homes, so that they do not use public transport.
  8. Care needs to be provided to the sick, including for their mental health. Evidence indicates that isolation and quarantine may result in mental health issues such as depression,  fear or  thoughts of suicide, etc.
  9. Counselling facilities should be made available at all the quarantine and isolation centres, to address any mental health concerns that they may have or might emerge. They should be allowed to be in touch with their family and near ones on the phone or otherwise.
  10. For those who are isolating or being quarantined at home, a trained and empathetic counsellor or social worker should be specifically assigned to speak to these persons on a daily basis via phone; there are sufficient health organizations and experts who would also volunteer their services to this end.
  11. The government should consult with and work with civil society and community based organizations on a regular basis as they address the growing challenge of dealing with Covid-19.

We urge you to consider the above mentioned measures and direct the State governments to uphold the rights of all persons who may require or are currently undergoing isolation or quarantine as a last resort. Urgent measures are also necessary to ensure that there is no breach of confidentiality of persons in isolation or quarantined in facilities or at home.

These are imperative for the people’s confidence in the health system. Our decades of experience have shown, that paradoxically, it is only when you respect the rights and fulfil the needs of those who are the most at risk of infection or have already got the virus, that you can effectively contain the spread of the virus.

Sincerely

Sarojini N, Veena Johari, Amar Jesani, Kajal Bharadwaj, Sundararaman, Jivika Shiv, Subha Sri, Deepa V, Neelanjana Das, Inayat Kakar, Kamayani Bali Mahabal , Richa Chintan, Surekha G, Chhaya, Prasanna and Raghunandan

Contact: (+91) 9818664634 | 9820808318

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