Public health measure 3: Quarantine	Study features	Outcomes and findings	Translational steps
Systematic reviews, guidelines
Brooks 2020*^ (rapid review) Mapping to: Acceptability, feasibility and related factors	Outcomes and aim: Psychological impact of quarantine and mitigation Inclusion and exclusion criteria: Included: participants entering quarantine of at least 24 hours, outside hospital setting Types of study and data: Rapid SR; 24 included studies. Surveys (cross‐sectional, longitudinal, other), observations; focus groups and interviews Included disease(s): SARS (14 studies), EVD (5), H1N1 (2), MERS (2), equine influenza (1) Countries included: Taiwan (2), Canada (8), Australia (2), Liberia (2), South Korea (2), China (4), Canada and USA (1), Sierra Leone, Senegal, Hong Kong Quality assessment: 4/9 AMSTAR rating% Funding source: The research was funded by the National Institute for Health Research (NIHR) Health Protection Research Unit in Emergency Preparedness and Response at King’s College London, in partnership with Public Health England, and in collaboration with the University of East Anglia and Newcastle University.	Reported on: Psychological effects of quarantine (health workers, patients (adult and child)) appear substantial and varied, including symptoms of depression, anxiety, PTSD; and may be long‐lived in some. Stressors during quarantine included duration (longer quarantine periods (10 days+) associated with poorer mental health outcomes); fears of infection (particularly in pregnant women or those with young children); frustration, isolation and boredom; inadequate supplies (e.g. food, water, shelter; also regular prescriptions); and inadequate information, such as insufficient or conflicting information about guidelines or quarantine purpose, risk levels, severity of outbreak. Numerous stressors post‐quarantine were reported, including financial losses (related to poor psychological outcomes and socioeconomic distress) and stigma (for both patients and healthcare workers, and in some cases particularly for minority groups within communities). Findings on factors (pre‐quarantine) predicting psychological impact were mixed. Recommendations: Quarantine people for the shortest possible time (based on scientific evidence of incubation times, rather than indefinitely). Provide information (rationale and guidelines for quarantine – what is happening, and why) through clear, consistent communication. Provide adequate supplies, both general and medical. Reduce boredom by providing meaningful activities and ensuring communication with social networks (including support lines). Provide clear lines of communication for those in quarantine, should they develop symptoms (e.g. phone line/online service staffed by health professionals). Consider health professionals as special cases, needing support from both immediate colleagues and organisationally. Public health messages should reinforce the protective, altruistic choice of quarantine/self‐isolation.	Communication purpose: Factors identified here may inform strategies for communicating with and supporting people in quarantine/self‐isolation, in particular to identify information required and channels of communication that may best support people in order to minimise psychological impacts of quarantine. Related to review questions: Findings suggest that lack of information, communication and support may have negative psychological effects that influence acceptability and related factors.
Gomez‐Duran 2020#^ Citation type: SR (rapid) Public health measure: Quarantine Mapping to: Acceptability Mapping to: Theme 3: support for individual and population behavioural changes Theme 6: distancing measures in schools and workplaces	Overview and aim: To investigate the psychological effects of quarantine on healthcare workers (HCWs) in order to better understand the needs and concerns of this group Type of study and data: SR; N = 12 studies; qualitative (3 studies) and quantitative (7 cross‐sectional, 1 observational, 1 prospective). 10/12 related to SARS outbreak, 2/12 EVD Inclusion and exclusion criteria: Included: primary research on HCWs in quarantine; report mental health/psychological outcomes related to quarantine; published in peer‐reviewed journal. No timing or language restrictions Excluded: not primary research, HCWs in quarantine or psychological outcomes Participant features and numbers, sampling details: Sample sizes ranged from 10 to approximately 270 HCWs, often as part of larger sample. Few details of professional role or demographics. Quarantine duration 10 days to 3 weeks Included disease(s): Outbreaks prior to COVID‐19 (included: SARS and EVD) Timing: Search for evidence April 2020 Countries included: Canada (5 studies), China (3), Taiwan (2), Senegal (1), Sweden (1) Most (8/12) studies in high‐income brackets; also middle income (upper‐middle China lower‐middle Senegal) Intervention or phenomenon of interest: Psychological impact of quarantine in HCWs, potential needs and concerns Quality assessment: AMSTAR 5/11 [1. No protocol; 4. Published papers only; 5. No excluded studies list provided; 8. Quality assessed but not closely integrated to findings; 10. no publication bias assessment; 11. no COI for included studies] Funding source: The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not‐for‐profit sectors.	Reported on: Mental health issues: Compared to those not in front line roles, lower mental health functioning was reported after front‐line care and after off‐duty quarantine shifts. In one study, altruistic acceptance of risk was negatively related to post‐traumatic stress symptoms. Quarantine associated with acute stress disorder and with reports of exhaustion, detachment, anxiety, fear of infecting family and stigma from the community due to hospital work. Cross‐sectional studies reported psychological symptoms (including depressive symptoms) 3 years after the SARS outbreak, and this was associated with having been quarantined (i.e. quarantined HCWs represented 19% of the overall sample but 60% of those identified as severely depressed; and those severely depressed were more likely to also be suffering PTSD symptoms and to show signs of alcohol abuse or dependency). Other psychological impacts reported include a correlation between quarantine time and emotional exhaustion, avoidance behaviours and anger; with shorter quarantine duration associated with a lower level of avoidance behaviours. Surveys of HCWs in quarantine indicated high levels of distress; and that following quarantine were more likely to suffer negative consequences such as stigma, avoidant behaviour from others in the community, and greater income losses. Emotional responses: During early days of quarantine, both general public members and HCWs feared being infected, and this was heightened if they experienced symptoms potentially related to infection. HCWs reported fears about becoming infected and fear of infecting others, with their dual roles (HCW, family member) creating internal conflict and leading to guilt, fear, anxiety and remorse. HCWs quarantined at home were concerned this exposed their own family to unnecessary risk. HCWs were particularly worried about infecting vulnerable family members or friends, particularly children; and restricting contact was reportedly more challenging with children in the household. Emotional effects on loved ones were a significant concern of HCWs, who despite being the primary source of information about the disease may also be the main potential source of exposure. HCWs found it difficult to explain the situation to their children; and one study documented those changes to household roles and routines created stress on entire families. HCWs in quarantine also found restrictions on physical and social contact to be physically and psychologically isolating; while colleagues may have shared the same situation and provided social contact and support, many HCWs also expressed concern about understaffing that occurs as a result of quarantined staff. Being monitored may be challenging for HCWs: it may lead to fear of being infected but also conflict with their own perceived ability to determine whether they are infected. Inadequate information: HCWs are more likely than the general public to understand the reasons for quarantine but being a HCW did not influence perceptions of the adequacy of information about home infection control measures. Lack of clear guidelines on minimising infection risk at home and in quarantine leads to frustration, fear of infecting their family and uncertainty about effectively mitigating risk. Poor communication may result in HCWs finding out about their need to quarantine from sources like the media; and lack of transparency about the level of risk for people quarantined can lead them to expect and fear the worst (as in EBV). Better information from authorities and the media to the population as a whole may also help to reduce stigma for HCWs. Financial losses: Financial losses during and after quarantine are a common risk factor for psychological distress amongst the general public, and outcomes may be particularly poor amongst those with lower household income. During Senegal’s EBV outbreak, financial losses were a central issue, with HCWs dependent on their families during quarantine as their jobs were unstable, incomes unpredictable, and they were not paid if not attending the workplace. This was worsened when the HCW was the family’s only income earner. Stigma: Stigma is a common theme. HCWs are typically more aware of infection prevention measures than the general public, and are more likely to experience stigmatisation and rejection by neighbours (than those not quarantined), but the degree to which HCWs experience stigma varies across countries. In some cases stigma leads HCWs to be highly selective about informing people of their status as contacts because others would regard them as infected; in some countries HCWs report little long‐term stigma; in others quarantine of female HCWs led to their husbands or mothers‐in‐law questioning their jobs. Stigmatisation occurred from partners, colleagues, and even in terms of whether HCWs’ children had the right to attend daycare. Generally, HCWs understood stigma to arise from poor understanding of the disease and risk, but also reported feeling angry and hurt, particularly when their children were stigmatised. Adverse reactions reportedly persisted after the end of the outbreak, and many avoided telling others about their jobs as HCWs as a result. Recommendations: Quarantine of HCWs leads to considerable psychological distress, mental health problems, isolation and financial losses, as well as stigma from various sources. Additionally, HCWs experience conflict between professional and family (personal) roles, with many expressing concerns about the impact of quarantine on their family’s safety and well‐being, especially their children. Psychological support for HCWs in and following quarantine is needed; without this, poor psychological effects can persist for years after the outbreak and quarantine period. Quarantine may present the opportunity to deliver psychological support to HCWs who would otherwise be too busy working to engage with these services. Clear, unambiguous information from health authorities and the media are needed to convey accurate information to the public about quarantined HCWs; while accurate, timely information to HCWs undergoing quarantine would assist them to manage uncertainty and consequent effects on their own health and well‐being. Concerns about their family was a common issue for HCWs; providing suitable accommodation to HCWs (outside the family home) may help to lessen the risk to families and alleviate HCWs’ concerns about infection risk.	Communication purpose: Findings may be useful in developing public communication strategies to convey accurate information about quarantine and associated risks. Findings may also inform communication strategies for HCWs in quarantine and help to identify better mechanisms of support. Related to review questions: High levels of distress, fear of infection and poor psychological outcomes are common in the public undergoing quarantine. These same outcomes are also prevalent in HCWs in quarantine, with additional complexity because of their dual role as HCW and family member. Such issues highlight the need for better support and information for HCWs in quarantine. Providing clear, accurate and timely information about disease and quarantine risks to both those undergoing quarantine and the general public may help to mitigate some of the poor outcomes people commonly experience. It may also serve to diminish stigma associated with quarantine by members of the general public and others. Psychological support is needed to help to address some of the poor outcomes experienced by HCWs in quarantine, some of which may be long‐lasting. Quarantine may provide a window of opportunity to intervene and provide support, as otherwise HCWs may be too busy during a disease outbreak. Support for HCWs might also include financial compensation, as financial losses are commonly reported and may increase psychological distress.
Lin 2014* (SR) Mapping to: Adherence Relevant to general PD measures (particularly crowd avoidance/individual PD)	Outcomes and aim: Identification of factors associated with communication inequalities during H1N1 pandemic Inclusion and exclusion criteria: Included: communication with public during H1N1 pandemic, empirical data Excluded: not published in English, French, Italian, Spanish, Chinese or Portuguese; focused on communication between agencies or health professionals, on development of telecommunication strategies, or on public health surveillance or epidemiology; or not related specifically to the H1N1 pandemic in 2009 Type of study and data: SR; 118 included studies Population‐based studies (92/118), studies on information environment; primarily survey‐based (cross‐sectional or other), some interview or focus group‐based Countries included: USA, China, UK main countries Quality assessment: 5/11 AMSTAR rating Funding source: We acknowledge funding support from the U.S. Centers for Disease Control and Prevention (CDC) grant number 5PO1TP000307‐05 Supplement.	Reported on: Several outcomes were reported, including communication outcomes (e.g. information‐seeking, trust and credibility, information use), preparedness outcomes (e.g. knowledge/awareness, preventive behaviours (including physical distancing), potential predictors of communication inequalities (e.g. socioeconomic status, social capital), and information environment (formal versus informal sources). Several factors were identified as predictors of behaviour compliance to preventive recommendations for H1N1, including sociodemographic (age, ethnicity, education), attitudinal (perceived severity of disease) and communication determinants (such as information‐seeking behaviours, knowledge levels, exposure to media). Trust in information source was linked to compliance with NPIs; and trust and credibility substantially affected people’s choice of information source as well as attitude towards the message. Trustworthy information sources included social networks (including physicians), communities and health agencies. Recommendations: Future communication efforts should engage with community leaders, physicians and others including the mass media to ensure that public health messages are accurate, timely and have the greatest possible reach in the community, including amongst more vulnerable groups. That people with higher levels of education were more informed about risks suggests that health communication messages need to be better tailored to those of lower educational levels. Future communication needs to consider identified factors in order to ensure the greatest compliance with preventive measures during a pandemic and to minimise communication inequalities in future pandemics. Findings suggest that younger people, the less educated and those of lower socioeconomic status might reasonably be the focus of future communication efforts in a pandemic as these groups may not know about the risk of disease, may perceive the risk to be low and may therefore be less likely to comply with preventive actions.	Communication purpose: Results may be useful for those planning communication campaigns and seeking to reduce communication inequalities across communities. Factors identified may be useful for developing targeted messages to vulnerable groups, and may inform the medium of communication, as well as the sources of information drawn upon. Related to review questions: Findings suggest that several factors influence community awareness of public health messages related to a pandemic, and this in turn influences compliance with recommended protective measures, including physical distancing measures. Communications intended to inform populations about pandemic disease and preventive measures need to take account of such factors to ensure that communication is as equitable and has as much reach within communities as is possible, in order to mount a consistent preventive response to a pandemic.
Sopory 2021#^ Citation type: SR (QES) Public health measure: Quarantine Mapping to: Acceptability adherence, Mapping to: Theme 1: features of public communication: content, timing and duration, and delivery Theme 2: recipients of public communication: audience, setting and equity Theme 3: support for individual and population behavioural changes	Overview and aim: To examine adherence to quarantine by exploring strategies to influence adherence, identifying barriers and enablers of acceptance and identifying benefits and harms of quarantine Type of study and data: QES; any primary qualitative research. N = 17 included studies (16 qualitative, 1 mixed‐methods with separate qualitative component) Inclusion and exclusion criteria: Included: Published 2001 onwards, English language; qualitative method. Excluded: Documents (e.g. commentary) Participant features and numbers, sampling details: Quarantined population general public (14 studies), healthcare workers (7). Vulnerable populations addressed 5/16 studies Included disease(s): General infectious disease (1 study), EBV (4), influenza (4), SARS (7) Timing: Published evidence sought 2001 onwards. Event year varied across time period 2003 to 2016. Data collection period was pre‐event (4 studies), post‐real event (10), and during a real event (6). Countries included: Canada (6 studies), United States (4), Australia (1), international (1), Taiwan (1), remote First Nations Canada (2), Africa (Liberia) (1), Senegal (1)) 12/17 conducted in high‐income countries. Authors noted that the synthesis was conducted for the US context, and this may have introduced bias weighted towards understanding the phenomenon for high‐, rather than low‐middle‐ income countries. Intervention or phenomenon of interest: Adherence to quarantine Quality assessment: AMSTAR 8/11 [5. No excluded studies listed; 10. Publication bias not assessed; 11. COI of included studies not reported] Re item 1. No protocol or a priori mentioned in published paper but formed part of a larger evidence synthesis report for National Academy so determined scope is implied 2. Duplicate processes confirmed by author response. 4. Extensive searching including grey literature outlined in accompanying report Funding source: Funding for the review was received by Pradeep Sopory and Julie Novak. The review was commissioned by the National Academies of Sciences, Engineering, and Medicine (National Academies) Committee on Evidence‐Based Practices for Public Health Emergency Preparedness and Response (Contract# 20000010696), which was sponsored by the United States Centers for Disease Control and Prevention (CDC).	Reported on: 18 synthesised findings were reported. Quarantine adherence (3 major findings, low‐high confidence): Community‐level impact of quarantine may be more meaningful than individual or abstract information. Agencies should work to understand the local context (e.g. economic status, trust of agencies and government, customs, political history) and work cooperatively with the community’s existing structures and leadership to increase adherence. Public information dissemination from agencies is important to both healthcare workers and the public, and increased adherence during an outbreak. Effective information was persuasive rather than threatening and aimed for two‐way information exchange (rather than one‐way); occurred over the course of the episode; and involved multiple channels (including mass media and interpersonal sources) and multiple sources, including public health and healthcare staff. Effective information included disease and quarantine information, including rationale for quarantine; avoided technical language; avoided arousing fear or anxiety and was not stigmatising; and included clear, consistent information about infection control and coping methods. To increase adherence to quarantine, agencies can focus on care (i.e. expressing concerns, providing support), rather than control/enforcement of restrictions. Quarantine adherence facilitators/acceptance (2 main findings, moderate ‐high confidence): Adherence was facilitated by agencies understanding that multiple actors (agencies, jurisdictions) were required to work co‐operatively to plan and implement quarantine. This included recognising that planning to scale up operations would be needed during an outbreak. Generally, the public, including vulnerable groups (e.g. those who are homeless) accepts the concept of quarantine as part of the outbreak response, for several reasons: sense of duty, civic‐mindedness and ethical concerns for the situation. Quarantine may be effective when people voluntarily comply, rather than because of legal enforcement. Quarantine acceptance (4 main findings, high confidence). Restrictions may be more acceptable to people undertaking quarantine when there is: Financial compensation for lost work, including partial/full income replacement (during quarantine), assurance of job security and economic recovery (at end of quarantine) and payment for housing and utilities. Provision of food and other essential supplies (by government, agencies, community groups or others), and that dietary requirements and preferences of those in quarantine were met. Provision of professional social support in the form of a new or pre‐existing general confidential hotline giving access to professional counselling. Provision of mobile phones to people without access to one was also needed. Reasonable flexibility in rules and procedures to accommodate the needs of the situation and the people in quarantine e.g. changes to policies for tobacco and alcohol use, leaving quarantine to get supplies or to work. Quarantine in this light is a nuanced measure, dependent on context. Harms of quarantine restrictions (4 main findings, high confidence): People undertaking quarantine may experience financial instability. Quarantine may be initiated with little advance notice, which may affect employment status, and, in the absence of compensation, suffer loss of wages or other income. This situation was particularly severe for those who worked part‐time, casually or were self‐employed. Social isolation is a salient harm of quarantine, leading to feelings of both physical and psychological isolation which were exacerbated by others’ physical distancing (e.g. family, friends, neighbours). People in quarantine experience social stigma as a harm, being publicly labelled as disease carriers, leading to mistrust, fear and avoidance by other people that extended beyond the quarantine period. Stigma was worsened when people quarantined were from marginalised groups. People in quarantine may experience many negative effects including heightened anxiety, fear, worry, stress and loneliness, due to financial stress, social isolation, stigma and risk of infecting others. Healthcare workers in quarantine experience similar harms to the general public, but these may be amplified (e.g. stronger negative psychological states due to the possibility of infecting patients in their care while infectious; worry about leaving colleagues overworked and understaffed). ‘Work quarantine,’ where essential workers must continue to care for infected patients, led to even greater anxiety and also led to resentment and conflict with non‐essential co‐workers put under quarantine at home. Quarantine and vulnerable groups (1 finding, high confidence): There should be recognition and acceptance that imposing quarantine on vulnerable groups (e.g. poor, homeless) requires greater modification of standard processes and organisers should be aware that greater harms are possible. Such groups have different needs to the general public, and policies may need to be more flexible to meet these needs. Harms such as financial, psychological and social harms may also be more pronounced. Recommendations: Findings were used to develop a conceptual framework, outlining topics for considerations in situations where quarantine may be implemented to curb disease outbreak. These may help to improve acceptance and adherence to quarantine in particular. Findings indicate two major sets of communication activities to be undertaken related to the topics identified: communication within and across agencies and organisations related to the coordination of quarantine activities, and communication of information about quarantine to the general public. Quarantine is controversial and relies on the public understanding the benefits as well as risks and potential harms. These need to be effectively communicated to the public by the agencies involved in planning and implementing the restrictions. When planning and implementing quarantine, vulnerable groups within the population such as the poor or marginalised, may need additional protections. Such groups may be more at risk of harms, or the harms may be more severe – such as financial hardships that are worsened by being required to quarantine, and/or the need to safeguard civil rights of vulnerable groups.	Communication purpose: Findings may inform development of communication strategies to provide information to the public about quarantine restrictions. Related to review questions: Information about quarantine is important to both the general public and to healthcare workers, and effective communication from agencies, tailored to local context and undertaken co‐operatively with local structures and leadership, is needed to promote acceptance and adherence to quarantine measures. Effective information and communication might best involve two‐way dialogue with the community, happen over the course of the disease outbreak, and involve multiple channels and sources. Information should be clear and accessible, non‐stigmatising or inflammatory, and include a rationale for the quarantine measures as well as information on the process and supports available for people. Recognition of the supports needed for the public undertaking quarantine is needed, alongside particular awareness of heightened risks of harms of quarantine in vulnerable groups is needed. Acceptance of quarantine may be greater, and harms minimised, where people’s needs are met, including financial compensation, food and essential supplies, and social support, and that there is some flexibility in the system to accommodate particular needs.
Webster 2020#^ (rapid review) Mapping to: Adherence	Outcome and aim: To identify factors affecting adherence to quarantine during disease outbreaks Inclusion and exclusion criteria: Included: participants entering quarantine of at least 24 hours, outside hospital setting. Studies reporting primary research, published in English or French, reporting factors associated with or reasons for (non)‐adherence outcomes Type of study and data: Rapid SR; 14 included studies. Surveys (cross‐sectional), retrospective cohort, interviews, focus groups Included disease(s): H1N1 (5 studies), EVD (3), SARS (5), mumps (1) Quarantine varied: Home quarantine (up to 14 days), EVD studies included restriction of movements (1 month), check‐ups and social distancing (21 days), state‐enforced home and neighbourhood quarantine (21 days). Countries included: Australia (5), Canada (3), Senegal, Liberia, Sierra Leone, Germany, Taiwan, USA Quality assessment: 5/11 AMSTAR rating Funding source: The research was funded by the National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Emergency Preparedness and Response at King's College London in partnership with Public Health England (PHE), in collaboration with the University of East Anglia and Newcastle University.	Reported on: Adherence to quarantine varied dramatically: across eight studies, estimates ranged from 0% compliance (home quarantine 10‐14 days, SARS, Taiwan) to 93% (home quarantine 7 days, H1N1, Australia). Voluntary quarantine adherence depends on a number of practical and psychological factors. Those most often reported were People’s knowledge about the outbreak and about the quarantine protocol (knowing why (rationale for), and what, to do); Social norms (e.g. social pressure to adhere, sense of altruism for adhering to voluntary measures); Perceived benefits of quarantine (such as preventing transmission to others, especially those at higher risk); Perceived risk of the disease (in terms of transmission and severity of the disease); Practical issues associated with being quarantined (such as loss of income, lack of supplies or medical care). These factors have also been associated with adherence to other protective measures, such as crowd avoidance. Recommendations: To increase adherence to quarantine protocols, public health officials should provide: A clear and timely rational for the measures; Clear information about the steps required (quarantine protocol); Clear messages reinforcing social norms and promoting the behaviour as altruistic; Clear messages that emphasise both the importance and benefits of quarantine for public health; Sufficient supplies and assistance for those financially impacted by undergoing quarantine.	Communication purpose: Results may inform decisions about main information messages to communicate to populations and individuals being asked to quarantine. Related to review questions: Findings indicate that several factors influence adherence to quarantine measures. Consideration of these factors should inform public health communications related to quarantine.
WHO 2021b# Citation type: GL (interim advice) Considerations for quarantine of contacts of COVID-19 cases: WHO interim guidance June 2021 Public health measure: Quarantine Mapping to: Acceptability, adherence Mapping to: Theme 1: features of public communication: content, timing and duration, and delivery Theme 3: support for individual and population behavioural changes Theme 4: community engagement to support communication	Overview and aim: Updated advice on implementation of quarantine for contacts of COVID‐19 cases, including provision of support for people under quarantine Type of study and data: GL (interim advice); based on review of evidence and informed by experiences from Member States Included disease(s): COVID‐19 Timing: Guidance refers to importance of early communication with the public about quarantine (i.e. prior to implementation), including engagement with communities at early stages to help improve acceptability of quarantine. The importance of communicating with those undertaking quarantine at the beginning of their confinement is also emphasised. Countries included: N/A, developed by WHO, across‐country application Intervention or phenomenon of interest: Quarantine implementation and communication with those involved Quality assessment: AGREE II scope and purpose 63.9%; stakeholder involvement 38.89%; rigour of development 8.3%; clarity of presentation 77.78%; applicability 22.92%; editorial independence 0% Funding source: Not reported	Reported on: Core public health and social responses are needed to break COVID‐19 transmission chains; three essential components are needed in every national response: 1. Identification, isolation, testing and clinical care for cases; 2. Tracing and supported quarantine for contacts; and 3. Promoting physical distancing, together with respiratory hygiene, hand hygiene, mask‐wearing and improved ventilation of indoor spaces. Prolonged absence from economic and social activities is challenging for most people and this is likely to affect people’s adherence to quarantine measures. Balancing the public health risks and benefits against social and economic impacts is therefore essential. Prior to implementing quarantine, authorities should communicate with the public about why the measure is needed and provide support to people so that they are able to quarantine safely. Authorities should provide clear, up‐to‐date, consistent and transparent guidance and reliable information about quarantine measures. Constructive community engagement is key to promoting acceptability of quarantine within the community. Since a range of cultural, geographic and economic factors influence acceptability and adherence to quarantine, the local context should be considered and potential barriers and enablers to quarantine identified and used to inform planning for the most appropriate and acceptable measures to be enacted. Authorities should communicate with people undertaking quarantine in a language understandable to the quarantined individuals, and include clear explanation of their rights, services available, the duration of quarantine and what will happen should they become ill; and if needed, provide contact information for their local embassy or consular support. Support is needed for people undertaking quarantine, whether quarantine is undertaken in a dedicated facility or at home. Support includes access to essential supplies (adequate food, water, protection, hygiene) for the person undertaking quarantine and for household members and children who are in their care; financial, social and psychosocial support; provision for communication including access to education for children who need to be quarantined, and paid leave or remote work arrangements for jobs; protection; and access to health monitoring and healthcare over the course of the quarantine period, including care for existing conditions. The needs of people from vulnerable groups should be prioritised. Facilities for quarantine should be disability inclusive and consider the needs of women and children. Authorities should avoid separating families and balance the child’s welfare against the risk of COVID‐19 transmission within the family. If the child is the contact requiring quarantine, the child should be quarantined at home in the care of a parent or other caregivers; where this is not possible, children should be quarantined in the household of another family member or caregiver who is at low risk of severe COVID‐19. Even if an adult is the contact, they should be kept together with the child (including supporting women who are breastfeeding infants). If home quarantine is not possible, children should be quarantined and cared for in child‐friendly facilities, taking into account their needs, safety and their physical and mental well‐being; and, if at all possible, with a carer or other family member to stay with them or visit daily. Settings expecting to host children (particularly those without caregivers) must provide trained staff to provide a safe, caring and stimulating environment that provides for the child’s psychosocial and educational needs. Children’s health should be monitored by those trained to recognise COVID‐19 symptoms in children, and referral pathways for medical care or urgent assistance be established ahead of time. Training and communication for infection control practices (IPC) are needed within quarantine facilities, including: educating all people quarantined about IPC upon arrival and over the course of quarantine; training personnel on IPC measures before they are implemented; educating quarantined people and personnel about the importance of promptly seeking medical care should they develop symptoms; and having in place policies and procedures to support early recognition and referral of suspected COVID‐19 cases.   Recommendations: People undertaking quarantine need clear, accessible information about why the measure is needed and what is involved, as well as a range of support to enable them to undertake quarantine safely and to adhere to the restrictions during the quarantine period.	Communication purpose: Guidance may be useful when considering communication with the public and with individuals in relation to quarantine. Related to review questions: Clear communication and information, together with community engagement, are needed prior to implementation of quarantine. This may improve acceptability and adherence to the measures. Provision of the range of supports identified may enable people to adhere to quarantine measures safely and to mitigate the economic and social risks of doing so.
Primary studies
Zhu 2020# (primary) Mapping to: Uptake. Relevant to general awareness of measures required (crowd avoidance)	Overview and aim: Public attention to a disease outbreak can be captured by social media posts, where awareness and attentiveness have implications for acceptance and adoption of prevention and control measures. Inclusion and exclusion criteria: Included: randomly sampled accounts of Weiboscope database, a nationally representative sample of the Weibo user population Timing: Between December 31, 2019, and February 12, 2020 Type of study and data: Longitudinal analysis of posts from cohort (52,268 randomly sampled accounts) of Weiboscope database Countries included: China Disease(s) included: Cohort’s posts were searched for COVID‐19‐related keywords and a daily percentage calculated (no. COVID‐related posts/no. total daily posts) Quality assessment: Response rate: + Representativeness: +++ Authors declared no COI; possibility of Internet censorship in China, sample included only one of several social media platforms; paper published (peer reviewed)	Reported on: Percentage of daily posts related to COVID‐19 from the sampled cohort Considered against major COVID‐related Chinese events, there was limited evidence of attention to the outbreak prior to January 20th (human‐to‐human transmission acknowledged and initiation of nationwide reporting in China began). Rapid increase in attention to the outbreak occurred after this date, with attention remaining high and particular peaks in posts after major events (e.g. Wuhan quarantine initiated). Recommendations: Adoption of personal protective behaviours is related to trust in government. Citizen’s awareness of outbreak severity at an early stage might increase acceptance and adherence with prevention and control measures such as large‐scale physical distancing measures. Governments might proactively communicate early warnings of disease outbreaks to the public in order to engage people earlier in control and prevention measures.	Communication purpose: Might inform decisions about timing of communication of outbreak information to communities and populations, where earlier awareness might promote better engagement with required physical distancing measures. Related to review questions: Findings suggest that lack of outbreak awareness creates missed opportunities for the public to take up preventive and control measures.