As of 5 April 2020, the total number of COVID-19 cases has crossed 1.2 million with over 60,000 deaths globally attributed to the novel coronavirus. Countries have been increasingly shutting their borders, imposing travel restrictions, and millions have been locked down to curb the spread of COVID-19. Three weeks ago, Italy was already the epicentre of the COVID-19 pandemic in Europe. Like many other citizens who were worried about border closures and flight cancellations, I too was racing to get back to my home country, India from Belgium where I had stayed for about a month for a short training course. Further, with growing numbers of COVID-19 cases, the Government of India had enhanced the screening of all passengers arriving at its international airports. With these rapidly changing events in mind, I was anxious about my safe arrival in India from Europe since I had to transit through France (which was identified as one of the COVID-19 risk countries at the time).
The harrowing ordeal
After a more than 10-hour flight, I landed at the Bengaluru Kempegowda International Airport in India around 11:40 pm on 14 March 2020. As we exited the plane, I saw a group of 5–6 people on the aerobridge diligently performing thermal screening of passengers. We also submitted a self-reporting form indicating our travel history and symptoms for COVID-19, if we had any. I had the impression that India was well-prepared to tackle the COVID-19 outbreak. But this impression did not last long. At the immigration counter, the officials were unsure if they should let passengers go after the immigration check. Suddenly, a senior public health official announced that all passengers from our flight were to be mass-quarantined for 14 days at a private teaching hospital close to the airport. We panicked! Some of us tried to explain that we came from non-COVID-19 risk countries and only had a transit flight from countries identified as COVID-19 risk areas and hence should be allowed to go home. Some argued that these instructions were not consistent with information available on the Government of India websites. The official stated that he was only implementing orders he had received from higher officials. Later I learnt that similar chaotic situations prevailed at other international airports in India as well.
Feeling helpless and frustrated, we ritualistically followed the instructions we received from the public health authority. All 59 passengers were then bundled into two buses and taken to a private teaching hospital around 15 km from the airport. We were anxious, venting our feelings and frustration to our co-passengers, and making assumptions about what would happen next. One of our co-passengers retorted that the procedures for quarantine and health screening made one feel like a criminal for travelling abroad and quarantine was equated to detention for the crime committed. The crowded conditions themselves during the long wait at the hospital just to collect our basic details posed a high-risk for infection transmission.
A little later, a few police personnel and a District Health Officer arrived at the scene. When we complained about our plight to the police personnel, one of them commented that they were there only to control riots if there were any and that they had no idea of how the health screening was organized for international travellers. Some of us complained to the officer about the poor planning and filthy toilets in the hospital. The mere sight of the ugly toilets in the hospital caused retching. There was no running water in some of the toilets. To make things worse, we were told that the health screening would be conducted only the next morning and hence were asked to occupy beds in the general wards of the hospital for that night. Upon our request, bottled drinking water was distributed to us. It was 3:00 am by the time I went to sleep, both mentally and physically exhausted.
The next morning, around 8 am, all of us received a modest breakfast, the only good thing that happened to me during this long ordeal. Soon after, a laboratory technician came to collect blood samples. No explanation was given regarding the reason for collecting our blood samples, the kind of tests that would be done, and when or how the results would be available. The nurse who was checking vital signs was also unaware of the next steps. After a while, a team of three doctors arrived along with other higher-ranking public health officers. For the health screening, all three doctors used only one table for consultation, making it very crowded and chaotic. No privacy was ensured. Currently there’s a huge focus on social distancing to control the spread of coronavirus. However, it looked like the social distancing mantra was forgotten during our quarantining and health screening. There was utter confusion between the officers about whether to let the asymptomatic passengers go home or not. Finally, all asymptomatic passengers including me were advised to be home-quarantined. I have no idea what happened to the passengers who were identified with respiratory-illness-related symptoms. The media also covered the ordeal of the passengers who went through this inhumane quarantine and health screening procedure. Things could have been handled in a much better manner.
In the absence of consistent, clear information, and guidance on the follow-up from reliable sources during times of quarantine like this, 19 of our co-passengers formed a WhatsApp group. This group helped us share personal feelings, our experiences with quarantine, and exchange knowledge regarding the prevention, diagnosis, and treatment of COVID-19. The WhatsApp platform also revealed that follow-up and monitoring of the quarantined passengers by the government machinery were erratic and unsystematic. Few had received automated calls to update their health status to the Ministry of Health and Family Welfare. Few received personal calls daily. A handful of the passengers were visited by a team of health and police personnel and stamped on their left-hand indicating that they have been home-quarantined. Also, a poster was put up outside their houses to make their family and neighbours aware that they were home-quarantined. We have now completed our quarantine period, yet have not heard about the blood samples that were collected. It still remains a mystery!
Blatant violation of individual rights
The above personal anecdote illustrates several violations of fundamental individual rights. For instance, the undue delay in organizing the health screening, the crowded conditions while transporting us, the unnecessary confusion and chaos during the health screening, and improper sanitation facilities at the quarantine centre evoke concerns on the dignified treatment of quarantined individuals. Further, such an environment is a veritable breeding centre for infection and posed a threat to the individuals’ right to life. This defeats the very purpose of quarantine and isolation. Failure to provide adequate consistent information by the authorities to already panic-stricken passengers amounts to a violation of the fundamental right to information, let alone a violation of the right to freedom from (mental) torture due to the uncertainty emerging from deficient and vague information. Non-adherence to the doctrine of informed consent by the health worker while collecting our blood samples violates the standards of medical ethics. The indecisive response of the authorities and the frontline workers to our queries as quarantined passengers raises important questions about the kind of communication that transpires between the different sectors of the government and the different cadres of staff in the COVID-19 response machinery. The deep-rooted cause of such a problem could be a complex interplay of systemic factors such as the lack of human and other resources for providing respectful care, poor governance in planning and execution of the state quarantine measures, and little imagination/knowledge of the ground realities by the central planning authority.
Public health safety vs. individual rights
This anecdote points out the piecemeal approach of the government to this public health crisis. It shows that the procedures adopted for quarantining and health screening of international travellers were poorly planned and inhumane. The anecdote also show how individual rights such as the right to privacy, right to dignified treatment, right to informed consent, right to information, or even right to living could be infringed upon during quarantine procedures. Public health security is of prime concern during pandemics. At the same time, such public health crises also invoke human rights issues. Measures such as quarantine and isolation are implemented at the cost of fundamental individual rights. It is important to remember that these measures should be done safely and respectfully. Basic needs such as food, safe water, and hygienic sanitary facilities must be ensured to the quarantined individuals. The conditions under which individuals are quarantined should be carefully monitored and reviewed regularly. There should also be an accessible, functional grievance redressal system for quarantined individuals to appeal if they feel that they are being subjected to inhumane conditions. Since states have an urgency to act during pandemics, there is a chance that individual rights are overlooked. States should be mindful of human rights concerns while planning and implementing measures to ensure public health safety during pandemics. After all, we live in so-called democratic societies and a public health crisis should thus not be an excuse to override fundamental human rights. The quarantine of international travellers in India, it turns out, was only a teaser trailer for worse to come in terms of human rights infringements. See the heart-wrenching inhumane plight of the hundreds of thousands of migrant workers in India who were sprayed with disinfectant or got stranded while walking back to their home towns/villages after the nationwide lockdown. Democratic regimes are expected to uphold human rights principles much better than authoritarian governments. You wonder whether that’s always the case.
I would like to acknowledge my PhD supervisor, Dr. Sara Van Belle at the Department of Public Health, Institute of Tropical Medicine, Antwerp, for seeding the idea to write about my quarantine experience. Thanks to Kristof Decoster and Ritwik Dahake for their suggestions to refine the blog.