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Social consequences of mass quarantine during epidemics: a systematic review with implications for the COVID-19 response

Open access
Chu, Isaac Yen-Hao, Alam, Prima, Larson, Heidi J, Lin, Leesa·2020·Journal of Travel Medicine
DOI 10.1093/jtm/taaa192PMC PMC7649384
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Abstract

Four billion people worldwide have experienced coronavirus disease 2019 (COVID-19) confinement. Such unprecedented extent of mobility restriction to curb the COVID-19 pandemic may have profound impacts on how individuals live, travel and retain well-being. This systematic review aims to identify (i) the social consequences of mass quarantine—community-wide movement restrictions—during previous and current infectious disease outbreaks and (ii) recommended strategies to mitigate the negative social implications of COVID-19 lockdowns. Considering social determinants of health, we conducted a systematic review by searching five databases (Ovid-MEDLINE, EMBASE, PsycINFO, China National Knowledge Infrastructure and the World Health Organization COVID-19 database) for publications from inception to 9 April 2020. No limitation was set on language, location or study type. Studies that (i) contained peer-reviewed original empirical evidence and (ii) focussed on non-epidemiological implications of mass quarantine were included. We thematically synthesized and reported data due to heterogeneous disease and country context. Of 3067 publications found, 15 original peer-reviewed articles were selected for full-text extraction. Psychological distress, heightened communication inequalities, food insecurity, economic challenges, diminished access to health care, alternative delivery of education and gender-based violence were identified as negative social consequences of community-based quarantine in six infectious disease epidemics, including the current COVID-19 pandemic. In contrast, altruistic attitudes were identified as a positive consequence during previous quarantines. Diverse psychological and social consequences of mass quarantine in previous and current epidemics were evident, but individual country policies had been highly varied in how well they addressed the needs of affected individuals, especially those who are socially marginalized. Policymakers should balance the pros and cons of movement restrictions, facilitate multisectoral action to tackle social inequalities, provide clear and coherent guidance to the public and undertake time-bound policy evaluations to mitigate the negative impact of COVID-19 lockdowns and to establish preparedness strategies for future epidemics.

AI snapshot

Written from the paper’s full text.

TL;DR

This systematic review synthesizes 15 peer-reviewed studies on the social consequences of mass quarantine during SARS, Ebola, H1N1 and COVID-19. It identifies seven negative social consequences—psychological distress, communication inequalities, food insecurity, economic challenges, diminished health care access, disrupted education and gender inequity/violence—with altruism as the only positive consequence.

Key findings

  • From 3067 publications screened, 15 studies were included; 8 concerned SARS, 4 Ebola, 2 COVID-19 and 1 H1N1. Seven social consequences were identified: psychological distress (n = 11), communication inequalities (n = 9), food insecurity (n = 8), economic challenges (n = 7), diminished access to health care (n = 6), disruptive education (n = 4) and gender inequity/violence (n = 3).
  • Psychological distress included emotional distress and mental disorder symptoms; Hawryluck et al. reported around one-third of respondents had PTSD and depression symptoms (28.9% and 31.2%, respectively), while Zhang et al. found those who stopped working had poorer mental health than those still employed (decrease of 2.60 points on Mental Composite Scale; 95% CI = −0.05 to −5.16).
  • Food insecurity varied by context: food inaccessibility was reported at 4% (n = 501) in a Canadian SARS study and 50% (n = 16) in a Liberian Ebola study. Economic impacts included reduced or no payment among 10.0–25.7% of surveyed Toronto SARS respondents, and 22% (n = 355) of Ontario respondents closed restaurants and cancelled social activities.
  • Altruism was the only positive consequence identified: most respondents in a Canadian study agreed quarantine orders would protect others from SARS, and community members provided emotional support or cared for orphans during Toronto SARS and Liberia Ebola quarantines.

Methods

  • Systematic review following PRISMA, registered with PROSPERO (CRD42020183756); searched Ovid-MEDLINE, EMBASE, PsycINFO, China National Knowledge Infrastructure and the WHO COVID-19 database from inception to 9 April 2020, with no language, location or study-type limitation.
  • Included studies with peer-reviewed original empirical evidence focused on non-epidemiological implications of mass quarantine, defined as restricting mobility/contact of at least 10 000 people or all residents in a jurisdiction.
  • Two authors independently screened and extracted data; thematic synthesis was used due to heterogeneous disease and country contexts, with quality assessed using MMAT 2018 and an ethics appraisal matrix.

Limitations

  • Stated: scarcity of COVID-19-related studies at the April 2020 search date limits transferability; most included studies concerned SARS and Ebola, whose scale and geography may not be comparable to COVID-19; sampling bias and heterogeneous populations limit generalizability; two studies were ethical analyses rather than lived experiences; no macroeconomic estimates were available; and not all social consequences (e.g. climate change) were identified.
  • Stated: quantitative findings require careful interpretation, especially from studies without high-quality methodologies; 6 of 15 included studies were low quality, and neither mixed-methods SARS study was rated high quality.
  • Evident from the text: all instruments measuring social consequences were ad hoc except two SARS studies using the Impact of Event Scale-Revised, and one key psychological study had a survey response rate of <1%, making reporting bias likely.

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Integrity signals

Registry

Crossref · 10.1093/jtm/taaa192

Cites

79 of 79 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 195 cited sources checked · 0 supported · 0 flagged

  • Findingnone given

    Altruistic attitudes were identified as a positive consequence of mass quarantine during previous quarantines.

    “In contrast, altruistic attitudes were identified as a positive consequence during previous quarantines.”
    Quote in the paperNot a substantial claim
  • Findingcitation

    The majority of respondents in a Canadian study agreed that following quarantine orders would protect others from contracting SARS.

    “The majority of respondents in a Canadian study agreed that following quarantine orders would protect others from contracting SARS.33”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [33] Tracy, 2009, Public perceptions of quarantine: community-based telephone survey following an infectious disease outbreak, BMC Public Health source

      Not checked in the free run.

  • Findingcitation

    Survivors of EVD in Sierra Leone experienced rejection from food sellers.

    “One study mentioned that survivors of EVD in Sierra Leone experienced rejection from food sellers.29”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [29] Kodish, 2019, A qualitative study to understand how Ebola virus disease affected nutrition in Sierra Leone – a food value-chain framework for improving future response strategies, PLoS Negl Trop Dis source

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  • Findingcitation

    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”
    Quote in the paperSubstantial claim0 of 9 sources checked
    • cites [21] Abramowitz, 2015, Community-centered responses to Ebola in urban Liberia: the view from below, PLoS Negl Trop Dis source

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    • cites [23] Cava, 2005, The experience of quarantine for individuals affected by SARS in Toronto, Public Health Nurs source

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    • cites [24] Charania, 2013, Assessing the effectiveness and feasibility of implementing mitigation measures for an influenza pandemic in remote and isolated First Nations communities: a qualitative community-based participatory research approach, Rural Remote Health

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    • cites [25] DiGiovanni, 2004, Factors influencing compliance with quarantine in Toronto during the 2003 SARS outbreak, Biosecur Bioterror source

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    • cites [26] Gostin, 2003, Ethical and legal challenges posed by severe acute respiratory syndrome, JAMA source

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    • cites [31] Pellecchia, 2015, Social consequences of Ebola containment measures in Liberia, PLoS One source

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    • cites [32] Reynolds, 2008, Understanding, compliance and psychological impact of the SARS quarantine experience, Epidemiol Infect source

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    • cites [33] Tracy, 2009, Public perceptions of quarantine: community-based telephone survey following an infectious disease outbreak, BMC Public Health source

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    • cites [34] Wilken, 2017, Knowledge, attitudes, and practices among members of households actively monitored or quarantined to prevent transmission of Ebola virus disease – Margibi county, Liberia: February–March 2015, Prehosp Disaster Med source

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  • Findingcitation

    One study revealed that people under physical distancing and movement restrictions suffered insomnia and depression.

    “While one study revealed that people under physical distancing and movement restrictions suffered insomnia and depression,30”
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    • cites [30] Mihashi, 2009, Predictive factors of psychological disorder development during recovery following SARS outbreak, Health Psychol source

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  • Classified as probably not a substantial claim. 37
  • May combine two claims. 36

  • Classified as probably not a substantial claim. May combine two claims.

    Findingown data

    After screening 3067 publications, 55 citations were included in full-text assessment and data were extracted from 15 eligible studies.

    “After screening the titles and abstracts of 3067 publications, we included 55 citations in the full-text assessment and extracted data from 15 eligible studies (Figure 1).”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    The reported periods of quarantine in the included studies varied from 7 days to 1 month.

    “The reported periods of quarantine varied from 7 days to 1 month.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The review identified seven types of social consequences of mass quarantine: psychological distress (n=11), heightened communication inequalities (n=9), food insecurity (n=8), economic challenges (n=7), diminished access to health care (n=6), disruptive education (n=4) and gender inequity and violence (n=3).

    “We identified seven types of social consequences of mass quarantine (Table 4): psychological distress (n = 11), heightened communication inequalities (n = 9), food insecurity (n = 8), economic challenges (n = 7), diminished access to health care (n = 6), disruptive education (n = 4) and gender inequity and violence (n = 3).”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Mass quarantine is a cause of the social consequences identified in the review.

  • May combine two claims.

    Findingcitation

    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”
    Quote in the paperSubstantial claim0 of 9 sources checked
    • cites [32] Reynolds, 2008, Understanding, compliance and psychological impact of the SARS quarantine experience, Epidemiol Infect source

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    • cites [25] DiGiovanni, 2004, Factors influencing compliance with quarantine in Toronto during the 2003 SARS outbreak, Biosecur Bioterror source

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    • cites [29] Kodish, 2019, A qualitative study to understand how Ebola virus disease affected nutrition in Sierra Leone – a food value-chain framework for improving future response strategies, PLoS Negl Trop Dis source

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    • cites [23] Cava, 2005, The experience of quarantine for individuals affected by SARS in Toronto, Public Health Nurs source

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    • cites [24] Charania, 2013, Assessing the effectiveness and feasibility of implementing mitigation measures for an influenza pandemic in remote and isolated First Nations communities: a qualitative community-based participatory research approach, Rural Remote Health

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    • cites [35] Zhang, 2020, Unprecedented disruption of lives and work: health, distress and life satisfaction of working adults in China one month into the COVID-19 outbreak, Psychiatry Res source

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    • cites [30] Mihashi, 2009, Predictive factors of psychological disorder development during recovery following SARS outbreak, Health Psychol source

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    • cites [34] Wilken, 2017, Knowledge, attitudes, and practices among members of households actively monitored or quarantined to prevent transmission of Ebola virus disease – Margibi county, Liberia: February–March 2015, Prehosp Disaster Med source

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    • cites [31] Pellecchia, 2015, Social consequences of Ebola containment measures in Liberia, PLoS One source

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  • May combine two claims.

    Findingcitation

    Interviewees mentioned community members offered emotional support and took care of orphans during mass quarantine in the Toronto SARS epidemic and Liberia EVD outbreak.

    “Interviewees mentioned how community members offered emotional support and took care of orphans during the mass quarantine in the Toronto SARS epidemic and in the Liberia EVD outbreak, respectively.23,29”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [23] Cava, 2005, The experience of quarantine for individuals affected by SARS in Toronto, Public Health Nurs source

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    • cites [29] Kodish, 2019, A qualitative study to understand how Ebola virus disease affected nutrition in Sierra Leone – a food value-chain framework for improving future response strategies, PLoS Negl Trop Dis source

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    Findingcitation

    Those who self-isolated were treated as disease spreaders and their behaviour was morally judged by other community members.

    “Those who self-isolated were treated as disease spreaders, and their behaviour was morally judged by other community members;”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [31] Pellecchia, 2015, Social consequences of Ebola containment measures in Liberia, PLoS One source

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  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingcitation

    Pellecchia et al. stated that top-down enforced lockdowns without community engagement may fuel distrust of authorities and resistance to restrictive measures, which could result in ineffective outbreak control.

    “Pellecchia et al.31 stated that top-down enforced lockdowns without community engagement may fuel distrust of authorities and resistance to restrictive measures, which could result in ineffective outbreak control.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [31] Pellecchia, 2015, Social consequences of Ebola containment measures in Liberia, PLoS One source

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    Findingcitation

    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”
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    • cites [23] Cava, 2005, The experience of quarantine for individuals affected by SARS in Toronto, Public Health Nurs source

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    • cites [25] DiGiovanni, 2004, Factors influencing compliance with quarantine in Toronto during the 2003 SARS outbreak, Biosecur Bioterror source

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    • cites [27] Hawryluck, 2004, SARS control and psychological effects of quarantine, Toronto, Canada, Emerg Infect Dis source

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    Findingcitation

    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”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [25] DiGiovanni, 2004, Factors influencing compliance with quarantine in Toronto during the 2003 SARS outbreak, Biosecur Bioterror source

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  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingcitation

    Gostin et al. argued that people in poverty could not afford space for physical distancing in their households during SARS outbreaks; similar challenges were found among the First Nations population in subarctic Canada.

    “Gostin et al.26 argued that people in poverty could not afford space for physical distancing in their households during SARS outbreaks; similar challenges were found among the First Nations population in subarctic Canada.24”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [26] Gostin, 2003, Ethical and legal challenges posed by severe acute respiratory syndrome, JAMA source

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    • cites [24] Charania, 2013, Assessing the effectiveness and feasibility of implementing mitigation measures for an influenza pandemic in remote and isolated First Nations communities: a qualitative community-based participatory research approach, Rural Remote Health

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    Findingcitation

    Mihashi et al. argued that delayed supply caused by limited transportation could aggravate psychological distress (e.g. anxiety) among Chinese individuals.

    “whereas Mihashi et al.30 argued that delayed supply caused by limited transportation could aggravate psychological distress (e.g. anxiety) among Chinese individuals.24”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [30] Mihashi, 2009, Predictive factors of psychological disorder development during recovery following SARS outbreak, Health Psychol source

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    • cites [24] Charania, 2013, Assessing the effectiveness and feasibility of implementing mitigation measures for an influenza pandemic in remote and isolated First Nations communities: a qualitative community-based participatory research approach, Rural Remote Health

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    Findingcitation

    Another Liberian study of EVD suggested that high quarantine compliance among village residents was attributed to designated health care personnel on-site.

    “Another Liberian study of EVD suggested that high quarantine compliance among village residents was attributed to designated health care personnel on-site.34”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [34] Wilken, 2017, Knowledge, attitudes, and practices among members of households actively monitored or quarantined to prevent transmission of Ebola virus disease – Margibi county, Liberia: February–March 2015, Prehosp Disaster Med source

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    Findingcitation

    Interviewees in Sierra Leone worried about their own food stock, whereas some Canadians were concerned about how others in economic difficulties preserved food under movement restrictions.

    “Regarding food storage, interviewees in Sierra Leone worried about their own food stock,29 whereas some Canadians were concerned about how others in economic difficulties preserved food under movement restrictions.23”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [29] Kodish, 2019, A qualitative study to understand how Ebola virus disease affected nutrition in Sierra Leone – a food value-chain framework for improving future response strategies, PLoS Negl Trop Dis source

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    • cites [23] Cava, 2005, The experience of quarantine for individuals affected by SARS in Toronto, Public Health Nurs source

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    Findingcitation

    Liberian community leaders argued that, despite being aware of EVD, they could not respond effectively to EVD control without a functioning health care system.

    “Liberian community leaders argued that, despite being aware of EVD, they could not respond effectively to EVD control without a functioning health care system.21”
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    • cites [21] Abramowitz, 2015, Community-centered responses to Ebola in urban Liberia: the view from below, PLoS Negl Trop Dis source

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    Findingcitation

    Indigenous people in Canada advocated against full border closures to retain the supply of basic needs.

    “Indigenous people in Canada advocated against full border closures to retain the supply of basic needs,”
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    • cites [24] Charania, 2013, Assessing the effectiveness and feasibility of implementing mitigation measures for an influenza pandemic in remote and isolated First Nations communities: a qualitative community-based participatory research approach, Rural Remote Health

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    Findingcitation

    Reduced personal incomes, unemployment and concerns about additional costs of employment were identified as consequences of community-wide containment.

    “When considering the economic impact on individuals, reduced personal incomes, unemployment and concerns about additional costs of employment were identified as the consequences of community-wide containment.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Mass quarantine is a cause of the social consequences identified in the review.

  • May combine two claims.

    Findingcitation

    In one study of the EVD outbreak in Liberia, some informants observed an increased number of deaths and complications from preventable health conditions, as most medical facilities within reasonable travel distances were closed.

    “In one study of the EVD outbreak in Liberia, some informants observed an increased number of deaths and complications from preventable health conditions, as most medical facilities within reasonable travel distances were closed.21”
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    • cites [21] Abramowitz, 2015, Community-centered responses to Ebola in urban Liberia: the view from below, PLoS Negl Trop Dis source

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    Findingcitation

    Kodish et al. indicated that decreased production of grains and reduced mobility of traders interrupted the domestic and international flow of agriculture trade.

    “They indicated that decreased production of grains and reduced mobility of traders interrupted the domestic and international flow of agriculture trade.”
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    • cites [29] Kodish, 2019, A qualitative study to understand how Ebola virus disease affected nutrition in Sierra Leone – a food value-chain framework for improving future response strategies, PLoS Negl Trop Dis source

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    Findingcitation

    Levels of food inaccessibility were reported at 4% (n=501) in one study of the SARS outbreak in Canada and at 50% (n=16) in another study of the EVD outbreak in Liberia.

    “Levels of food inaccessibility were reported at 4% (n = 501) in one study of the SARS outbreak in Canada22 and at 50% (n = 16) in another study of the EVD outbreak in Liberia.34”
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    • cites [22] Blendon, 2004, The public’s response to severe acute respiratory syndrome in Toronto and the United States, Clin Infect Dis source

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    • cites [34] Wilken, 2017, Knowledge, attitudes, and practices among members of households actively monitored or quarantined to prevent transmission of Ebola virus disease – Margibi county, Liberia: February–March 2015, Prehosp Disaster Med source

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    Findingcitation

    Liberians stressed that the compulsory quarantine order damaged the tradition of mutual support between village dwellers and left those self-isolated unaided and starving.

    “Liberians stressed that the compulsory quarantine order damaged the tradition of mutual support between village dwellers and left those self-isolated unaided and starving.31”
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    • cites [31] Pellecchia, 2015, Social consequences of Ebola containment measures in Liberia, PLoS One source

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    Findingcitation

    Three studies revealed changes in health-seeking behaviour during lockdowns, including reduced visits to nutrition screening, hiding treatable illnesses and seeking help from unverified sources.

    “Three studies revealed changes in health-seeking behaviour during lockdowns, including reduced visits to nutrition screening, hiding treatable illnesses and seeking help from unverified sources.21,29,31”
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    • cites [21] Abramowitz, 2015, Community-centered responses to Ebola in urban Liberia: the view from below, PLoS Negl Trop Dis source

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    • cites [29] Kodish, 2019, A qualitative study to understand how Ebola virus disease affected nutrition in Sierra Leone – a food value-chain framework for improving future response strategies, PLoS Negl Trop Dis source

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    • cites [31] Pellecchia, 2015, Social consequences of Ebola containment measures in Liberia, PLoS One source

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    Findingown data

    The review identified seven negative social consequences of community-wide movement restrictions: negative impacts on mental well-being, communication, food security, economy, health care access, education and gender equality.

    “Our review identified seven negative social consequences of community-wide movement restrictions, including negative impacts on mental well-being, communication, food security, economy, health care access, education and gender equality.”
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    Findingcitation

    They underscored that the reported reduction in malnutrition screenings resulted from movement restrictions under quarantine, behaviour changes in service users due to lack of trust and resource competition between the EVD outbreak management and humanitarian nutrition programmes.

    “They underscored that the reported reduction in malnutrition screenings resulted from movement restrictions under quarantine, behaviour changes in service users due to lack of trust and resource competition between the EVD outbreak management and humanitarian nutrition programmes, both of which were vital to survival.”
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    • cites [29] Kodish, 2019, A qualitative study to understand how Ebola virus disease affected nutrition in Sierra Leone – a food value-chain framework for improving future response strategies, PLoS Negl Trop Dis source

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    Findingcitation

    A qualitative study reported that residents in Sierra Leone during the EVD outbreak were unable to work due to village-based quarantine, which further impacted labour force supply and the agricultural cycle.

    “A qualitative study reported that residents in Sierra Leone during the EVD outbreak were unable to work due to village-based quarantine, which further impacted labour force supply and the agricultural cycle.29”
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    • cites [29] Kodish, 2019, A qualitative study to understand how Ebola virus disease affected nutrition in Sierra Leone – a food value-chain framework for improving future response strategies, PLoS Negl Trop Dis source

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  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingcitation

    Gostin et al. expressed that travel restrictions caused enormous damage to businesses relying on mobility and individuals having economic interests in tourism.

    “Gostin et al.26 expressed that travel restrictions caused enormous damage to businesses relying on mobility and individuals having economic interests in tourism.”
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    • cites [26] Gostin, 2003, Ethical and legal challenges posed by severe acute respiratory syndrome, JAMA source

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    Findingcitation

    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.”
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    • cites [25] DiGiovanni, 2004, Factors influencing compliance with quarantine in Toronto during the 2003 SARS outbreak, Biosecur Bioterror source

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    Findingcitation

    Communication inequalities comprise discrimination against Asian populations, unverified claims about lifting quarantine measures, and breaking quarantine orders by organizing unauthorized gatherings and anti-quarantine protests.

    “Such inequalities comprise discrimination against Asian populations,48 unverified claims about lifting quarantine measures49 and breaking quarantine orders by organizing unauthorized gatherings and anti-quarantine protests.50”
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    • cites [48] Lin, 2020, Solidarity with China as it holds the global front line during COVID-19 outbreak, J Travel Med source

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    • cites [49] Rubin, 2009, Public perceptions, anxiety, and behaviour change in relation to the swine flu outbreak: cross sectional telephone survey, BMJ source

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    • cites [50] Ohlin, 2020 source

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    Findingown data

    The review identified a research gap in the gender impacts of mass quarantine.

    “Our review also identified a research gap in the gender impacts of mass quarantine.”
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    Findingcitation

    John et al. emphasized the invisibility of gendered home care in countries undergoing mass quarantine.

    “They emphasized the invisibility of gendered home care in countries undergoing mass quarantine and called for rights-based support to prevent violence against women.”
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    • cites [28] John, 2020, Lessons never learned: crisis and gender-based violence, Dev World Bioeth

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    Findingcitation

    In a study of H1N1 preparedness among indigenous citizens, some interviewees argued that adults with school-aged children could provide home schooling if both schools and workplaces were shut down in mass quarantine.

    “In a study of H1N1 preparedness among indigenous citizens, some interviewees argued that adults with school-aged children could provide home schooling if both schools and workplaces were shut down in mass quarantine.24”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [24] Charania, 2013, Assessing the effectiveness and feasibility of implementing mitigation measures for an influenza pandemic in remote and isolated First Nations communities: a qualitative community-based participatory research approach, Rural Remote Health

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    Findingcitation

    The authors of the included study argued that women might delay visits to hospitals because being hospitalized would risk their family care responsibilities.

    “The authors also argued that women might delay visits to hospitals because being hospitalized would risk their family care responsibilities.”
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    • cites [21] Abramowitz, 2015, Community-centered responses to Ebola in urban Liberia: the view from below, PLoS Negl Trop Dis source

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    Findingcitation

    John et al. maintained that the trend of domestic violence cases escalated since the COVID-19 lockdown in both Hubei province, China and the UK.

    “John et al.28 maintained that the trend of domestic violence cases escalated since the COVID-19 lockdown in both Hubei province, China and the UK.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [28] John, 2020, Lessons never learned: crisis and gender-based violence, Dev World Bioeth

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingcitation

    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.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [25] DiGiovanni, 2004, Factors influencing compliance with quarantine in Toronto during the 2003 SARS outbreak, Biosecur Bioterror source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingcitation

    One Chinese study argued that male respondents under quarantine were 3.5 times more likely (odds ratio = 3.5, 95% CI = 1.6-7.7) to report psychological disorders, defined as scoring seven and more in the 30-item General Health Questionnaire, albeit without psychiatric diagnoses for clinical confirmation.

    “Considering the implications of quarantine on men, one Chinese study argued that male respondents under quarantine were 3.5 times more likely (odds ratio = 3.5, 95% CI = 1.6–7.7) to report psychological disorders (defined as scoring seven and more in the 30-item General Health Questionnaire), albeit without psychiatric diagnoses for clinical confirmation.30”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [30] Mihashi, 2009, Predictive factors of psychological disorder development during recovery following SARS outbreak, Health Psychol source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Scholars have raised concerns over travel, ethical, legal and equity challenges during confinement in the COVID-19 pandemic.

    “In the current response to the COVID-19 pandemic, scholars have raised concerns over travel, ethical, legal and equity challenges during confinement.13–16”
    Quote in the paperNot a substantial claim0 of 4 sources checked
    • cites [13] Gostin, 2020, Responding to COVID-19: how to navigate a public health emergency legally and ethically, Hastings Cent Rep source

      Not checked in the free run.

    • cites [14] Lewnard, 2020, Scientific and ethical basis for social-distancing interventions against COVID-19, Lancet Infect Dis

      Not checked in the free run.

    • cites [15] Studdert, 2020, Disease control, civil liberties, and mass testing – calibrating restrictions during the COVID-19 pandemic, N Engl J Med source

      Not checked in the free run.

    • cites [16] Parmet, 2020, COVID-19 – the law and limits of quarantine, N Engl J Med source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    Diverse psychological and social consequences of mass quarantine in previous and current epidemics were evident, but individual country policies had been highly varied in how well they addressed the needs of affected individuals, especially those who are socially marginalized.

    “Diverse psychological and social consequences of mass quarantine in previous and current epidemics were evident, but individual country policies had been highly varied in how well they addressed the needs of affected individuals, especially those who are socially marginalized.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Mass quarantine is a cause of the social consequences identified in the review.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    The Mixed Methods Appraisal Tool (MMAT, version 2018) was applied to evaluate qualitative, quantitative and mixed-methods studies.

    “Considering quality assessment, the Mixed Methods Appraisal Tool (MMAT, version 2018)19 was applied to evaluate qualitative, quantitative and mixed-methods studies”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [19] Hong, 2018, The Mixed Methods Appraisal Tool (MMAT) version 2018 for information professionals and researchers, Educ Inf

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    None of the eligible studies were excluded based on the results of the quality appraisal.

    “None of the eligible studies were excluded based on the results of our quality appraisal.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    Studies satisfying at least four of five criteria were considered 'high quality'.

    “Studies satisfying at least four of five criteria were considered ‘high quality’.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Two authors independently screened all searches by title and abstract.

    “Two authors (I.Y.C. and P.A.) independently screened all searches by title and abstract.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    Ethics articles were examined using the five-item ethics critical appraisal matrix by Jansen and Ellerton.

    “ethics articles were examined using the five-item ethics critical appraisal matrix by Jansen and Ellerton.20”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [20] Jansen, 2018, How to read an ethics paper, J Med Ethics source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The study followed the PRISMA guidelines for design, analysis and interpretation of results.

    “We followed the PRISMA guidelines for design, analysis and interpretation of results.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductown data

    All instruments for measuring social consequences of mass quarantine were employed on an ad hoc basis, except that two studies of SARS applied the Impact of Event Scale-Revised.

    “All instruments for measuring social consequences of mass quarantine were employed on an ad hoc basis, except that two studies of SARS applied the Impact of Event Scale-Revised.27,32”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductown data

    Of all 15 included studies, 6 were of low quality and 9 were regarded as high quality.

    “Of all 15 included studies, 6 were of low quality and 9 (2 quantitative studies,32,34 all 5 qualitative studies21,23,24,29,31 and both ethics studies26,28) were regarded as high quality.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    Two authors conducted data extraction independently and compared the results.

    “Two authors (I.Y.C. and P.A.) conducted data extraction independently and compared the results.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The protocol is registered with PROSPERO (CRD42020183756).

    “The protocol is registered with PROSPERO (CRD42020183756).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationcitation

    Mass quarantine affected health care access through the reallocation of health care resources to the outbreak emergency and by deepening health inequity among vulnerable populations.

    “Mass quarantine affected health care access through the reallocation of health care resources to the outbreak emergency and by deepening health inequity among vulnerable populations.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Mass quarantine is a cause of the social consequences identified in the review.

  • May combine two claims.

    Interpretationreasoning

    Food access during quarantine varied and could be country specific.

    “Food access during quarantine varied and could be country specific.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Mass quarantine is a cause of the social consequences identified in the review.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationcitation

    Their results highlighted the interconnectivity between the business economy and employment.

    “Their results highlighted the interconnectivity between the business economy and employment.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [29] Kodish, 2019, A qualitative study to understand how Ebola virus disease affected nutrition in Sierra Leone – a food value-chain framework for improving future response strategies, PLoS Negl Trop Dis source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationcitation

    The authors argued that these precautions, intersecting with SARS-related stigma against Asian businesses, could potentially harm the local economy.

    “The authors argued that these precautions, intersecting with SARS-related stigma against Asian businesses, could potentially harm the local economy.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [22] Blendon, 2004, The public’s response to severe acute respiratory syndrome in Toronto and the United States, Clin Infect Dis source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    The review's findings may be generalized to neither all countries worldwide nor identity-specific individuals.

    “Our findings may be generalized to neither all countries worldwide nor identity-specific individuals.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Previous studies have suggested negative associations between the extent of communication inequality and countries' outbreak preparedness, hindering the effectiveness of containment efforts and weakening societies' capability in response to health emergencies.

    “Previous studies have suggested negative associations between the extent of communication inequality and countries’ outbreak preparedness,49,52 hindering the effectiveness of containment efforts and weakening societies’ capability in response to health emergencies.53–55”
    Quote in the paperNot a substantial claim0 of 5 sources checked
    • cites [49] Rubin, 2009, Public perceptions, anxiety, and behaviour change in relation to the swine flu outbreak: cross sectional telephone survey, BMJ source

      Not checked in the free run.

    • cites [52] Lin, 2014, What have we learned about communication inequalities during the H1N1 pandemic: a systematic review of the literature, BMC Public Health source

      Not checked in the free run.

    • cites [53] Lin, 2014, Media use and communication inequalities in a public health emergency: a case study of 2009–2010 pandemic influenza A virus subtype H1N1, Public Health Rep source

      Not checked in the free run.

    • cites [54] Lin, 2017, Tuning in and catching on? Examining the relationship between pandemic communication and awareness and knowledge of MERS in the USA, J Public Health (Bangkok)

      Not checked in the free run.

    • cites [55] Savoia, 2013, Communications in public health emergency preparedness: a systematic review of the literature, Biosecur Bioterror source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    Mass quarantines can lead to multidimensional social consequences and may potentially heighten existing disparities across various contexts.

    “Mass quarantines can lead to multidimensional social consequences and may potentially heighten existing disparities across various contexts.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationcitation

    During COVID-19 lockdowns, the social consequences of mass quarantine have added to the emotional burden and heightened existing communication inequalities in society.

    “During COVID-19 lockdowns, these consequences have added to the emotional burden and heightened existing communication inequalities in society, defined as uneven abilities of individuals or social groups in accessing, processing and disseminating information on health topics.47”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [47] Viswanath, 2006

      Not checked in the free run.

  • May combine two claims.

    Study design and conductnone given

    Most included studies are subject to sampling bias, with heterogeneous characteristics of research populations.

    “Secondly, most of the included studies are subject to sampling bias, with heterogeneous characteristics of research populations (e.g. urban, rural, high-income and low- and middle-income settings).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationcitation

    Distance learning may seem feasible in urban settings but highlights digital inequality in remote areas with limited network infrastructure as well as in people living in poverty.

    “Distance learning may seem feasible in urban settings but highlights the digital inequality in remote areas with limited network infrastructure as well as in people living in poverty.66”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [66] United Nations Children's Fund, 2020

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Recent reports suggested positive health effects of reduced air pollution during COVID-19 lockdown.

    “Recent reports suggested positive health effects of reduced air pollution during COVID-19 lockdown.84,85”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [84] Chen, 2020, Air pollution reduction and mortality benefit during the COVID-19 outbreak in China, Lancet Planet Health source

      Not checked in the free run.

    • cites [85] Venter, 2020, COVID-19 lockdowns cause global air pollution declines with implications for public health risk, Proc Natl Acad Sci

      Not checked in the free run.

  • May combine two claims.

    Study design and conductreasoning

    The majority of included studies focus on SARS and EVD, and the scale and geographic locations of community-wide movement restrictions may not be comparable to the COVID-19 pandemic.

    “The majority of the included studies focus on SARS and EVD, whereas the scale and geographic locations of community-wide movement restrictions may not be comparable to the COVID-19 pandemic.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The International Monetary Fund has forecast a worldwide recession caused by COVID-19 lockdowns.

    “The International Monetary Fund has forecast a worldwide recession caused by COVID-19 lockdowns.81”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [81] International Monetary Fund, 2020 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Interpretationnone given

    Food insecurity refers to hoarding supplies and panic buying in high-income countries, but it may result in starvation and famine at population levels in low-income countries.

    “Food insecurity refers to hoarding supplies and panic buying in high-income countries, but it may result in starvation and famine at population levels in low-income countries.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The review's findings did not thoroughly identify all the social consequences of mass quarantine.

    “Lastly, our findings did not thoroughly identify all the social consequences of mass quarantine.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The review was registered in PROSPERO under CRD42020183756.

    “CRD42020183756.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductcitation

    The review cannot provide insights into the debate over cost-effectiveness of mass quarantine but offers evidence through the lens of individuals' perceptions of economic hardship.

    “Our review cannot provide insights into the debate over cost-effectiveness of mass quarantine but offer evidence through the lens of individuals’ perceptions of economic hardship.82,83”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [82] Eichenbaum, 2020

      Not checked in the free run.

    • cites [83] Craze, 2020

      Not checked in the free run.

63 of 63

  • The paper relies on this without support.

    No prior studies have systematically assessed the social consequences of mass quarantine.

    “Nevertheless, no studies have systematically assessed the social consequences of mass quarantine, defined as the impact of large-scale population-based containment with movement restrictions on individuals in specific social contexts.17”

  • The paper relies on this without support.

    Little is known about the negative implications of community confinement that countries should consider in developing mitigation strategies in managing the current COVID-19 pandemic and preparedness for future epidemics.

    “Little is known about the negative implications of community confinement that countries should consider in developing mitigation strategies in managing the current COVID-19 pandemic and preparedness for future epidemics.”

  • The paper relies on this without support.

    Mass quarantine may result in far-reaching social implications because most activities in society involve local, regional and international travel.

    “As most activities in our society involve local, regional and international travel, movement restrictions attributed to mass quarantine may result in far-reaching social implications.”

  • The paper relies on this without support.

    Mass quarantine is a cause of the social consequences identified in the review.

    “negative social consequences of community-based quarantine”
4 of 4

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Existing gender inequalities in labour, income, personal safety, education, and food security intensified during the pandemic, with regional variations.

    “existing widespread gender inequalities in terms of labour, income, personal safety, education, and food security intensified over the course of the pandemic, with important regional, national, and local variations and disparities.”

    From The Lancet Commission on lessons for the future from the COVID-19 pandemic (2022) · cites this paper as [286]

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Blendon study is given two publication years

    Minor

    The study table dates Blendon et al. to 2003, but its corresponding reference gives 2004.

  • Hawryluck study has conflicting research-design classifications

    Minor

    Table 1 classifies Hawryluck et al. as quantitative, whereas the quality assessment calls it a mixed-methods study.

  • Kodish study is given two publication years

    Minor

    Table 2 labels the cited Kodish study as 2013, while Table 1 and reference 29 date it to 2019.

  • Wilken study has conflicting research-design classifications

    Minor

    Table 1 classifies Wilken et al. as qualitative, but the quality assessment counts study 34 among the two high-quality quantitative studies.

4 of 4

Cites

Flagged first, then by citations

Research works printed but not linked: 16

  1. Dunford, 2020, Coronavirus: the world in lockdown in maps and charts
  2. Intenational Energy Agency, 2020, Changes in Transport Behaviour During the COVID-19 Crisis
  3. World Health Organization, About Social Determinants of Health
  4. International Labour Organization, 2020, ILO Monitor: COVID-19 and the World Of Work: Updated Estimates and Analysis—Second Edition
  5. Médecins Sans Frontières, 2015, Pushed to the Limit and Beyond: A Year Into the Largest Ever Ebola Outbreak
  6. Fraser, 2020, VAWG Helpdesk Research Report No. 284
  7. Kochhar, 2020, The Financial Risk to U.S. Business Owners Posed by COVID-19 Outbreak Varies by Demographic Group
  8. United Nations Children's Fund, 2020, COVID-19: Are Children Able to Continue Learning During School Closures? A Global Analysis of the Potential Reach of Remote Learning Policies
  9. The U.S. Small Business Administration, 2020, Paycheck Protection Program
  10. Andani, 2020, We All Lose When We Exclude Refugees, Asylum Seekers and Migrants
  11. HM Revenue & Customs, 2020, Work Out 80% of Your Employees’ Wages to Claim Through the Coronavirus Job Retention Scheme
  12. Dagens Nyheter, 2020, Annika Linde: En Månads Stängning Hade Gett Oss Tid
  13. Statistics Sweden, 2020, GDP Indicator: Sharp Contraction in Second Quarter 2020
  14. Nikel, 2020, Norway Opens Border to Most Nordic Countries, Sweden Restrictions Remain
  15. Eichenbaum, 2020, Containing COVID-19 Will Devastate the Economy. Here’s the Economic Case for Why It’s Still Our Best Option
  16. Craze, 2020, COVID-19 Hurts the Most Vulnerable – But So Does Lockdown. We Need More Nuanced Debate

Cited by

Sorted by citations

Related

Authors
Chu, I. Y.-H., Alam, P., Larson, H. J., & Lin, L.
Affiliations
  • London School of Hygiene & Tropical Medicine (GB)
  • University of Washington (US)
Corresponding author
Lin, Leesa
ORCID
Venue
Journal of Travel Medicine
Publisher
Oxford University Press (OUP)
Published
2020-10
Volume
27
Issue
7
ISSN
  • 1195-1982 (ISSN-L)
  • 1708-8305
DOI
10.1093/jtm/taaa192
PMC
PMC7649384
OpenAlex
W3091974420
Semantic Scholar
147c2e8543f78983f26f3717586e389b0377de89
Cited by
247
References
79
Citations by year
2026: 7 · 2025: 22 · 2024: 44 · 2023: 52 · 2022: 60 · 2021: 57 · 2020: 5
FWCI
3.42
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of Travel Medicine (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
Funders
  • Merck
  • GSK
  • Economic and Social Research Council’s 1+3 Studentship
  • Taipei Veterans General Hospital-National Yang-Ming University Excellent Physician Scientists Cultivation Programme (S103-F-052)
  • Wellcome Trust (215373/Z/19/Z)
Topics
  • Social Sciences › Psychology › Clinical Psychology › COVID-19 and Mental Health
  • Social Sciences › Sociology and Political Science › COVID-19 Prevention and Impact
  • Physical Sciences › Mathematics › Modeling and Simulation › COVID-19 epidemiological studies
Keywords
COVID-19 lockdown, social consequences, psychological distress, food insecurity, economic hardship, health care access, education service delivery, gender-based violence, altruism, social inequality, social determinants of health, infectious disease outbreaks, pandemic preparedness, communication inequalities
MeSH terms
COVID-19, Communicable Disease Control, Disease Outbreaks, Female, Humans, Male, Mental Health, Pneumonia, Viral, Public Health, Quarantine, Social Isolation, Socioeconomic Factors, Travel, World Health Organization, Coronavirus Infections, Risk Assessment, Pandemics

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-06.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-06.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

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