Estimating the Costs and Benefits of Supported Quarantine and Isolation in Massachusetts: The Missing Link in Covid-19 Response

The slow rollout of vaccines against SARS-CoV2, the virus that causes Covid-19 disease, and the emergence of viral variants that threaten vaccines’ efficacy demonstrate the urgent need to bolster non-vaccine public health strategies to mitigate viral transmission. Quarantine and isolation are critical epidemic mitigation strategies wherein exposed or infected individuals, respectively, stay apart from others until they are no longer contagious. For SARS-CoV-2, the CDC recommends quarantine and isolation periods ranging from 7-14 days. Successfully completing this period of separation may prove too challenging for many individuals. Challenges may include forfeiting wages, forgoing procurement of basic necessities, and failing to fulfill family or community obligations. “Supported” quarantine and isolation refers to public programs that aim to help individuals overcome these challenges by providing financial incentives and wraparound services so that they can successfully complete separation periods and stop transmission of the virus. The purpose of this paper is to estimate the need for a supported quarantine and isolation program in Massachusetts and to describe a budgeting model to help the state calculate the costs of instituting them, compared to the costs of not providing them, for the duration of the SARS-CoV2 epidemic. To assess the need for supported quarantine and isolation programs we reviewed the literature on successful support programs and interviewed public health practitioners working directly with infected individuals through the Massachusetts contact tracing program. We found three main drivers of failed quarantine and isolation: the need to go to work to maintain salary, the need to purchase essential necessities, and the need for social services counseling. Our model estimates the costs of addressing these challenges, through both home-based and facility based programs. We assessed that providing these supports would result in a weighted-average cost of $430/person. Using current projections of when the epidemic will resolve and the number of new cases per day averaged over the time period from March-December 2020, our model estimates providing these services to infected individuals and their contacts would be in the range of $300-570 million, depending on the trajectory of infections over the next 211 days and assumptions regarding the number of contacts per infected individual. In addition, we modeled the medical care costs of failed quarantines and isolation, in which onward transmission of the virus is not interrupted. Each Covid-19 case is associated with ~$2,500/person in medical care expenses.1 The model estimates how sensitive direct medical costs are to the Effective Reproduction Number, (Rt), or the average number of people an infected person will in turn infect. A supported quarantine program that reduces infection transmission can offer savings in direct medical costs. For example, if a supported quarantine program could reduce an average Rt of 1.09—the average Rt of the SARS-CoV2 epidemic in Massachusetts through 2020—to 1.06, this intervention could save $610 million in medical costs, exceeding the estimated cost of the program at this level of incidence and transmission. While estimated savings are particularly pronounced when high levels of transmission are brought down, even at low levels of transmission, a reduction in Rt is associated with lower direct medical costs for payors.