Adherence to stay-at-home orders: awareness, implementation and difficulties of officially ordered quarantine measures in the context of the COVID-19 pandemic in Cologne – a retrospective cohort study

OBJECTIVES: To estimate the awareness, implementation and difficulty of behavioural recommendations and their correlates in officially ordered domestic isolation and quarantine during the COVID-19 pandemic. DESIGN: Online retrospective cohort survey conducted from 12 December 2020 to 6 January 2021 as part of the Cologne–Corona Counselling and Support for Index and Contact Persons During the Quarantine Period study. SETTING: Administrative area of the city of Cologne, Germany. PARTICIPANTS: 3011 infected persons (IPs) and 5822 contacts over 16 years of age who were in officially ordered domestic isolation or quarantine between 28 February 2020 and 9 December 2020. Of these, 60.4% were women. OUTCOME MEASURES: Self-developed scores were calculated based on responses about awareness and implementation of 19 behavioural recommendations to determine community-based and household-based adherence. Linear regression analyses were conducted to determine factors influencing adherence. RESULTS: The average adherence to all recommendations, including staying in a single room, keeping distance and wearing a mask, was 13.8±2.4 out of 15 points for community-based recommendations (CBRs) and 17.2±6.8 out of 25 points for household-based recommendations (HBRs). IPs were significantly more adherent to CBRs (14.3±2.0 points vs 13.7±2.6 points, p<0.001) and HBRs (18.2±6.7 points vs 16.5±6.8 points, p<0.001) than were contact persons. Among other factors, both status as an IP and being informed about the measures positively influenced participants’ adherence. The linear regression analysis explained 6.6% and 14.4% (corr. R²) of the adherence to CBRs and HBRs. CONCLUSIONS: Not all persons under official quarantine were aware of the relevant behavioural recommendations. This was especially true in cases where instructions were given for measures to be taken in one’s own household. Due to the high transmission rates within households, HBRs should be communicated with particular emphasis.