Quarantining: a mentally distressful but physically comfortable experience in South Korea

Study populationSample population under quarantine during the COVID-19 pandemic

Since the outbreak of COVID-19, the Korean government imposed a 14-day quarantine together with the 3T strategy (test, trace, treat) for those who were exposed to confirmed cases and in-bound travelers in the early stage [19, 20]. All preventive measures, including quarantine and screening spots, were managed by local district councils and local community public health centers in local governments coordinating with central governments. The Project of Seoul COVID-19 Study for Quarantine (SCS-Q) was jointly conducted by the Seoul Health Foundation with the affilicated districts of Seoul Metropolitan Government. Accordingly, people living in Seoul Metropolitan City, aged 19 years or older, under a two-week quarantine from October to November 2020, were the subjects of this study.

Quarantinees voluntarily participated in the cross-sectional online survey. A total of 5,175 people under quarantine from October to November 2020 were asked to participate in this online survey. Response to the survey was conditional to the subject’s consent. In total, 1,139 (22.0%) agreed to complete the questionnaire.

Control population before the COVID-19 pandemic

To measure the impact of quarantine on HRQoL during the COVID-19 pandemic, a comparison group was established from nationally representative data from the Korea Community Health Survey (KCHS), which has been conducted annually since 2008 on a target population of adults aged 19 years or older [21]. Given that the KCSH includes standardized and validated questionnaires to assess community health status, such as EuroQol-5-Dimensions (EQ-5D) for HRQoL, we selected a group of people similar to the sample case from the KCHS 2019 conducted from August to October 2019 before the COVID-19 pandemic. To do so, the propensity score matching (PSM) technique [22, 23] was employed to pair the quarantinees with participants of the KCHS who are most like them in accordance with the propensity scores computed as a function of individual characteristics such as sex, age, dwelling district, income, working status, education, and hypertension as predisposing diseases. These covariates were selected based on their significance by performing logistic regression with a stepwise selection option.

Health-related quality of life

Generalized HRQoL instruments are designed to be applicable across all diseases or conditions, different medical interventions, and a wide range of populations [24, 25]. In this study, the EQ-5D, a widely used generic instrument of HRQoL, was used to survey HRQoL among quarantinees during the COVID-19 pandemic. The study used the validated Korean version of the questionnaire [26, 27]. The EQ-5D, with a range of 0 to 1 representing death to perfect health, comprises five questions on mobility, self-care, usual activities, pain or discomfort, and psychological status with three possible answers for each item (1 = no problem, 2 = moderate problem, 3 = severe problem). Responses to individual dimensions of the EQ-5D were also explored.

Statistical analysis

Categorical variables are expressed as frequencies and percentages, and continuous variables are expressed as means and standard deviations (SD). Chi-square test for categorical variables and Student’s t-test for means were performed. The Mann-Whitney median test for continuous variables and Fisher’s exact test for categorical variables were performed where appropriate.

Factors contributing to the overall EQ-5D scores, calculated based on the Korean Tariff [26, 27], were analyzed with a beta logit distribution considering ceiling effects and anticipated violations of normality and homoscedasticity [28, 29]. Since the EQ-5D scores range from 0 to 1, the bounded variables were rescaled for beta regression [30, 31]. In addition, each domain of the EQ-5D was dichotomized into “no problem” versus “any problems” and analyzed with logistic regression adjusting for socioeconomic and health-related variables. All statistical analyses were performed with SAS 9.4 software (SAS Institute, Inc., Cary, NC).

Ethical statement

This study was approved by the institutional review board of the Seoul Metropolitan City (IRB No. 2020-10-0001). All participants provided informed consent online before initiating the survey.

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