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Moving Past the Quarantine

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Moving Past the Quarantine

How to get Americans back to work safely March 23, 2020
Covid-19
Economy, finance, and budgets

Public-health experts largely agree that a period of nationwide slowdown—including school closings, remote work, social distancing, and shelter-in-place orders for 80 million Americans—is necessary to curb the spread of Covid-19. As cases have escalated and threaten to overload the health system, these suppression methods are essential to “flatten the curve” of rising hospitalizations to ensure that they do not exceed our hospital capacity.

Yet these efforts come at a frightening economic cost. As in-person contact becomes prohibitively difficult, entire industries—hospitality, restaurants, tourism, and more—have shut down almost completely. Millions of workers are set to lose their jobs. The stock market is in freefall, and bankruptcies loom for both households and corporations. Steep as they are, it’s worth paying these costs to avoid even greater human tragedy. But eventually, we must consider ways to lift quarantines safely and get Americans back to work. It’s essential to use these weeks to prepare for how to do that.

It’s helpful to look at the non-Chinese East Asian countries that, so far, have tackled the spread of Covid-19 more effectively. None of these countries has imposed the sorts of quarantine efforts now being tried in America. Though schools were cancelled in Japan, they have remained in session in other countries after temporary breaks. Work and ordinary life have also continued. How have these countries managed this relative normalcy—and does their experience suggest any lessons for how America can move forward?

At this point, the level of uncertainty makes it difficult to draw solid conclusions. But it’s essential to have a public debate about the tradeoffs inherent in different quarantine strategies.

The most important policy for achieving an end to lockdowns remains mass testing. Since early Covid-19 cases are often asymptomatic—but still contagious—there can be no substitute for a widespread testing approach. So far, South Korea has led the way on scaling up testing. Such efforts could ultimately involve universal testing in certain hotspots, as has been done in the Italian town of Vò. It may also involve random-sample testing, as California and India have started, to investigate the prevalence in different communities. An industrial-scale effort to increase our testing capacity drastically, as soon as possible, remains the most urgent task. Fortunately, we have made substantial progress in this direction, including expanding testing capabilities and shortening turnaround times, but we remain far from instituting a sufficiently rigorous testing strategy nationwide.

Even if testing isn’t universal, it can be paired with other strategies to help mitigate the spread of the disease. South Korea, Taiwan, and Singapore have shown that extensive social-tracing efforts can remove clusters of infected individuals from the population. This strategy can address both symptomatic and asymptomatic cases by forcing a self-quarantine of all individuals having close contact with those who test positive. These efforts require considerable manpower and raise important privacy considerations and other tradeoffs. Several countries, for example, have begun using cell-phone location data to trace prior contacts or to ensure that quarantined individuals stay at home. When faced with the prospect of indefinite quarantine, Americans may well feel that these surveillance efforts are justified to ensure public safety.

Temperature checks have now become a regular part of life across many Asian countries. Ohio governor Mike DeWine recently mandated their daily use for employers. This is an imperfect solution. A New England Journal of Medicine article about hospitalized patients in China suggests that only 44 percent of patients present at admission with a fever. Still, temperature checking may be an important way to identify newly spreading clusters. Donald G. McNeil, Jr., a science reporter for the New York Times, emphasizes the ability of Internet-enabled thermometers to provide public-health officials with early detection of possible Covid-19 clusters. Mobile-phone applications, such as those used in China and recently launched in Singapore, may also help people self-report infection at an early stage.  

Masks are another essential component of mitigation. Though still considered a hyperbolic response in many parts of Europe and the U.S., masks, worn publicly, have become commonplace in Asia, and it’s increasingly apparent that they offer some containment benefit. Unfortunately, shortages of masks and other personal protective equipment in hospitals prevent widespread use of masks from being recommended. Rather than limiting their use, the U.S. should have followed Taiwan’s approach and launched a massive effort to increase mask production. These efforts could proceed in tandem with the system-wide building of additional hospital capacity—especially ventilators, essential to the care of Covid-19 patients suffering respiratory failure.

We should also consider more selective containment efforts. After a two-week period of quarantine—corresponding to the upper limit of the incubation period of the disease—some regions will see less community spread than others. We can then lift restrictions in these areas, permit more business activity, and institute border checks to enter cleared zones. Such a strategy may violate traditional views of America as a land of unrestricted free movement. But just as oil tankers separate interior compartments to minimize the disruption of a spill, we may need temporarily to isolate certain regions in order to revive some economic activity in others.

We should also propose different quarantine procedures for the young and the old, recognizing the reality that the elderly are far more likely to require hospitalization and face a substantially higher mortality risk than the young. In addition, individuals with preexisting health conditions such as cardiovascular disease, diabetes, and chronic respiratory disease, as well those with compromised lung function (for instance, due to smoking) face elevated mortality risks. We must find ways to ensure that these vulnerable populations can quarantine themselves and stay safe, while mitigating their economic losses and allowing lower-risk individuals to return to work.  

While any of these efforts, in isolation, may be incomplete, they may work in tandem with other mitigation strategies to reduce the all-important R0, a measure of the contagiousness of the virus. As Aaron Caroll and Ashish Jha noted in The Atlantic, individuals with Covid-19, unchecked, spread the disease to two to three additional people, leading to an exponential spread. If, through a variety of suppression efforts, we can lower this number below 1.0, the disease can be brought under control. Strong and visible efforts along these lines may also improve public trust, helping Americans feel confident enough to come out of hibernation.

We must take advantage of the time that we gain from these essential, but costly, shelter-in-place measures and invest now in strategic planning to lift the quarantine. We need an open debate about the costs and benefits of widespread quarantine efforts, the data that would help us make better decisions, and the investments required to minimize disease transmission. Each day that Americans aren’t working, shopping, or attending school represents progress in preventing Covid-19 transmission—but also countless losses to ordinary workers, who will suffer other health and financial consequences.  

Photo by Spencer Platt/Getty Images

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