SARS control and psychological effects of quarantine, Toronto, Canada
As a transmissible infectious disease, severe acute respiratory syndrome (SARS) was successfully contained globally by instituting widespread quarantine measures. Although these measures were successful in terminating the outbreak in all areas of the world, the adverse effects of quarantine have not previously been determined in a systematic manner. In this hypothesis-generating study supported by a convenience sample drawn in close temporal proximity to the period of quarantine, we examined the psychological effects of quarantine on persons in Toronto, Canada. The 129 quarantined persons who responded to a Web-based survey exhibited a high prevalence of psychological distress. Symptoms of posttraumatic stress disorder (PTSD) and depression were observed in 28.9% and 31.2% of respondents, respectively. Longer durations of quarantine were associated with an increased prevalence of PTSD symptoms. Acquaintance with or direct exposure to someone with a diagnosis of SARS was also associated with PTSD and depressive symptoms.
Severe acute respiratory syndrome (SARS) was contained globally by widespread quarantine measures, measures that had not been invoked to contain an infectious disease in North America for >50 years (1-6). Although quarantine has periodically been used for centuries to contain and control the spread of infectious diseases such as cholera and the plague with some success (1-4, 6-8), the history of invoking quarantine measures is tarnished by threats, generalized fear, lack of understanding, discrimination, economic hardships, and rebellion (1, 3, 4, 6-8).
Quarantine separates persons potentially exposed to an infectious agent (and thus at risk for disease) from the general community. For the greater public good, quarantine may create heavy psychological, emotional, and financial problems for some persons. To be effective, quarantine demands not only that at-risk persons be isolated but also that they follow appropriate infection control measures within their place of quarantine. Reporting on SARS quarantine has focused on ways in which quarantine was implemented and compliance was achieved (1-4, 6-8). Adverse effects on quarantined persons and the ways in which those quarantined can best be supported have not been evaluated. Moreover, little is known about adherence to infection-control measures by persons in quarantine.
Knowledge and understanding of the experiences of quarantined persons are critical to maximize infectious disease containment and minimize the negative effects on those quarantined, their families, and social networks. The objectives of our study were to assess the level of knowledge about quarantine and infection control measures of persons who were placed in quarantine, to explore ways by which these persons received information to evaluate the level of adherence to public health recommendations, and to understand the psychological effect on quarantined persons during the recent SARS outbreaks in Toronto, Canada.
Description of Quarantine in Toronto
During the first and second SARS outbreaks in Toronto, >15,000 persons with an epidemiologic exposure to SARS were instructed to remain in voluntary quarantine (Health Canada, unpub, data). Data on the demographics of the quarantined population were collected but have not yet been analyzed (B. Henry, Toronto Public Health, pers. comm.). Quarantined persons were instructed net to leave their homes or have...
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