Quarantine to Cohorting: The Evolving Toolkits of Biosecurity

Quarantine came into limelight for most Indians during the Covid-19 pandemic. It has been used since the 13 th –14 th century in port cities of Europe to control bubonic plague, and later was used to manage other infectious diseases. In the 19 th and 20 th centuries, it was extended to be used in new-age diseases like tuberculosis (TB). The International Health Regulations established the standardization of quarantine practices. The discovery of vaccines for infectious diseases decreased the use of quarantine as a biosafety tool, and quarantine homes, “Lazaretto,” were closed until the emergence of COVID-19. Quarantine comes with its own set of ethical issues, which is debatable. The duty of easy rescue opines on the moral responsibility of citizens during enforced quarantine. There has been an increase in cases of hospital-acquired infections in recent times, mostly caused by multidrug-resistant organisms. Infection control strategies need to be developed to prevent transmission by direct or indirect means. The concept of cohorting is evolving as a new tool, but no major health organization has recommended any guidelines. India, which issued the first guidelines for intensive care unit admission in 2023, lacks the infrastructure to implement cohorting. Increasing cases of multidrug-resistant TB and extensively drug-resistant TB are an emerging public health problem in India. Community-based cohorting in a dedicated “Long-term care Facility for TB” can be proposed to prevent further spread. Cohorting is reported as a success in various studies conducted in hospital settings, but its use in community settings needs to be explored.