JOURNAL LA SOCIALE
VOL. 01, ISSUE 03 (010-023), 2020
DOI: 10.37899/journal-la-sociale.v1i3.128

Reviewing the Insights of Confinement and Social Distancing as Measures
Involved in the Prevention of the COVID-19 Pandemic
Georges Pius Kamsu Moyo⃰, Dany Hermann Ngwanou,
Daniel Armand Tague Kago, Nelly Kamgaing,
Ginette Claude Mireille Kalla, Andreas Chiabi,
Paul Olivier Koki Ndombo
Faculty of Medicine and Biomedical Sciences, The University of Yaoundé I, Yaoundé,
Cameroon
Corresponding Author: Georges Pius Kamsu Moyo
Email: kamsuzicfried@yahoo.fr
Telp: (+237) 690206817
Article Info

Abstract

Article history:
Received 20 August 2020
Received in revised form 31
August 2020
Accepted 1 September 2020

Confinement and social distancing have been widely used in the
prevention of the COVID-19 pandemic, as interventions consisting in
reducing physical contact between individuals to prevent the spread of
the disease. In order to demonstrate the pattern of these measures, we
did a review of pertinent articles on the subject available online. We
found that though confinement and social distancing significantly
contributed to the mitigation of the COVID-19 infection in a number of
countries worldwide, there however exist a dilemma in choosing
between the expected benefits and adverse effects, especially when
applied on a large scale. Thus considerations with regards to socioanthropological and politico-economic impacts should be considered in
order to protect citizens, especially the vulnerable. Besides, population
information, education and communication helps to increase adherence
and observation of recommendations. However, further improvements
need to be implemented in other to render these measures more bearable
and less restrictive while ameliorating their efficacy.

Keywords:
Confinement
Social Distancing
COVID-19

Introduction
As of March 2020, the COVID-19 infection had claimed more than 20.000 lives in the world,
with a case fatality rate close to 0.6-3.5% (Kraemer et al., 2020; Wu & McGoogan, 2020).
After the intensification of the pandemic, the World Health Organization urged governments
of all nations to consider the control of the disease within their boundaries as a top priority
(WHO, 2020). As a matter of fact, public health authorities from all parts of the world had to
make sure decision makers are aware, understand and consider the pandemic (Mark et al.,
2020). Several optimal nation-wide medical, social, economic and political interventions have
been undertaken to curb the COVID-19 pandemic, trying to eradicate the virus, while
preserving human lives as much as possible (Kissler et al., 2020). Considerable advances in
various research areas have been reported as well, in a myriad of aspects since the beginning
of the crisis. Apart from the timing of intensive preventive measures reported in a number of
studies conducted in China, the relative low prevalence of the epidemic in Africa prompted the
development of further theories over the determinants of the disease’s spread (Kissler et al.,
2020).
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The influence of climatic factors and seasonal influences have been evoked, just as genetic and
immunological make-up, probably associated with a lower average age of the population,
reduced life expectancy and life-span (Kraemer et al., 2020; WHO, 2020; Kissler et al., 2020).
On the other hand, some apostolic and spiritual-end hypotheses about the outbreak diverge
from predictions on divine justice over mankind’s evil acts calling for a change from perverted
lifestyle, to apocalyptical predictions of the end of the world, calling for repentance (Curtis,
2020).
Whereas, from the scientific stand point, COVID-19 revealed once more the complex
interconnectivity between the human organ systems as a whole and pathophysiological
processes, as well as the flexibility of pharmacological concepts with major antimalarial drugs
used for curing a viral infection, beside the necessity for palliative or supportive care in
critically-ill patients (Zhang et al., 2020). Nevertheless, experience from the strongest leading
nations such as the USA, China and Italy taught the world COVID-19 could lead to
overwhelming of healthcare capacities of countries having highest resources, with infected
people dying at home without being attended to (Moore & June, 2020; Winfield, 2020; AP
News, 2020). Indeed, in some cases, because of medical staff and equipment shortage, the
increased demand for respiratory assistance, hospitals for patients’ isolation, and protection
material, exceeded capacities, causing healthcare burden due to difficulties to handle the excess
demands (Kraemer, 2020; Moore & June, 2020; Winfield, 2020; AP News, 2020). This in
addition to the necessity to care for other patients having nothing to do with the epidemic, while
protecting the staff and visitors from contamination (Heymann et al., 2013). Though drastic
control measures substantially led to mitigation of the epidemic several months after in China,
the said measures could not be integrally replicated in all nations worldwide due to varying
parameters including Socio-anthropological and politico-economic factors mainly (Kraemer,
et al., 2020; Kissler et al., 2020; Hawryluck, 2004). In a number of countries, these
determinants were responsible for the deviation from ideal public health policies, causing on
one hand differences as far the nature, the intensity and duration of preventive measures are
concerned, and on the other hand subsequent variability in the dynamics of the disease
transmission and spread [Kraemer et al, 2020; Kissler et al., 2020). Given that only 15%
patients manifest severe forms of the disease, while less than 5% develop critical forms, it
seemed more beneficial to admit such patients, meanwhile those with milder forms, not
requiring critical care would be followed-up at home while being confined (Wu & McGoogan,
2020; Mead, K., & Johnson, 2004; Hauser et al., 2020; Verity 2020). Thus among various
preventive measures in the prevention of COVID-19, confinement and social distancing though
subjected to contextual modifications appear to be the most commonly used intervention to
reduce the peak intensity of the pandemic thereby flattening the curve. These interventions
permit to reduce the risk of overwhelming health systems and buys time for the development
of efficient treatments or vaccines (Verity 2020). The rationale of this measure is founded on
the fact that the virus to which Newton’s laws of gravity apply as well because of its size,
cannot remain suspended in the atmosphere and so relies on physical contact and human
mobility for its dissemination and transmission (Kraemer, 2020). Therefore, restricting human
mobility through confinement and social or physical distancing automatically breaks the chain
of transmission. Nevertheless, confinement measures are best implemented when resources for
populations’ support and accompanying measures such as logistic, nutritional, financial, and
psychological assistance are provided especially during large scale or community-wide
confinement (Anderson et al., 2020).
Background

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Social distancing in reality refers to physical distancing and may be better understood as such,
in order to preserve social interactions. This is a group of actions including confinement
measures (quarantine and isolation), mask wearing, forbidden handshaking and prohibited
mass gathering, to prevent the transmission of a highly contagious disease, thereby reducing
pressure on healthcare services [Anderson et al., 2020; ECDC, 2020). They are drastic
measures which had no more been used to contain infectious diseases for more than fifty years
before the recurrence of the Severe Acute Respiratory Syndrome (SARS) in 2003 (Risse, 1992;
Twu et al., 2003; Toronto Public Health. 2003; Barbera, 2001).
Although they had periodically and successfully been used for centuries to control diseases
such as cholera and plague, especially in travelers (Risse, 1992; Twu et al., 2003; Centers for
Disease Control and Prevention (CDC), 2003; Mandavilli, 2003; Toronto Public Health, 2003;
Barbera et al., 2001; Markel, 1995; Markel, 1993).
In effect, the mobility parameter "to have visited Wuhan in China" was seriously taken into
account at the beginning of the COVID-19 epidemic for the "definition of cases". This was
however gradually abandoned as the epidemic progressed to a global dimension, becoming a
pandemic. But yet, motion restriction remained a pertinent aspect for the control of the
epidemic, as human mobility seems to predict the magnitude of spread (Kraemer et al., 2020).
Confinement may be adopted at various levels, varying from home quarantine indicated for
contact persons assimilated to asymptomatic carriers of the infection, to hospital isolation for
ill individuals. Whereas, the mobility restriction of citizens within cities and countries
corresponds to community-wide confinement. Although there is no evidence that confinement
and social distancing have led to the termination of an epidemic, it has however been shown
that travel restriction, isolation and quarantine are particularly useful as confinement measures
in the management of the early stage of an epidemic outbreak, especially when delimitated to
the epicentre (Kraemer et al., 2020, Jones & Carver, 2020).
While most high-income countries, opted for a total confinement approach with enough
accompanying measures for citizens during the COVID-19, other governments mainly from
middle and low-income countries opted for a “semi-confinement” approach. This consisted in
appealing citizens to stay at home as much as possible, prohibiting mass gathering, crowding
avoidance, and the closure of related environments including schools, bars, leisure and sports
places (European Centre for Disease Prevention and Control, 2020). However, for all forms of
confinement, barrier measures including face masks wearing, frequent handwashing, and social
distancing including forbidden handshaking, one to two meters distancing between persons
were strictly recommended (European Centre for Disease Prevention and Control, 2020).
Nonetheless, Confinement and social distancing are however considered useless when the
epidemic is widespread, given that community-borne immunity may soon be reached.
Moreover, the dilemma of choosing between the expected benefits of confinement and its
negative impact on freedom of movement, economy and socialization are as well important
issues to deal with (Kraemer, 2020).
Quarantine
Quarantine may be defined as the restriction of persons exposed to a contagious disease but not
manifesting signs nor symptoms (asymptomatic carriers), in order to prevent dissemination
(Hawryluck et al., 2004; Anderson et al., 2020). It basically consists in separating individuals
potentially exposed to an infection, and thus at risk for a disease, from the general community
for the good of the majority (Hawryluck et al., 2004). Etymologically, quarantine originates
from the 14th century during the prevention of plague, when infected-ships were forced to sit
at anchor for a “quar-antine” to mean “forty-days” observation before disembarking
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(Hawryluck et al., 2004). Although its scientific basis has been reinforced with time, there
however exist an associated historical stigma causing apprehensions due to the connotation of
“sacrificing a few to save the majority” (Cetron & Simone, 2004). The goal here is to suppress
the exponential spread of the disease beyond care giving capacities, to a manageable proportion
relatively easier to handle. The recommendation of quarantine restriction may be voluntary or
mandatory according to the pathogen’s infectivity, virulence and other environmental or human
factors (Hawryluck et al., 2004; Anderson et al., 2020). Community-wide quarantine refers to
the closing of community borders or the erection of real or virtual barriers also known as
“cordon sanitaire” around a geographic area (Kraemer et al., 2020). Quarantine restriction is
generally time-limited and short lasting according to factors of pathogenicity such as the
pathogen’s life cycle, its life span, mode of transmission, and the incubation period. The
duration of quarantine was changed from 40 to 14 days, based on the incubation periods of
diseases for which quarantine is recommended, as provided by the Public Health Service Act
in the USA for instance (Anderson et al., 2020). Quarantine is one of the most feared and
misunderstood, but effective method for controlling communicable disease outbreaks. It has
been noticed that in a context of good information and communication over the necessity for
people be on quarantine, more than 99.9% adhere to the recommendation (Anderson et al.,
2020). In effect in a study conducted in the USA to assess the acceptation of quarantine, only
22 people out of 30000 expressed oppositions, requiring mandatory detainment (Kennedy &
Hamilton, 1997). Home quarantine is generally preferable and should be favoured as much as
possible, just as voluntary quarantine should prevail over mandatory quarantine. Furthermore,
the success of quarantine requires that individuals involved continue to be closely monitored
with appropriate control measures within their place of quarantine, including regular
temperature measurement at least twice daily (Anderson et al., 2020). It is recommended that
health authorities should be notified at the earliest onset of signs and/or symptoms in
quarantined persons, so as to enable their extraction and separation from others who are well
(Hawryluck, 2004). Being on quarantine may create heavy psychological and financial
repercussions in some persons, and so most public health policies advocate psychological
support, food, water, household and medical supplies should be provided as accompanying
measures (Anderson et al., 2020).
Isolation
Isolation may be described as the separation of ill persons affected with a particular disease,
generally a contagious one, to either preserve non-affected individuals and/or favour the
recovery of the patients. Contact isolation may as well be indicated for patients with multidrugresistant pathogens such as Methicillin-Resistant Staphylococcus Aureus (MRSA) (Abad et al.,
2020). If not for the facts that isolation is meant for ill persons, and implemented with more
rigor, with duration determined by the patient’s recovery, it may be confused with quarantine
and both terms falsely used interchangeably according to various contexts. A review of studies
on the adverse effects of isolation in patients revealed a negative impact on mental wellbeing
and behaviour, including higher scores for depression, anxiety, and anger (Stelfox et al., 2003;
Hollenbeck et al., 1980). The reasons behind the negative effects of isolation probably stem
from related feelings of uncertainty and loss of control reported in patients (Catalano et al.,
2003; Gammon, 1998). A number of researchers suggest prior psychological preparation
through education and information is necessary to decrease adverse effects in such patients as
they better understand the essence of the process and cope with it (Holland et al., 1977;
Knowles, 1993). During isolation, various dimensions of patients’ care may be altered as well,
mainly due to the fact that healthcare workers might spend less time in caring for isolated
patients, this in line with formal or institutional recommendations, or because of an exaggerated
fear of being contaminated. Furthermore, the use of gowns and special gloves could impede
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examination, manipulations, and be stigmatizing (Saint et al., 2003; Kirkland & Weinstein,
1999). All these factors affect the level of patients’ satisfactions, produces a negative impact
on their safety, and cause up to eight-fold increase in adverse events pertaining to supportive
care failure (Rees, 2000). However, there is evidence that patients’ satisfaction is proportional
to the quality of communication with the healthcare provider and so may be prevented (Rees
et al 2000). The efficiency of contact isolation may be further reinforced with barrier measures.
Objectives
Social distancing measures including confinement as used in the prevention of the COVID-19
pandemic refers to efforts aiming at decreasing or interrupting the transmission of the infection
in a population, through the minimization of physical contact between potentially infected
individuals or population groups with high incidences and transmission rates, and those with
no or low level of the disease transmission (European Centre for Disease Prevention and
Control, 2020). From a public health perspective, they are intended to separate individuals
exposed to a dangerous communicable disease from the general population and so may appear
as a collective action for a common good (Anderson, 2020). It is intended to favour the recovery
of already infected or exposed individuals and protecting others from inadvertent exposure
(HHS, 2006). While “social distancing” involves various measures to reduce physical contact
as a means to break the chain of transmission, it may reduce social contact and interpersonal
interactions thereby affecting relationships. However, this is not the specific aim of the process.
Social distancing measures could be reinforced or implemented concomitantly with other
preventive measures such as contact tracing or tracking, and eventually testing and treating
affected individuals. These interventions serve to protect vulnerable groups such as patients
beyond 70 years, with comorbidities and at risk of severe outcomes, thereby decreasing the
peak magnitude of the epidemic (European Centre for Disease Prevention and Control, 2020).
More so, the prevention of the COVID-19 through social distancing has as advantage to have
preserved health care capacities as well, preventing overwhelming of hospital’s services.
Initiating and stopping the measures
In order to answer the question as to when confinement and other social distancing measures
should be initiated, it may be necessary to recall that the success of such dispositions over a
long period of time depends on the ability to make sure that people maintain some degree of
social contact with relatives, though from a physical distance. For the past twenty years,
internet-based communications, as well as Information and Communication technologies
(ICTs) have proven to be essential for maintaining distant human relationships (European
Centre for Disease Prevention and Control, 2020).
Community-wide confinement measures are best indicated when the transmission of an
infectious disease in a given area is evident and the epidemiological links between new cases
are unknown. Experience from observational and modelling studies from past epidemics such
as the SARS pandemic in 2003, and evidences gathered from the progress of the COVID-19
with China as the epicentre reveal that the early, decisive, rapid, coordinated and
comprehensive initiation of social distancing is probably more efficient in decelerating the
spread of the virus than delayed interventions (Medicine Io, 2006; WHO, 2020). In fact, it is
believed that the implementation of social distancing over one to three weeks at the beginning
of the COVID-19 outbreak in China, may have yielded as much as 66 to 95% reduction of the
spread of the disease, while reducing the number of affected areas as well (Lai et al., 2020).
Therefore, the adoption of social distancing should be done as early as possible, when
indicated. More so, before the finding of effective antivirals or preventive and therapeutic
vaccines, confinement measures appeared to be the mainstays of containment strategies
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(Anderson, 2020). In as much as the layering of several measures likely increases the
effectiveness of individual measures through additive or synergistic effects (Hatchett et al.,
2007).
However, to render the course of social distancing more acceptable and bearable, the
population should regularly be informed of various possible eventualities such as the extension
of the measures if required by circumstances, the removal of some measures while adding some
others as time goes on, and the possibility of re-imposing larger scale social distancing and
restrictive measures in case there is resurgence of transmission following the lifting of
measures (European Centre for Disease Prevention and Control, 2020). Today, various
principles of public health strategies limit the use of quarantine and social distancing to extreme
situations with highly contagious diseases (Anderson et al., 2020). When implementing such
measures, it is important that an anticipated end date be communicated as soon as possible,
based on scientific estimations or non-scientific but obvious realistic observation including
political motivations (European Centre for Disease Prevention and Control, 2020). This
enables psychological predisposition and mind setting based on targeting and planning, thereby
improving resilience capacity and performance.
One of the limiting factors of social distancing measures seems to be the “time factor” which
determines their success or failure. Besides, mass vaccination programs, the development of
sufficient levels of immunity in the population through community exposition and
contamination, also known as the “herd immunity” appears to be the end point of these
measures, when they could become useless and may be stopped (European Centre for Disease
Prevention and Control, 2020).
Considerations
Some considerations should be taken into account when adopting social distancing measures,
given that the natural pattern of the epidemic, the socioeconomic, political and legal contexts
may vary from one nation to another. As such the balance between scientific justification,
social implications of such measures including norms and values associated with the freedom
of movement should be compared with the public reactions with respect to restrictive constrains
and exposition risk (Mori, 2020). Other factors to be considered may also include feasibility of
measures, the time factor, institutional parameters and international pressures.
On the other hand, the legal and ethical considerations are well established as far as social
distancing as a preventive measure during epidemic outbreaks is concerned. In most countries
worldwide, it is the responsibility of public health authorities in conformity with national and
international legal principles to prevent the introduction, the transmission and the spread of
communicable diseases from foreign countries or from one geographical area to another within
a country (Anderson, 2020; Council on Ethical and Judicial Affairs, 2005). They determine the
conditions and principles required for imposing confinement measures including quarantine,
isolation and other social distancing measures with respect to the hierarchy of juridical norms
and considerations. In most countries, individuals may however have to some extends, the right
to appeal within ten days for legal procedures and hearing before competent instances for the
release from quarantine, and relief from violations due its conditions (Anderson et al, 2020;,
United Nations, Economic and Social Council, 1985; WHO, 2005). The bioethical conflict
which may arise between policies intended to protect the community and the necessity to
respect principles regarding the care of individual patients, may be resolved by ensuring
communities’ information. This in order to enable their participation in the development of
policies, programs, priorities, their accessibility to basic resources, and conditions necessary
for health and protection of confidentiality (Anderson et al, 2020).
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In the same vein, ethical recommendations require that when implementing extreme measures,
decisions should be rooted in scientific rationale, proven effectiveness, efficacy of the said
measure, and the public necessity. Likewise, proportionality in minimal infringement, justice,
fairness and reciprocity should be assured for all (Mori, 2020). In such a scheme, the
implementation of various measures would be applicable to all and not differentiating between
individuals’ social or economic classes.
Furthermore, a comprehensive communication on “risks” should be developed in order to
present the rationale justifying the implementation of various measures. This should aim to
encourage people to take actions, at least at the individual level for self-protection (European
Centre for Disease Prevention and Control, 2020). A communication targeting all social strata,
including minorities may further enhance adhesion and large scale implication. All these
factors need to be considered and anticipated as well as mitigation planning.
Restrictive measures due to confinement and social distancing lead to the limitation of human
mobility and eventually short or medium-term financial burden (Cetron & Landwirth, 2005).
Therefore, financial compensation and support for income and employment loss would help to
reinforce adherence to public health measures (European Centre for Disease Prevention and
Control, 2019). However, some degree of business continuity as far as critical and essential
services is concerned, is recommended. This is the case of healthcare services, pharmacies,
fire, water, gas and electricity sectors for example, for which interruption may cause high
societal consequences (Willem et al., 2020; International Organization for Standardization,
2019).
Enough support for people and communities subjected to social distancing measures should be
provided to ease adherence. Such support consists in ensuring the provision of necessary
services and supplies such as food, medication, and healthcare especially for vulnerable
subpopulations (DiGiovanni et al., 2004; Barbera et al., 2001). As for smaller children,
including contact or infected neonates and toddlers, they could be accompanied by a parent or
a care giver during confinement, with the reinforcement of barrier measures to prevent
contamination. Contact with relatives through internet-based systems should be favoured in
order to preserve some level of socialization. Home practice of physical activity and good
feeding should be promoted as well (UNESCO, 2020).
More so, confinement measures may further be strengthened by the promotion of solidarity
and mutual community support. This has been the case in some countries where people from
their homes were found singing together, comforting each other, applauding and encouraging
health workers from their apartment buildings, through windows or balconies, hanging banners
carrying encouraging messages. Furthermore, various industries and commercial enterprises
could assist the vulnerable with food, face masks and other donations, just to name a few
(European Centre for Disease Prevention and Control, 2020).
Stigmatization should be prevented as much as possible, given that evidence from previous
epidemics management reveal people under quarantine and isolation may suffer stigmatization
even when proven not to be affected by the disease (Desclaux et al., 2017). Such experiences
may reduce adherence and cause long-term psychosocial frustrations (Brooks et al., 2020). It
is therefore necessary for health authorities to proactively address this issue through the
promotion of solidarity, by putting forward the fact that everyone is potentially at risk of being
infected and that only common efforts would help protect everyone (Brown et al., 2003).
Control processes and regular assessments with regards to the impact of various measures
implemented, their efficacy as well as the population’s adherence should be constantly carried
out to enable consequent adjustments (Willem et al., 2020; ECDC, 2020).
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Benefits and advantages
Confinement and social distancing during the COVID-19 pandemic significantly contributed
to curb the disease’s spread in most countries, if not all. Mankind adaptability and flexibility
was proofed, but succeeded through readjustment of habits, changing usual modes of
functioning and established protocols, directing attention towards other interests and
possibilities. Confinement and other social distancing measures have however been
implemented with varying rigor and extends from one state to another, with relative
effectiveness and efficacy (Willem et al., 2020; European Centre for Disease Prevention and
Control, 2020). While it was total and community-wide in a number of developed countries, it
was rather milder and less restrictive in most developing countries, especially in Africa. This
permitted to prevent cataclysmic predictions while maintaining some degree of socioeconomic
preservation. However, the majority of high-income countries could cope with country-wide
confinement without unbearable adverse effect, and so were more prone to large scale
confinement over three months and more, promoting populations’ mutual support and
solidarity (European Centre for Disease Prevention and Control, 2020). On the other hand, the
restriction of international transaction and exchanges allowed for resilience, self-reliance,
emulation and development especially in low-income countries. As such, considerable
ameliorations and progress in scientific research, improvement of health systems and facilities
occurred. The COVID-19 epidemic outbreak has equally strengthened some aspects of
international relations, bringing nations together, in the sense of putting in efforts in a bid to
find common solutions through collaboration, and contextual-motivated solidarity (Anderson
et al., 2020; European Centre for Disease Prevention and Control, 2020; Willem et al., 2020;
ECDC, 2020).
During these periods of restricted human mobility and decreased outhouse job occupation, most
family links and relationships were reinforced, as parents became more available and hence
closer to their wives and children (Cetron & Landwirth, 2005; Mori, 2020; Council on Ethical
and Judicial Affairs, 2005). Likewise working at home helped to relieve stress in some persons,
with necessary and sufficient rest, producing favourable effects on mental health status.
Moreover, increased online services improved the knowledge and use of digital Information
and Communication Technologies (ICTs) (European Centre for Disease Prevention and
Control, 2020). More so, confinement provided enough time for other interests including
introspective assessment, contributing to personal development based on spirituality and
religion, necessary to build up faith, with prayer as an appeal for divine salvation. Forbidden
handshaking and regular hand washing helped to increase good hygiene practices. Furthermore,
the dedication of television programming and media advertisement, as well as the free access
to written articles about COVID-19 also contributed for public education on the topic
(Anderson., 2020).
Burden and inconveniences
Confinement and social distancing has led to considerable degradation of socialization and
social interactions, promoting individualism, and egoistic self-reliance and self-sufficiency
(Anderson., 2020, European Centre for Disease Prevention and Control, 2020). The significant
degradation of the economic tissue comprising financial limitations, large scale unemployment,
increased rate of job loss, reduced circulation of commodities, and the limitation of services
drastically impacted incomes and revenues (Anderson., 2020, European Centre for Disease
Prevention and Control, 2020; Council on Ethical and Judicial Affairs, 2005). Eventually, the
political situation of some unstable nations got worsened, due to the increase of contestations
with regards to administration strategies, decision making, and failure of governmental
systems. More so, international cooperation and exchanges have been reduced as well, because
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of confinement measures (Anderson et al., 2020; European Centre for Disease Prevention and
Control, 2020).
Other undesirable repercussions of confinement measures involved national and international
missed appointments, academic and professional cancellation or cessation of activities and
services. Moreover, even though confinement and social distancing have been effective in
reducing the spread of infectious diseases, it is however believed a 100% implementation may
never be reached, and so the possibility of repeating the process due recontamination exists.
More so, prolonged confinement may lead to missed family planning, increased birth rates and
eventually demographic expansion. Some mathematical projections of modelling research
predict the pandemic may take up to five years before being eradicated from the face of the
earth, when considering social distancing alone (Kraemer et al., 2020). In this case, it would
be quite a long-lasting process, difficult to bear.
Furthermore, confinement and quarantine measures in some cases may lead to the violation of
individual rights such as poorly justified deprivation of freedom and access to basic necessities
including health assistance. Moreover, the difficulty to follow-up patients with known preexisting comorbidities including cardiovascular and psychological backgrounds, may be
responsible for the onset of decompensation and degradation of previously stabilized health
conditions (European Centre for Disease Prevention and Control, 2020). These
decompensation phenomena could be aggravated by confinement-related stress and anxiety,
the restriction of needs and rights, as well as the increased rates of obesity due to reduced
human mobility and physical exercises (Anderson et al., 2020). On the other hand, there may
be difficulties with the observation of various restrictions in some vulnerable subjects such as
rebel adolescents, the sedentary old, the mentally unstable and the handicapped (Kraemer,
2020; Anderson et al., 2020, European Centre for Disease Prevention and Control, 2020).
Moreover, by the end of the confinement process, citizens may drastically neglect further
recommendations or restrictions with carelessness, and excessive loosing up due to a period of
long lasting privation. Such an “obstacle removal syndrome” would therefore be in line with
or occur as a result of the “forbidden fruit theory”. In such a context, this would be a risk factor
for recontamination and restarting the process all-over.
Perspectives
In periods of serious lives claiming by epidemics, confinement measures including quarantine
and isolation should be mandatory for symptomatic individuals and contact subjects, with
written order and recommendation carrying the highest authority’s signature, so as to improve
the control of cases and preserve the lives of many (Anderson et al., 2020; European Centre for
Disease Prevention and Control, 2020). Resources should be made available to support the
vulnerable including the sick, the old, the poor, and the disable. Moreover, barrier measures
such as one to two meters physical distancing, face masks wearing, regular hand washing, and
forbidden hand shaking among individuals should be associated and penalty constraints
established to achieve rigorous observation (Kissler et al., 2020; Anderson et al., 2020;
European Centre for Disease Prevention and Control, 2020).
Confinement places including hospitals, workplaces and houses should regularly be disinfected
to reduce viral concentration in the area and hence infectivity. A network of psychological
support should be put in place to care for the confined. More so, the reinforcement of targeted
information, communication and debates relative to daily statistical updates, disease
transmission and preventive measures, may serves a great purpose in such contexts (Anderson
et al., 2020; Markel, 1993; Knowles, 1993; Rees et al., 2000).
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Education should be continued by conceiving detailed and explicit electronic lessons and
teachings, as well as video conferences especially for secondary, high school and university
students. These could be made available and accessible to students through the internet, such
that they can be downloaded and read at any moment. In the same vein, teleworking tasks could
be developed and made feasible for workers on confinement, so as to reduce the rate of
unemployment, job loss and financial limitations (Kissler et al., 2020; Anderson et al., 2020;
European Centre for Disease Prevention and Control, 2020). Some degree of physical
distancing may still be observed on workplaces while delivering the minimal necessary
services, especially when non-essential staff are oriented towards teleworking and
homeworking (European Centre for Disease Prevention and Control, 2020). In a similar
manner, efforts should be made in order to preserve permanent health services to attend people
with diseases different from the ongoing epidemic (Kissler et al., 2020; Anderson et al., 2020;
European Centre for Disease Prevention and Control, 2020). Furthermore, patients should be
encouraged to contact their physician as much as possible before each visits, so that the
necessity of a visit could be appreciated and the required predispositions taken.
Social interactions could be virtualized during this period in order to maintain a certain level
of socialization (European Centre for Disease Prevention and Control, 2020). For such makeups, the closer to reality they seem, the better the impact produced. They could include large
screen viewing of family reunions, meetings, parties, and concerts, sufficiently charged with
emotions to generate feelings of attachment. Due to forbidden mass gathering, matches and
sports competitions should be diffusely broadcasted in real time, including through television,
radio stations and the internet (Anderson., 2020; European Centre for Disease Prevention and
Control, 2020). Pre-recorded supporters’ noises may help to motivate competitors, players, and
tele viewers, by producing sensational effects. Likewise, religious activities may be followed
and performed at home as well, to avoid crowding.
Conclusion
It appears that confinement and social distancing are effective and efficient in reducing
epidemic dissemination, and should be implemented as early as possible during deadly
outbreaks. Their effectiveness may be time-limited, depending on the development of natural
community-borne immunity or a vaccine. The negative impacts of these measures are mainly
the restriction of human mobility, as well as human interactions and this may affect almost all
aspects of human activities, impacting the lives of nations as a whole. However, as a response,
preserving some level of socioeconomic functioning, while strengthening the necessary
support to citizens through the implementation of accurate accompanying measures could help
to prevent further misery and the escalation of health issues.
Acknowledgements
All collaborators to this project.
Funding
Private
Conflict of Interest
The authors declare that they have no competing interest.
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