Factors influencing compliance with quarantine in Toronto during the 2003 SARS outbreak
Abstract
The purpose of this study was to cull lessons from Toronto's experiences with large-scale quarantine during the outbreak of Severe Acute Respiratory Syndrome in early 2003. We focused on issues that affected the population's willingness to comply with quarantine. Information was acquired from interviews, telephone polling, and focus groups. Issues of quarantine legitimacy, criteria for quarantine, and the need to allow some quarantined healthcare workers to leave their homes to go to work were identified. Also important was the need to answer questions from people entering quarantine about the continuation of their wages, salaries, and other forms of income while they were not working, and about the means by which they would be supplied with groceries and other services necessary for daily living. The threat of enforcement had less effect on compliance than did the credibility of compliance-monitoring. Fighting boredom and other psychological stresses of quarantine, muting the forces of stigma against those in quarantine, and crafting and delivering effective and believable communications to a population of mixed cultures and languages also were critical. The need for officials to develop consistent quarantine policies, procedures, and public messages across jurisdictional boundaries was paramount.
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Eleven articles highlighted the psychological implications of mass quarantine as emotional distress and symptoms of mental illness.
“Eleven articles from various geographical and disease contexts highlighted the psychological implications of mass quarantine as emotional distress and symptoms of mental illness.22–25,27–32,35”
From Social consequences of mass quarantine during epidemics: a systematic review with implications for the COVID-19 response (2020) · cites this paper as [25]
People in or after quarantine experienced emotional distress including annoyance, anxiety, boredom, disappointment, life dissatisfaction, fear of infection, isolation, loneliness and mistrust.
“Among people in or after quarantine, some experienced emotional distress, including: annoyance,32 anxiety,25,29 boredom,23,25,32 disappointment and life dissatisfaction,24,32,35 fear of infection,23,25,30,34 isolation,23,25,32 loneliness25,32 and mistrust.31”
From Social consequences of mass quarantine during epidemics: a systematic review with implications for the COVID-19 response (2020) · cites this paper as [25]
Participants from three studies of the SARS outbreak in Toronto stressed that authorities did not provide clear and consistent messages on why, how and how long to enact quarantine, and that they were unable to contact designated public health staff.
“Participants from three studies of the SARS outbreak in Toronto stressed that authorities did not provide clear and consistent messages on why, how and, how long to enact quarantine, and that they were unable to contact designated public health staff.23,25,27”
From Social consequences of mass quarantine during epidemics: a systematic review with implications for the COVID-19 response (2020) · cites this paper as [25]
Nine studies stressed how mass quarantine aggravated inequalities in individuals' access to, understanding of, and actions on prevention and control of infections.
“Nine studies stressed how mass quarantine aggravated inequalities in individuals’ access to, understanding of, and actions on prevention and control of infections.21,23–26,31–34”
From Social consequences of mass quarantine during epidemics: a systematic review with implications for the COVID-19 response (2020) · cites this paper as [25]
Contradictory quarantine instructions from public health officials, mass media and expert opinions widened communication inequalities, made it difficult for interviewees to comply with quarantine orders and drove the public to take on word-of-mouth recommendations.
“Moreover, contradictory quarantine instructions from public health officials, mass media and expert opinions widened communication inequalities, made it difficult for interviewees to comply with quarantine orders and drove the public to take on word-of-mouth recommendations that might or might not be true.25”
From Social consequences of mass quarantine during epidemics: a systematic review with implications for the COVID-19 response (2020) · cites this paper as [25]
Identifying trustworthy information became challenging for the public due to diverse and unverified sources as well as heightened uncertainty during disease outbreaks.
“In addition, identifying trustworthy information became challenging for the public due to diverse and unverified sources as well as heightened uncertainty during disease outbreaks.23,25,27”
From Social consequences of mass quarantine during epidemics: a systematic review with implications for the COVID-19 response (2020) · cites this paper as [25]
DiGiovanni et al.'s study argued that individuals who work part-time or are self-employed had no guarantee to an income, as local governments delayed offering financial compensation to asymptomatic people under quarantine who could not work without travel.
“DiGiovanni et al.’s25 study argued that individuals who work part-time or are self-employed had no guarantee to an income, as local governments delayed offering financial compensation to asymptomatic people under quarantine who could not work without travel.”
From Social consequences of mass quarantine during epidemics: a systematic review with implications for the COVID-19 response (2020) · cites this paper as [25]
Loss of income following unemployment was the key consequence raised in qualitative research on the SARS and EVD outbreak.
“Loss of income following unemployment was the key consequence raised in qualitative research on the SARS and EVD outbreak.”
From Social consequences of mass quarantine during epidemics: a systematic review with implications for the COVID-19 response (2020) · cites this paper as [25]
The review found negative psychological impacts of mass quarantine, such as low life satisfaction, emotional isolation and fear of infection.
“Consistent with previous studies,10,36,37 our review presents a range of negative psychological impacts of mass quarantine, such as low life satisfaction, emotional isolation and fear of infection.23–25,30,32,34,35”
From Social consequences of mass quarantine during epidemics: a systematic review with implications for the COVID-19 response (2020) · cites this paper as [25]
Four studies stressed how school closures under lockdowns affected children and adolescents.
“Four studies stressed how school closures under lockdowns affected children and adolescents.21,24,25,29”
From Social consequences of mass quarantine during epidemics: a systematic review with implications for the COVID-19 response (2020) · cites this paper as [25]
Communication inequalities are often compounded by poor information governance across authorities during outbreaks, such as non-justified decision-making, inconsistent instructions and non-synchronized implementation of mass quarantine.
“Often, communication inequalities are compounded by poor information governance across authorities during outbreaks, such as non-justified decision-making, inconsistent instructions and non-synchronized implementation of mass quarantine.23,25,27,51”
From Social consequences of mass quarantine during epidemics: a systematic review with implications for the COVID-19 response (2020) · cites this paper as [25]
Two studies from both remote and urban areas in Canada reported coping strategies among affected caregivers and teenagers.
“Two studies from both remote and urban areas in Canada reported coping strategies among affected caregivers and teenagers.24,25”
From Social consequences of mass quarantine during epidemics: a systematic review with implications for the COVID-19 response (2020) · cites this paper as [25]
In DiGiovanni et al., adolescent respondents contended that they could obey quarantine orders and learn from home given that mobile connections and web-based learning platforms were available.
“In another study by DiGiovanni et al.,25 adolescent respondents contended that they could obey quarantine orders and learn from home given that mobile connections and web-based learning platforms were available.”
From Social consequences of mass quarantine during epidemics: a systematic review with implications for the COVID-19 response (2020) · cites this paper as [25]
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- Authors
- DiGiovanni, C., Conley, J., Chiu, D., & Zaborski, J.
- Affiliations
- Defense Threat Reduction Agency (US)
- Strategic Planning and Analysis, Hicks and Associates, Arlington, Va.
- DFI Government Services, Washington, DC.
- Venue
- Biosecurity and Bioterrorism: Biodefense Strategy, Practice, and Science
- Publisher
- SAGE Publications
- Published
- 2004-12
- Volume
- 2
- Issue
- 4
- Pages
- 265-272
- ISSN
- 1538-7135 (ISSN-L)
- 1557-850X
- OpenAlex
- W2051329386
- Cited by
- 483
- References
- 12
- Citations by year
- 2026: 5 · 2025: 5 · 2024: 7 · 2023: 38 · 2022: 96 · 2021: 143 · 2020: 136 · 2019: 2 · 2017: 2 · 2015: 2
- FWCI
- 14.92
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Biosecurity and Bioterrorism Biodefense Strategy Practice and Science (publishedVersion)
- PubMed (publishedVersion)
- Funders
- U.S. Department of Defense
- Defense Threat Reduction Agency
- Topics
- Health Sciences › Health Professions › General Health Professions › Public Health Policies and Education
- Health Sciences › Health Professions › Emergency Medical Services › Disaster Response and Management
- Social Sciences › Sociology and Political Science › COVID-19 Prevention and Impact
- Keywords
- quarantine compliance, SARS epidemic, quarantine enforcement, public communication, multilingual communication, Toronto
- MeSH terms
- Adaptation, Psychological, Attitude to Health, Disaster Planning, Disease Outbreaks, Humans, Ontario, Quarantine, Psychological Distance, Focus Groups, Severe Acute Respiratory Syndrome
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