Govt's forced quarantine plans come under scrutiny

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While limitation of rights may occur in the public interest in the context of a pandemic, the SA government's plans forcibly to isolate people who test positive for COVID-19 in government camps, even if they have the means to self-isolate, have come scrutiny in the SA Medical Journal.

Plans to isolate people who test positive for COVID-19 in government camps have been challenged by medical ethicist Dr Jerome Singh, of the Centre for the Aids Programme of Research in South Africa (Caprisa). In order for isolation processes in South Africa to claim legitimacy, it is important that these principles as well as national laws and constitutional rights are embedded in state action, he writes in a critique published in the SA Medical Journal. Separately, Prof Keymanthri Moodley, Director of the Centre for Medical Ethics and Law at Stellenbosch University, writes, also in the SA Medical Journal, that while limitation of rights may occur in the public interest in the context of a pandemic, it is also important that it does not have the paradoxical effect of increasing spread of infection and public risk. To achieve this, " a fair measure of compassion, restraint and respect for human rights" must be exercised.

Times Select reports that Singh questions the decision by the KwaZulu-Natal government to forcibly quarantine people who test positive for COVID-19 at such camps, even in cases where they have the means to self-isolate.

The report says the scientific opinion comes as lobby group AfriForum asked minister of co-operative governance and traditional affairs (Cogta) Nkosazana Dlamini-Zuma to overturn a directive forcing people who test positive for COVID-19 to be held in government quarantine camps. The lobby group has given the government 48 hours to do so, or face legal action. The report says the letter to the minister came after KZN Health MEC Nomagugu Simelane-Zulu said that the provincial government has resolved to discard the policy of self-isolation for people who test positive for COVID-19. Simelane-Zulu said, effective from Sunday, anyone testing positive will be kept and monitored at state-identified quarantine sites.

This policy change, Singh said, marks a dangerous departure from the country’s prevailing position on home-based self-isolation and “should not be replicated elsewhere”.

National Cogta spokesperson Lungi Mtshali said the department had not received the correspondence from AfriForum. The report says later efforts to reach him were unsuccessful.

Singh, who teaches health law and ethics at the University of KwaZulu-Natal (UKZN), said mandatory isolation should be based on a demonstrable threat to public health. “In this regard, the KZN government has provided no corroborating evidence to demonstrate that the spread of COVID-19 in the province is attributable to defaulting self-isolators,” he said.

Singh said the KZN government’s strategy of putting everyone who tests positive for the virus at government quarantine centres unduly burdens those able to responsibly self-isolate and could potentially deprive more needy patients of beds. Thus, it fails the test of distributive justice.

Singh said since community transmission of COVID-19 became established in South Africa, individuals who test positive for COVID-19 and do not require hospitalisation are permitted to self-isolate in their homes to reduce the burden on the health system. He described KZN’s policy as “heavy-handed”, adding that the provincial government has not clarified how it plans to manage the social implications of mandatory isolation.

He argued that the rationale behind forcing people into government camps is flawed, as premier Sihle Zikalala’s stance is premised on suspicions about self-isolating defaulters. “In relevant circumstances, it is undeniably necessary and in the interests of public health to remove an infected individual from their dwelling to safeguard the health of others residing there – say, for example, where all members of the household live in a single-room informal dwelling. However, where an individual is able to self-isolate and does so responsibly, they pose little or no infection risk to others. In such instances, mandatory institutional isolation would be unreasonable and ineffective in containing the spread of COVID-19.”

Less restrictive measures, including intensified counselling, random checks on the self-isolating individual and the levying of penalties for non-compliance, could be introduced to discourage defaulting, Singh said. He suggested that mandatory hospital isolation should be decided on a case-by-case basis, be evidence-based and be reserved for those with the highest probability of poor outcomes.

Abstract
Less than 3 months after the World Health Organization (WHO) declared COVID-19 a Public Health Emergency of International Concern, and within a month of the WHO declaring COVID19 a global pandemic, COVID-19 infections and fatalities have grown exponentially, globally. Now, more than ever, the world needs responsible political leadership, evidence-based decision-making, and co-ordinated global health action.

Authors
J A Singh

Also, researchers at the Centre for Medical Ethics and Law at Stellenbosch University and the School of Public Health and Family Medicine at the University of Cape Town urge adherence to the Siracusa Principles adopted by the UN Economic and Social Council in the transition from voluntary to mandatory isolation.

Prof Keymanthri Moodley, Director of the Centre for Medical Ethics and Law at Stellenbosch University, writes, also in the SA Medical Journal, that while limitation of rights may occur in the public interest in the context of a pandemic, it is also important that it does not have the paradoxical effect of increasing spread of infection and public risk. 

This would be the case if there is fear, intimidation, abuse or victimisation. Under such circumstances the aim of containing the infection will be defeated, as patients avoid testing for fear of what they see as incarceration. This, in turn, may defeat the purpose of the policy and render any rights limitations under the policy unjustifiable. 

While quarantine measures are an accepted containment strategy in public health emergencies, and they may be both legally and ethically justifiable under particular circumstances, a fair measure of compassion, restraint and respect for human rights must accompany them. Such an approach serves to ensure  democratic legitimacy with measures our Bill of Rights envisages as compatible with human dignity, equality and freedom in an open and democratic society. 

Abstract
In the midst of an unprecedented public health crisis, extraordinary containment measures must be implemented. These include both isolation and quarantine, either on a voluntary basis or enforced. In the transition from voluntary to mandatory isolation, conflicts arise at the intersection of ethics, human rights and the law. The Siracusa Principles adopted by the United Nations Economic and Social Council in 1985 and enshrined in international human rights legislation and guidelines specify conditions under which civil liberties may be infringed. In order for isolation processes in South Africa to claim legitimacy, it is important that these principles as well as national laws and constitutional rights are embedded in state action.

Authors
K Moodley, A E Obasa, L London

Full Times Select report

SAMJ abstract

SAMJ abstract


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