Intended for healthcare professionals


Covid-19: Why test and trace will fail without support for self-isolation

BMJ 2021; 372 doi: (Published 08 February 2021) Cite this as: BMJ 2021;372:n327

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Support for self-isolation is critical in covid-19 response

  1. Chris Stokel-Walker, freelance journalist
  1. Newcastle-upon-Tyne, UK
  1. stokel{at}

The spread of SARS-CoV-2 will only slow if people who test positive for the virus self-isolate. But expecting them to do so is a bigger ask than governments seem to realise. Chris Stokel-Walker reports

Carina Marquez was surprised to see the Latino man return to the test site she was running in San Francisco. He’d received a positive test result but had come back seeking advice.

“I think he was probably undocumented and still had to go to work,” says Marquez, associate professor in the school of medicine at the University of California, San Francisco, and an infectious disease expert. “He was very nervous to tell his boss and was totally conflicted.” Presenting only mild symptoms, he reasoned he couldn’t be that infectious. The patient was torn between going to work to earn money for his family and doing right by his community by isolating.

For millions worldwide, a positive coronavirus test isn’t just a medical blow but a financial one too. Internal UK government polling suggests just 17% of people showing symptoms are subjecting themselves to tests, for fear that a positive result and the ensuing self-isolation will lose them money.

It’s the same quandary Marquez’s patient in San Francisco faced—until she gave him a $500 (£366; €416) gift card to support his family. It’s part of a Californian system implemented by primary care doctors and lawmakers, called the Right to Recover Act, to encourage the city’s least wealthy to come forward for testing, funded mostly through philanthropic donations.

The policy was designed to counteract people shying away from coronavirus testing for fear they’d lose income and slip into poverty. In an October 2020 paper for Plos One, Marquez and colleagues evaluated the scheme’s success, finding it helped encourage people to self-isolate.

“All of a sudden he relaxed,” …

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