Coronavirus (COVID-19) support study experiences of and compliance with self-isolation: main report

5.3 International Traveller participants' attitudes and experiences of self-isolation

5.3.1 International Traveller views on the effectiveness of the self-isolation strategy as a means of helping prevent the spread of COVID-19

While agreement that 'self-isolation is an effective way to help prevent the spread of COVID-19' was high among International Traveller participants (81%), it was lower than observed among Index and Contact Case participants (92%). Views on the effectiveness of the self-isolation strategy did not vary significantly by type of self-isolation undergone, with the exception that strong agreement with the statement was higher among those self-isolating at home (42%, compared with 32% in managed isolation). [Figure 5.5, Table 5.6]

International Traveller participants fully compliant with their own isolation were more likely than those who partially complied to agree that the strategy is an effective way to prevent the spread of the disease (83%, compared with 76%)^[53]. [Table 5.6]

5.3.2 Views on where decision-making around self-isolation should lie

The majority of International Traveller participants did not agree that 'it should be up to the individual, not the government, to decide whether they need to self-isolate or not' (70%), a lower proportion than among Index and Contact Cases combined (83%). One in six (15%) did agree that the decision should sit with the individual. [Figure 5.6, Table 5.7]

International Travellers self-isolating in managed isolation were more likely than those self-isolating at home to agree that individuals, not the government, should decide when to self-isolate (20% and 14% respectively). [Table 5.7]

5.3.3 Belief that restrictions for international travel were effective in reducing the spread of COVID-19 and variants

International Traveller survey participants were also asked the extent to which they agreed that 'international travel restrictions will help reduce the spread of COVID-19 and new variants of it'. Around six in ten (61%) agreed that the rules will help, while two in ten disagreed (20%) and a similar proportion (19%) neither agreed nor disagreed. Those in managed isolation were less likely than those self-isolating at home to agree that the international travel rules would help reduce the spread of the virus (51% and 63% respectively), as were those who were partially compliant (55%) compared with those who were fully compliant (63%). [Figure 5.7, Table 5.8]

Agreement that international travel rules will help reduce the spread of COVID-19 was highest among the oldest International Travellers (74% among those aged 65 and over, compared with 60% among those aged 16-64). [Table 5.8]

International Travellers with previous experience of self-isolating were also less likely than those with no prior experience to agree that the international travel restrictions were helpful (55% versus 64%). [Table 5.8]

Agreement that international travel restrictions are effective was significantly higher among those who agreed that self-isolation was effective in preventing the spread of COVID-19 (72%) than among those who disagreed that this was the case (9%). [Table 5.8]

5.3.4 What impact did self-isolation have on the mental health of International Travellers?

International Traveller participants' perceived impact of self-isolating on their mental health was similar to that observed for Index and Contact Case participants combined. Half (49%) reported a negative impact, 8% a positive one and for 43% the reported impact was neither positive or negative. Those International Traveller participants in managed accommodation were more likely than those isolating at home to report a negative impact on their mental health (57% and 48% respectively). [Figure 5.8, Table 5.9]

As was the case for Index and Contact Case participants, young International Travellers were more likely than others to cite that self-isolation had a negative impact on their mental health (63% of those aged 16-24, as did 56% of those aged 25-44, 43% of those aged 45-64 and 32% of those aged 65 and over). Those who had been asked to self-isolate previously were also more likely to report a negative impact (56% and 45% respectively), as were those who were partially compliant (57%) compared with those who fully complied with their own isolation (47%). [Table 5.9]

Chapter 8 includes findings on financial support needs, the impact of self-isolation on their mental health and access to informal support.

5.3.5 Perceived financial hardship during self-isolation

The level of perceived financial hardship among International Traveller participants was similar to that observed for Index and Contact Cases that took part. Half (50%) indicated that they managed comfortably on their household income while self-isolating, while 14% reported struggling. Those self-isolating at home were more likely than those in managed isolation to report being comfortable on their household income during self-isolation (52% and 38% respectively). [Figure 5.9, Table 5.10]

In line with Index and Contact Cases, perceived financial hardship varied according to household income and area deprivation for International Travellers. Younger International Travellers were more likely than older age categories to indicate struggling on their income during self-isolation (15% among those aged 16-24 and 19% aged 25-44 compared with 10% of those aged 45-64 and 5% of those aged 65 and over), as were those living in the two most deprived SIMD quintiles (21% comapred with 11% of those living in other areas). [Table 5.10]

5.3.6 Impact of self-isolation on different aspects of finances

Self-isolation impacted on the finances of International Travellers in a range of ways with 52% indicating that they had paid more for online deliveries than normal, 39% that they had spent more on groceries, 27% that they had lost income and 20% that they were likely to lose their job or miss out on work.

When analysed by self-isolation arrangement, those in managed isolation were more likely than those isolating at home to mention losing income (40% compared with 25% of those self-isolating at home) and losing their job/missing out on work (31% and 18% respectively). [Figure 5.10, Table 5.11]

Figure 5.10 Ways in which finances were impacted by self-isolation by arrangement type (%)

Finances impacted by self-isolation	All International Traveller participants	Managed isolation package	At home with test kit
Likely to lose my job/miss out on work	20%	31%	18%
Paid for online deliveries wouldn't normally have needed	52%	54%	52%
Paid more for groceries than I would normally	39%	38%	39%
Lost income	27%	40%	25%
Paid for a dog walker	4%	5%	4%
Impact finances in another way	36%	65%	30%

International Travellers more likely to mention financial impacts on their employment, income or paying more for groceries/ deliveries included those aged 16-44^[54] and those with a household income of <=£16,900. When asked to describe the other ways in which self-isolation had impacted on finances responses included paying for tests and the cost of managed isolation packages. [Table 5.11]

5.4 Positive and negative impacts of self-isolation (qualitative interviews with Index Cases, Contact Cases, and International Travellers)

5.4.1 Mixed and negative impacts of self-isolation

On the whole, qualitative interview participants (of all case types) were more likely to report mixed or negative impacts of self-isolation. A number of interview participants spoke of the health impacts of self-isolation, which were predominantly related to mental health, with physical impacts appearing to be due to actual COVID-19 infection. Although the majority of interview participants appeared to be able to cope with self-isolation measures with relative ease, others stated that they found the experience very stressful and emotionally challenging. It was also said that stress levels rose within households, affecting others living there.

"It was quite difficult. It was really tough. Really emotional, just because of the fact that you can't go out and you've got a disease that you don't know nothing about…I'd say staying in for ten days was really challenging and really emotional." (Index Case)

"I must admit I actually felt like I was getting depressed I was sitting vegging, not getting dressed, just sitting in front of the telly because I was just like what's the point? There's nowhere to go, I've nothing to do. That was hard for me." (Contact Case)

The main factors cited were the inability to go outside, exercise and enjoy the fresh air; not being able to see partners, family or friends in person; not coping with family demands (especially not being able to entertain younger children); and as has been mentioned elsewhere the challenge of dealing with pets. However, there was a range of additional issues identified, though the participants noted that this was not always necessarily due to self-isolation as opposed to having COVID-19 and experiencing lockdown and other aspects of the pandemic itself.

"I'm quite a gregarious person and I really like the company of other people, friends and family, and I miss that desperately, and my partner misses that desperately as well. We miss the contact, not being able to interact with other people, and that's awful…The negative impacts are that mentally it's been a real strain. The whole of this lockdown and restrictions and the rest of it is a very, very negative effect. There's nothing positive about it." (International Traveller)

"You can see people on FaceTime or Teams or whatever it might be, but it's not quite the same as seeing someone in person. That was an odd sort of issue, mental health sort of issue, I guess…I think certainly that, and I think certainly just the lack of fresh air and the lack of sunlight, all that sort of thing. Can't quite get that from your home…I had to self-isolate, and I think in some sense I welcomed the break, welcomed a bit of time alone to recoup. Then there's also that lack of socialisation, the lack of contact with other people; lack of freedom, which is a very odd feeling to be told you can't leave your home. It's for the right reasons, but it's odd nonetheless. Very mixed, I would say." (Contact Case)

5.4.2 Impacts in the context of specific personal circumstances

Personal circumstances and contexts also impacted upon people's experience of self-isolation. For example, a few interview participants had experienced death of close family members (not COVID-related) prior to self-isolation, and then had to deal with the aftermath when they were unable to go out and meet with others. Also, participants were trying to cope with seriously ill members of the same household who had COVID-19, as well as continue with their own lives, as they still had to work or look after other household members.

"We had to isolate twice because the whole family had COVID at that point, so our isolation wasn't the normal. We had to go on the longer, up to 28 days, because then the other family members started getting the COVID, so it took us time to actually go out of COVID and the normal isolation everybody would have done…I think it led to heightened emotions between the family because you are all isolating, in terms of who is going to cook and having food to eat and all that support. Even though I had some stuff delivered to me, you have to be cleaning the place and all that once you've used it. It led to some level of stress…I easily get stressed or easily get angry even though I don't have to, because you've just been at one place for a long period of time. I think that was the major thing I would say, because I was just getting upset quite easily for no reason, like certain things I'm not supposed to get annoyed at just became annoying because I was stressed. That would be the major thing I would say." (Household Contact Case)

A minority of participants said that they had financial concerns that appeared to get more pressing during self-isolation. This was due to either the participants or their partners not being able to work, falling into arrears with rent or as a result of unpaid bills.

International Travellers, particularly those with experience of facing hotel quarantine within and outwith the UK, tended to have more negative views of self-isolation. This seemed to be due to having less space and control over their own environment.

One participant argued that she thought there was a stigma associated with having a COVID-19 infection. Her view was that others assumed she and her family had behaved inappropriately, and were in some way to blame for their own infection. It should be noted that other participants did not appear to share this perception. The same participant was also very frustrated that she and her partner missed COVID vaccination appointments when isolating, and no rearranged appointments had been made at the time of interview.

"I kind of think there's a bit of stigma around about it whereby people are kind of judging how do you manage to catch it? As if you've done something that you shouldn't have done. So I think that's affected me more than I thought it would because you know we haven't broken any rules, we hadn't done anything that we shouldn't have done...we were hoping to rearrange our vaccinations but they didn't give us alternative appointments, we couldn't get alternative appointments and they just said to us well you'll just go back on the allocations list and we'll write out to you whenever." (Index Case)

5.4.3 Positive impacts or experiences of self-isolation

A minority of participants were able to report positive elements of the self-isolation process. Of these, the main positive aspect reported was that those self-isolating were behaving properly or 'doing the right thing', they were acting in a manner which should have reduced the transmission of a potentially deadly virus and were contributing to society's fight against COVID-19. This did seem to be the main motivating factor which aided the adherence to self-isolation measures.

"The positive impact for me is I'm playing my part. I'm doing what's expected of me. This is what I want to model for my children. Sometimes there are rules. I don't always like them, but this is the reason that we're being asked to do this." (Contact Case)

"The positives are obviously that you're not spreading it to anybody and you're not a risk to anybody else. I wouldn't say there were any real negatives." (Index Case)

A few participants also stated that they benefited from the break, and it allowed them time to heal, recoup and improve their mental and physical well-being. Also, the fact that family members and close contacts who had experienced serious illness as a result of COVID infection were now recovering was viewed positively.

"I think for me, because of what I've just been through and I've been through a lot of stress and a lot of panic attacks and things like that, my ten days at home actually helped my mental health because I didn't have to deal with the outside world, because me dealing with the outside world now is causing me panic and things like that. So, it was actually for me, ten days to lie in my bed, watch TV and just be. It probably helped a wee bit." (Index Case)

"Well I didn't have much time off in the last year so ten days in the house it was'nae that bad." (Household Contact Case)

Other positive aspects that were reported included the support from family members and friends, even if they were not able to meet in person, and an improvement in household finances as there was no option to go out and spend money. It was also claimed that it made it easier to relate to the experiences of others who had been self-isolating.

Encouraging self-isolation

While adhering to isolation requirements wasn't easy for all participants, it was perceived that having a self-isolation period was important in terms of tackling COVID-19 and should continue to be supported by Test and Protect. Interviewees were asked if anything more could be done to make the isolation period easier and encourage people to adhere to all isolation requirements. As previously mentioned, improvements to communication and accessibility of information and support were noted. Reducing the isolation period and allowing outdoor exercise for those who test negative for COVID-19 were also suggested by interviewees. As the survey and qualitative interviews have illustrated, International Travellers found hotel quarantine both financially and emotional challenging. Therefore, allowing those International Travellers who live in Scotland to self-isolate at home rather than quarantine in a hotel was one way participants thought the requirement to self-isolate could be made easier as it would assist people both financially and emotionally.

"To isolate I think is important; I don't think it's something you should get rid of; I think it's necessary…I'm enough of a realist to know that as long as we have high numbers of COVID, we need to isolate, or if you're coming from a country where there seems a higher rate, isolating….It's just one of the things that you'd have to do." (International Traveller)

"Only use it as a last resort, self-isolation as a very last resort, not as the norm, as it is at the moment…if I had been trusted to come into Scotland, to land in Scotland, go straight on to my home destination and come to my house, then that would have been fine. Had I arrived in Scotland and been put straight into a hotel, that's wrong. That cannot be allowed, because you have hotels that are full of people that are self-isolating, so if any one of them has got it everyone will get it, because you have an air conditioning system that recycles air. I bet the filters on it are nowhere near as good as the airline filters." (International Traveller)

It was stressed by participants that they adhered to isolation requirements to protect others and to help in the effort to tackle COVID-19. However, it was felt that some may only adhere to self-isolation guidelines if they are either incentivised or deterred (e.g. isolation monitored, or issued a penalty for breaking self-isolation rules) but implementation of either approach was deemed problematic. Incentives or monitoring people's movements would be ethically questionable, expensive and may not be effective.

"My son lives in the [name of country], but he travelled home and then he had to have a period of self-isolation…he had at least four phone calls checking that they were where they said they were. I quite liked that because I felt that they were following up on what they were meant to be doing. I don't know, maybe consequences for people that were not self-isolating, but to be honest, even as I'm saying that I don't know how that would be policed. I think maybe making it clear that people have a responsibility. They've got to play their part and we're all in this together kind of thing. I quite liked the fact that they did get in touch with my son on numerous occasions to check that he was still at this address and he was doing what he was meant to be doing and that he knew the dates that his self-isolation period ended." (Contact Case)