Analysis: Late And Leaky. How The UK Failed To Impose An Effective Quarantine System

The government issued a public appeal on Sunday, to trace someone who has been infected with a coronavirus variant first identified in the Brazilian city of Manaus. The unidentified person failed to properly fill out a test registration card, meaning British authorities had no idea who, or where, they are.

They are one of six cases infected with the variant, known as P1, which studies suggest has mutations that make it more transmissible and able to evade immunity from previous coronavirus infection and possibly vaccines.

Direct flights from Brazil to the UK were banned in January, but two cases of the variant have been traced to a family who returned from Brazil on February 10. They are believed to have traveled on a Swiss Air flight from Sao Paulo, via Zurich, to London Heathrow.

Critics who warned that the government’s failure to clamp down on indirect flights from high-risk countries like Brazil would make it easier for variants to spread in the UK have been vindicated.

“It demonstrates the slowness of the government to close off even the major routes, but also the unwillingness to confront the fact that the virus doesn’t travel by direct flights,” opposition Labour party leader Keir Starmer told a virtual meeting on Monday, according to PA Media.

To further prevent the arrival of new variants and control coronavirus case numbers, the government announced its 10-day hotel quarantine plan in January, but it was not implemented until February 15, just days before the indirect Swiss Air flight from Brazil landed — and months after health experts had called for such a program to be introduced.

Johnson defended his government’s policies on Monday, saying the UK had “one of the toughest border regimes anywhere in the world for stopping people coming in to this country who may have variants of concern.”

At a press conference later that day, Health Secretary Matt Hancock said all the evidence showed that five of the known cases had followed prior quarantine rules that required them to isolate at home, and that no knock-on transmissions had been caused by the missing case.

But the long-overdue hotel quarantine measures are half-baked, Dr. Gabriel Scally, president of epidemiology and public health at the Royal Society of Medicine, told CNN.

The UK’s hotel quarantine rules apply to people returning from 33 “red list travel ban” countries, where variants of concern identified in Brazil and South Africa are believed to be spreading. The ban also includes nations with strong travel links to those countries.

But Scally argues that this is insufficient: “It should be all countries — even now we are half doing it.”

He pointed out that the US, which has one of the world’s highest daily rates of reported Covid-19 cases per 100,000 people, is not on the list. “If you build quarantine measures, you either do it properly or not at all,” he said.

This was also pointed out by Dr. Catherine Bennett, epidemiology chair at Australia’s Deakin University when speaking to a cross-party parliamentary group on Covid-19 [APPG] last week. Bennett said the measures surrounding the UK’s quarantine hotels were incomplete, highlighting that the UK rules allow people to leave their rooms to exercise, visit a dying family member or attend a funeral. The isolation period is also 10 days — contrary to international standards.

“If there are too many holes in the sieve, then why bother with the sieve?” Bennett asked, explaining that the UK needs to either have a “hard commitment at something to make it work or pull back” and just rely on its Covid-19 surveillance systems.

Slow off the mark

The British government procrastinated from the very start of the pandemic. Even as the movement of people came to a virtual standstill worldwide, the UK’s borders remained open to all.

Analysis by the Pew Research Center in April 2020 found that 91% of the world’s population was living in places that had imposed travel restrictions related to Covid-19 — but those figures did not include the UK.

The British government did not order inbound travel restrictions until June, at which point it ordered all international arrivals to self-isolate for two weeks, at a location of their choice.

But the following month it dropped those self-isolation restrictions for people arriving from more than 50 countries with low infection rates.

The summer travel season led to the import of a Covid-19 variant first identified in Spain, which became the dominant variant in the UK by the fall of 2020, Scally said.

And in December, just weeks before the country’s worst wave of the pandemic began, the two-week self-isolation period for international arrivals was cut to 10 days.

Then the hotel quarantine plan took weeks to implement, seeing the arrival of the Brazil variant just days before its launch.

Scally believes that instead of talking to New Zealand, Taiwan or Australia, all of which have been revered for their pandemic response and have nearly a year’s experience of border restrictions and hotel quarantine measures designed to combat Covid-19, the UK has created another leaky system that needs a rethink.

For example, many countries in the Asia-Pacific region have remained off-limits to all travelers except for returning citizens and residents. Australia caps weekly international arrivals of Australians and residents at around 4,000.

In sharp contrast, the UK sees up to 15,000 people enter the country on any given day, one third of whom are hauliers and another third of whom are British citizens, Paul Lincoln, director of the Home Office’s Border Force, told the Home Affairs Committee last week.

Only 150 of those — just 1% of that figure — go into quarantine hotels, Yvette Cooper, Labour Party lawmaker who chairs the committee, said on Twitter last week. The “majority can still go straight onto public transport home without being tested on arrival,” she said.

Tennis stars like Novak Djokovic had to undergo Australia's two week quarantine ahead of the Australian Open tennis tournament in Melbourne.

Australia has also blocked its own citizens from leaving the country and people in quarantine are strictly forbidden from leaving their hotel rooms during the two-week period.

In Singapore, where similar quarantine rules are in place, a British man is facing six months in prison, or a fine of more than $7,500, for leaving his room to visit his fiancée, who was staying in the same hotel.

“I wish the UK would look at and model successful countries more — and have been wishing that since February 2020,” Dr. Tim Colbourn, associate professor of global health epidemiology at the University College London, told CNN.

Dithering and delays in introducing restrictions and lockdowns “has made all the difference between low and manageable cases, and overwhelmed hospitals” in the UK in the past year, Colbourn said, adding that earlier lockdowns could have saved tens of thousands of people.

A better blueprint

The systems in Australia and Singapore are not faultless.

A spike in Covid-19 cases in April 2020 saw Singapore seal migrant workers off in their dormitories, but case numbers continued to climb as the cramped living quarters made it near impossible for those inside to socially distance. The move, which shone a light on the plight of the poorly-paid South Asian workers, sparked outrage.

In Australia, a coronavirus outbreak that began in Melbourne last July was reportedly caused by a hotel staff member, who is presumed to have picked it the virus from a returning traveler.

Australia has learned from some of its failures. Meal times at quarantine hotels are now staggered, after two separate groups of guests living in adjacent rooms in a Melbourne hotel were infected with a variant first identified in the UK, known as B.1117.

Authorities think the virus spread when both guests opened their doors at the same time, allowing the virus to spill out following high concentrations in one of the rooms. “The viral load in the room of the family of five … was so high that just even opening the door to pick up your food has seen the virus get into the corridor,” Victoria’s Police Minister Lisa Neville said in a February press conference.

There are now calls to move Australia’s hotel quarantine program out of cities and into more sparsely populated areas.

Australia’s states also changed their approach, of allowing Australian-based flight crews to quarantine at home, after a spate of infections were linked to crew members.

But experts say Australia’s success in containing the pandemic is partly a product of its geography, as an island nation that can easily close its borders.

The same is true of Singapore, which has a considerably smaller population than the UK, and which has stopped border traffic to all except commercial vehicles on the causeway linking it with Malaysia due to the pandemic.

What both Singapore and Australia also have is political will. It is still unclear if a year of lessons learned by Australian officials is being taken seriously by their British counterparts and in the meantime, cases continue to spread and the threat of new variants looms, with international travel expected to increase this summer.

Too many cases

Many countries in the Asia-Pacific region are trying to maintain zero Covid-19 cases within their borders.

The UK government has instead emphasized the importance of learning to live with the virus, simply accepting that a certain level of cases will continue to circulate in the community.

On Tuesday, the UK recorded 6,391 new cases, while Australia recorded seven new cases — all of which occurred within the hotel quarantine system — on the same day. And the Australian government says its borders will remain closed for another three months, showing that it’s not backing down despite the low number of cases there.

High case numbers in the community require an effective track-and-trace system to be in place. The UK has scaled up its Covid-19 testing and contact-tracing system following widely reported failures last spring, but gaps in the process remain — including the one that led to officials making a public appeal to trace the missing case of the P1 variant, which critics say highlights sloppy data collection standards.

UK guidance also does not recommend testing of a positive case’s close contacts, in contrast to guidance in the US and Europe, said Scally.

“All the way along the pandemic, the government has not taken this stuff seriously: They don’t take making schools safe seriously; they don’t take quarantine seriously; they don’t take test and trace seriously,” he said. “I am sure this is why the UK has done so badly.”

The UK’s immunization campaign, one of the fastest in the world, has provided some respite, say experts, as has the hope that reformulated vaccines, providing increased immunity against variants, could be available by this fall.

The country is also a world leader in sequencing the Covid-19 genome, which is crucial in analyzing the spread of new variants.

But while it is “amazing” that Britain is sequencing 25,000 positive Covid-19 cases a week, Colbourn believes it would be better to get weekly case numbers below that figure in the first place.