Reform laws to ease burden of those quarantined

Food items left outside the home of a family of six quarantined during the Sars crisis in Singapore in 2003.
PHOTO: Reform laws to ease burden of those quarantined

The Ebola outbreak that has killed more than 900 people across West Africa since March is a timely reminder that quarantine laws may need to be reformed in the light of the Sars experience.

While the use of quarantine had well nigh disappeared in the half-century before, in 2003, Sars saw it revived on a big scale in affected cities.

In Taiwan, 131,132 contacts - those unfortunate enough to have come into contact with Sars patients - were quarantined; in Toronto, over 30,000; in Beijing, 30,173; in Shanghai, 4,090; in Singapore, 3,034; and in Hong Kong, 1,282.

A 2004 study by the US Centers for Disease Control and Prevention found that most people in these cities willingly complied with Sars quarantine orders.

But since breaking a quarantine order was criminalised, the penalties had been enough to convince many. The penalties in Singapore consisted of fines of up to S$5,800 and six months in prison.

This threat of enforcement was likely why most complied with quarantine orders despite the high costs they had to bear.

The direct costs of being quarantined included the physical distress and mental anguish of - as well as the social stigma attached to - being confined. But much less attention was paid to the financial burden these individuals bore.

By contrast, the impact on companies was widely noted. In Singapore, S$230 million was set aside in 2003 in terms of tax breaks for those sectors most affected by Sars - tourism, hotels, commercial realty, restaurants and transportation.

However, much less was done to alleviate the financial impact of a quarantine on individuals, who were entitled to a public allowance of up to only S$70 per day for the duration of confinement.

Contacts of Sars patients were confined at home for 10 days while all probable Sars cases that had been hospitalised and discharged after recovery were quarantined at home for 14 days.

Only S$2.8 million was paid to quarantined individuals and small businesses that were shuttered temporarily because their workers were quarantined. The Government called this programme "a symbolic gesture for people who have to learn how to cope with challenges themselves".

While law enforcement may think of a quarantine order as a tool for defending the perimeter, it impacts people, not places.

One fear that people have is not being paid their wages while under a quarantine order. Being compelled to take one's paid annual leave for the duration of a quarantine is tantamount to not being paid one's wages for the period.

The other fear they may have is job loss, if employers find ways to dismiss them post-quarantine.

Apart from those who are quarantined, their caregivers could have similar fears about income loss and/or job loss. In Hong Kong, a woman allegedly sacked during the epidemic just because her mother had Sars sued her former employer the following year.

If the job security of caregivers may be similarly jeopardised, they may be reluctant to provide care, in which case the burden would be transferred to public services.

In addition, if quarantined individuals have no family to help them, some might feel compelled to break their quarantine orders and get out and about to attend to their own needs.

Such apprehensions about income or job loss that may make some reluctant to comply with a quarantine order must be addressed systematically. Instead of ad hoc measures devised in the throes of an epidemic, experts suggest that institutionalising income replacement and job protection by requiring them by law would improve quarantine compliance.

But can requiring job protection and income replacement by law be ethically justified? While quarantines seek to create a good for all - that is, to minimise the risk of harm to everyone - those who are confined shoulder nearly all the financial and mental costs. Thus quarantines are inherently unfair in their allocation of benefits and burdens. If so, compensating the quarantined is fair and square.

In its November 2003 report on Sars, the Canadian government concurred that "society has a duty to provide support to those... under quarantine; equity requires that the financial burden be borne by the community as a whole, so (there should be) compensation for those quarantined".

To balance this unfair distribution of costs and benefits, the law must be amended to mandate paid leave of absence and job protection for all quarantined persons as well as all those caring for quarantined family members.

Early in the crisis, the Shanghai municipality government legislated compensation for quarantined individuals. This was to be borne largely by their employers who had to continue to pay their wages.

This measure gave affected persons a degree of certitude concerning the personal financial consequences of complying with a quarantine order.

In contrast, the Beijing municipal government did not do so. As a result, millions of migrant workers, some of whom might well have been Sars contacts, fled the city for fear of being quarantined.

Late in the crisis, the Ontario provincial government in Canada also enacted a new law mandating that workers may not be sacked from a job for complying with a quarantine order and employers had to give such persons paid leave for the duration. However, it had no compensation scheme.

In Singapore, the Infectious Diseases Act has no provision to protect the employment security of quarantined persons and their family caregivers, or provide income replacement for them either.

It should be amended to guarantee wages during a quarantine that do not come from one being made to take annual leave; assure workers the right to their jobs as well as protection from employment discrimination post-quarantine; and mandate an equitable scheme of compensation as well.

Such amendments to relieve and reassure affected individuals would equitably boost compliance with quarantine orders. This being the case, they are best enacted now and not during an epidemic.

This article was first published on August 10, 2014. Get a copy of The Straits Times or go to straitstimes.com for more stories.