Significant social support may be necessary to allow clients diagnosed with COVID-19 to safely self-isolate and contacts to safely self-quarantine. For some of the most vulnerable populations in the United States, self-isolation or self-quarantine will be a hardship that may be impossible without additional assistance. Adherence to isolation and quarantine instructions will greatly depend on each individual’s safety, comfort, and health during this period. Social support services must be an integral component of a jurisdiction’s case investigation and contact tracing activities. In developing jurisdictional protocols, programs must define their social support services package and eligibility criteria.
Many clients with COVID-19 and close contacts will be able to self-isolate and self-quarantine at home with a basic kit of resources, such as cloth face coverings, gloves, thermometers, hand sanitizer, disinfectants, and health education materials. Others may need additional wrap-around services, such as food and pharmacy delivery, laundry services, and garbage removal. Also, financial considerations must be made for those whose employment will be affected by their need to self-isolate or self-quarantine. There may be additional needs that persons with disabilities may require to successfully self-isolate or self-quarantine. Jurisdictions can adapt the Self-Isolation and Self-Quarantine Home Assessment Checklist pdf icon[2 pages] to evaluate individuals’ ability to safely isolate or quarantine in their homes.
Care resource coordinators will be essential in this process, acting as a bridge between the client and key service providers. The case resource coordinator will assist the client in identifying services available to meet their needs. It will be essential that these staff be able to communicate in a culturally and linguistically appropriate manner. In some instances, care resource managers may be reflective of the affected communities and viewed as a trusted resource. Jurisdictions are encouraged to engage community leadership and community-based organizations that have strong ties to specific groups in the community with unique needs such as members of tribal nations, refugees, migrants and recent immigrants. This is particularly important during case investigation and contact tracing associated with clusters or outbreaks. If jurisdictions are unable to employ a care coordinator, they should ensure that case investigation and contact tracing staff are appropriately trained to evaluate client and contact needs, assess their eligibility, and link them to the appropriate resources.
- Basic social support such as food, household supplies, laundry, pharmacy, and garbage removal services. Internet access should also be considered.
- Provision of a telemedicine safety net pool of providers for on-call clinical consultations with clients and contacts who do not have a primary healthcare provider. Transportation to medical care should also be considered.
- Health insurance navigation, Medicare/Medicaid assistance, mental health treatment services, substance abuse and misuse services.
- Childcare and/or dependent adult care services support should also be considered for those who are the primary caregivers for family and other household members.
- Economic support to recover income lost during the self-isolation/self-quarantine period, including working with employers to provide paid time off, unemployment assistance, and negotiations with landlords.
Success in this area will require assessment of individual needs and cultural factors within communities, in addition to multi-sector partnerships to bring resources together for comprehensive support for individuals, their families and their communities. Jurisdictions should take inventory of the existing resources available to assist clients and contacts who are self-isolating/self-quarantining, as well as their families, and find ways to fill any critical service gaps.
Once social support services are in place, jurisdictions will need to determine how to rapidly triage requests and assess eligibility. It will be essential to have mechanisms in place to ensure that people under self-isolation/self-quarantine orders receive expedited waivers for eligibility criteria or an alternative source of support for basic psychosocial needs. Absence of timely support may cause hardship and a break in self-isolation/self-quarantine.
Throughout the nation, there are many close-knit families with multiple generations living in the same household. Clients and contacts in these living situations may need to be supported with alternative living arrangements in order to protect their families and other household members. Others who may need alternate housing support include people being released from correctional institutions and those experiencing homelessness.
To address these situations, jurisdictions should identify facilities that can be used for alternative housing, as well as criteria to determine eligibility and access to out-of-home isolation and quarantine accommodations. Public health departments will need to engage other local government agencies and community organizations to partner for locally relevant housing solutions. Alternative housing may be necessary for people self-isolating/self-quarantining who are healthcare workers, living in group housing, living with individuals at high risk for severe disease, discharged from hospitals or correctional facilities, and experiencing homelessness and others in need. Behavioral health teams should be involved in the planning for these sites to facilitate continued access to support for people with substance use or mental health disorders.
Some states have established emergency orders to use hotels in order to support the isolation and quarantine of COVID-19 clients. Other states have engaged in cooperative agreements with facilities on an as-needed basis. Jurisdictions are using local hotels, dormitories, and disaster relief housing units for individuals who need to be relocated from their homes. Some jurisdictions are establishing large shelters in public buildings to house and monitor people experiencing homelessness. Others are setting up outreach systems for check-ins to monitor clients and contacts at tent encampments. It is important that facilities that are used for out-of-home isolation and quarantine be able to provide basic services and resources to those temporarily housed there.