How To Create A Low-risk Quarantine Bubble?

August 17, 2020

After three months of lockdown, many people in the United States and around the world are turning to quarantine bubbles, pandemic pods, or quarantine zones in an effort to balance the risk of a pandemic with the emotional and social demands of life.

I am an epidemiologist and mother of four children, three of whom are teenagers on the cusp of adventure. As the country grapples with how to navigate the new risks in the world, my children and I are doing the same.

Studies have shown that if done carefully, isolation bubbles can be effective in limiting the risk of contracting SARS-CoV-2 while allowing people to have much-needed social interactions with friends and family.

If you can’t eliminate the risk, you need to reduce it
An isolation zone is a small group of people who form their own social circle and work together to isolate – and is a perfect example of a harm reduction strategy.

Harm reduction is a pragmatic public health concept that explicitly acknowledges that all risks cannot be eliminated, so it encourages risk reduction. A harm reduction approach also takes into account the intersection of biological, psychological, and social factors that influence health and behavior.

For example, abstinence-only education is not as effective. On the other hand, safe sex education, which aims to limit risk rather than eliminate it, is more effective in reducing teen pregnancy and sexually transmitted infections.

Bubble isolation is a way to limit the risk of contracting or transmitting SARS-CoV-2 while expanding social interactions.

Mental health is also important
Staying indoors, avoiding any contact with friends or family, and having food and groceries brought in are the best ways to limit the risk of contracting SARS-CoV-2. But the risks of an epidemic go beyond just the damage of infection. Health includes both mental and physical health.

The negative impact of the epidemic on mental health is already beginning to be felt. A recent survey of U.S. adults found that 13.6 percent reported severe symptoms of psychological distress, up from 3.9 percent in 2018.A quarter of people aged 18 to 29 reported severe psychological distress, the highest of any age group. Many feel anxious and depressed because of the epidemic, or are already living with these challenges. Loneliness certainly doesn’t help.

Loneliness and social isolation increase the risk of depression and anxiety, and may also lead to an increased risk of serious physical illnesses such as coronary heart disease, stroke and premature death.

Isolation is therefore not just a convenient idea as it allows people to see their friends and family. Isolation comes with serious health risks – both physical and mental – and social bubbles can help mitigate this risk while improving social well-being and quality of life.

Social network theory suggests that isolation is effective.
Social relationships can enhance well-being and mental health, but they are also a tool for spreading infection. As people around the world emerge from isolation, it is a dilemma: how do we increase social interactions while limiting transmission risks?

A recent study used social network theory – how information spreads through a population – and an infectious disease model to see if quarantines could play a role in such a pandemic.

To do this, the researchers created computer models of social interactions to measure how the virus spreads. They created models of typical behavior, models of typical behavior but only half as many interactions as normal, and three different types of social alienation.

The first social alienation scheme groups people by characteristics – for example, people will only see people of a similar age. The second scenario groups people by local community and limits inter-community interactions. The last scenario restricts interaction to small social groups with mixed characteristics from different locations – i.e. isolation bubbles. These bubbles can contain people of all ages and from different communities, but these people can only interact with each other.

All measures of social distancing reduce the severity of a pandemic and are better than simply randomly reducing interactions, but the isolation bubble approach is the most effective in flattening the curve. Compared to no social distancing, isolation bubbles delay the peak of infection by 37%, reduce the height of the peak by 60%, and reduce the overall number of infections by 30%.

Other countries are now beginning to include isolation bubbles in their prevention guidelines because of the low infection rates and the contact tracing programs in place. The UK is the latest country to announce isolation guidance with their supportive bubble policy.

New Zealand implemented a quarantine bubble strategy in early May and it appears to have worked. In addition, a recent survey of 2,500 adults in England and New Zealand found high levels of support for the policy and high levels of motivation to comply with it.

How to set up a quarantine bubble
To make an effective pledge, you need to do the following.

First, everyone must agree to follow the rules and be honest and open about their actions. Individual behavior can put the entire team at risk, and the basis of the assurance is trust. The team should also discuss beforehand what to do if someone breaks the rules or comes into contact with an infected person. If someone starts to show symptoms, everyone should agree to self-quarantine for 14 days.

Second, each person must decide how much risk is acceptable and set rules that reflect that decision. For example, some people may feel able to have a close family member visit, but others may not. Our families have agreed that we will only visit with friends outside, not inside, and that everyone must wear a mask at all times.

Finally, people need to actually follow the rules, observe the physical distance outside the quarantine area, and come forward if they think they may have been exposed.

Additionally, communication should be ongoing and dynamic. The realities of an outbreak change rapidly, and what may be okay one day may be too risky for some people the next.

Risks of joining the quadruple vaccine
Any increase in social contact is now inherently riskier. There are two important points in particular that a person should consider when considering how much risk he or she is willing to take.

The first is asymptomatic transmission. Current data suggest that anywhere from 20% to 45% of people infected with SARS-CoV-2 at any given time are asymptomatic or pre-symptomatic and able to transmit the virus to others. The best way to know if someone is infected is to get tested, so some people may want to consider asking to be tested before agreeing to be enrolled in the quadruple vaccine.

The second thing to consider is that the consequences of getting sick aren’t the same for everyone. If you or someone you live with has another health condition – such as asthma, diabetes, heart disease, or a compromised immune system – then the assessment of the risks and rewards of the Tetravaccine should change. The consequences of COVID-19 for people at high risk for developing it are far more serious.

One of the biggest difficulties facing scientists and the public alike is the uncertainty about the virus and its future. But some things are known. If individuals are informed and sincere in their quarantine, and follow the usual guidelines of social distancing, masking, and enthusiastic hand washing, quarantine can provide a robust and structured middle ground approach to managing risk while experiencing the joys and benefits of friends and family. These are all things we can all benefit from today, and for now, quarantine may be the best step forward as we work together to rid ourselves of this epidemic.