In the past three decades, the world has lived through two pandemics that have known no borders. In the 90s, we came face to face with HIV/Aids pandemic, which reigned supreme, leaving disaster in its wake.
Exactly 30 years later, we are here facing Covid-19, with uncannily similar challenges save for the epidemiologic distribution. In any medical epidemic or pandemic, it is almost impossible to avoid the creation of stigma.
The panic and fear drives us all to withdraw into our very basic self-preserving mode. This means we focus our fears on a target. With HIV/Aids, the sexual transmission mode came with a connotation that it was a self-inflicted disease. Those suffering were stigmatised, greatly hampering efforts to bring the disease under control. Many feared getting tested because of the stigma they would face for the rest of their lives, should they test positive.
This is a situation that has taken years to correct, but we are not yet out of the woods. The Ebola epidemic saw the same behaviour. The message to the public was that Ebola had no cure, hence the expectation was that patients would die. This made it harder to re-integrate Ebola survivors back into their communities.
As we deal with Covid-19, these challenges remain with us. We saw discrimination all over the world against people such as the Chinese. The discriminatory acts range from the snide remarks made behind their backs to the outright physical violence. Things got worse as Africans were shown on the streets, following a resurgence of cases in China.
Closer home, cases of stigma have been witnessed. The case of the nurse from Kenyatta National Hospital, one of the contacts of a patient who succumbed to Covid-19, facing stigma from his own village mates even after testing negative for the disease. His family was forced into fresh quarantine at his village home despite completing the mandatory two-week quarantine back in Nairobi. Several factors have contributed to the development of stigma.
The manner in which communication regarding the disease had been done has not always been helpful. One key area had been communication on quarantine directives. The directives themselves were not the issue as they are enshrined in the law. The challenge was in the lack of public education on the rationale for these directives as recommended by the World Health Organization (WHO). From the beginning, the directives were accompanied with threats of punishment in case of failure to comply.
WHO recommends that quarantine facilities may include hotels, hostels, dormitories or the contact’s home. Further, that the facility must be spacious, well ventilated and with ensuite sanitary facilities. In the event this is not possible, shared rooms must ensure the beds are well spaced to ensure social distancing. The facility is expected to provide appropriate standard of food, clean water, sanitation, security and medical care where necessary.
Early on, all those travelling home were advised to self-quarantine at home for 14 days. This quickly changed to quarantine in designated facilities. There was no room for home quarantine, even for those who were probably better suited to quarantine themselves. Further, the cost of quarantine in these centres was borne by the travellers and contacts. This had created a massive problem, further compounded by the illogical transformation of quarantine centres into police cells for all those considered to have flouted the public health rules regarding Covid-19 containment.
Another illogical implementation of rules was regarding isolation of all Covid-19-positive people in hospital. This may have made sense when we only had imported cases, but at this point, we are well into community transmission. This practice has long been overtaken by events.
It is critical that the decision-makers listen to the health experts. The Health ministry has technical teams that have the developed well- thought out guidelines regarding management of the disease. These are continually being updated as new evidence on best practice trickles in. These guidelines need to be implemented to the letter.
Earlier on, there had been a call on healthcare workers to get tested for Covid-19. Well, I for one would not get willingly tested if I knew that if I had mild or asymptomatic disease I would end up bundled off to a hospital ward at my own cost because no one believed I had the common sense to self-isolate in my home until I recovered. We are healthcare workers. We are going to be continuously ex-posed to the virus. We will always remain at risk of requiring to be quarantined on and off. It is not sustainable to keep us in paid facilities.
Let's support home quarantine for all. The designated quarantine facilities should be dedicated for those who are unable to self-quarantine at home. A massive public awareness campaign is required to urgently counter the stigmatisation of sick people as this will hinder effective implementation of home quarantine. If we do this, the community will be team players in ensuring those quarantined are complying with regulation to keep us all safe. In addition, there is need to stop the forced quarantine of offenders. When quarantine is not properly implemented, it will transform into a cauldron for incubating additional contamination and dissemination of the disease.
Further, those incarcerated in the quarantine centres have been brought in by the law enforcement agencies who have no technical expertise to implement a quarantine. The law enforcement needs to do its job and let health workers handle public health matters.
Dr Bosire is an obstetrician/gynaecologist