Can Quarantines Go Too Far?

Reviewing COVID-19 quarantines and the trade-off between public heath and economic crisis

Mar 20, 2020 | Medium post

Quarantines come at the expense of the economy. The shuttered businesses and restaurants are only the surface of the actualities of economic damage — it breaks an entire production chain that can have lasting effects on all kinds of people, especially the working class. So is it worth it?

  • Should we just let the virus break free in an apocalyptic survival-of-the-fittest style?

  • Should we loosen regulations, enforcing self-isolation measures and work from home protocols but keeping factories, shops, and businesses open?

  • Should we simply maintain our current level of containment, enforcing strict-isolation guidelines, travel bans for non-essential travel, and closure of non-essential businesses?

  • Or, should quarantine measures be even more stringent that what they are right now?

To evaluate these options, we first need to understand the contagiousness of the virus. Neil Ferguson, an epidemiologist at Imperial College in London, produced a study based on influenza outbreaks that showed COVID-19 to have a “basic reproduction number” of 2.4, meaning that if no precautions are taken in a world where no immunity for the virus exists, each case will lead to 2.4 secondary cases on average. Under those model conditions, within 3–4 months, the majority of the population will be infected with the disease, and given the world population of people over 65 and or have cardiovascular and respiratory problems, we could be witnessing tens of millions of deaths, potentially matching or exceeding that of the Spanish Flu in 1918.

The Economist chart below shows the exponential growth of confirmed cases of several European countries compared to that of South Korea, which implemented stringent containment guidelines and aggressive testing.

Option 1: If a survival-of-the-fittest approach is adopted, and immunity builds within the communities that are strong enough to combat the virus, we will see millions of people perish as a result. If we value human life equally among different age groups and health conditions, then this is an extremely inhumane thought. Not to mention, the demand for intensive-care units (ICUs) will far exceed the supply, leading to the overexertion of doctors and nurses and the potential collapse of the healthcare industry once Medicare starts paying out more in hospital bills than the premiums it collects.

Option 2: What if we loosen regulations and only enforce isolation for those who are older than 65, and advise social distancing to the younger population until a vaccine is developed? First, isolating the elderly population from society and their families is harmful for their mental and health, as some studies have shown. The growing feeling of loneliness spawning from targeted isolation measures can result in health problems such as cognitive decline, depression, and heart disease within that population. Additionally, many elderly people do not have caregivers, and hence need to purchase their own groceries, cook their own meals, and take their own medication, which requires them to leave their apartment for grocery and pharmacy runs. Secondly, given the high infection levels of COVID-19, we cannot guarantee that the more vulnerable population will not be infected. The virus can survive on surfaces for up to several days, and it is not unlikely that people from this population will be infected from purchasing a piece of fruit from a nearby shop. Therefore, we cannot simply isolate one population and hope that the virus will simply contain itself until a vaccine is discovered, which could take at least a year.

Option 3: So does this mean the current containment measures are the best approach? As retail stores and restaurants shut down, schools close, stock market tumble, festivals and conferences get postponed, and travel industry shatters from border closings and non-essential travel bans, how far is too far? Prominent economists remark that a recession is very likely, even if the mortality rate is limited. If we value all lives equally, we must also consider the economic carnage resulting from quarantines as jobs are lost, businesses go bankrupt, and retirement funds dwindle in worth. Hence, economic scarring may cause a bleaker future for the younger generation and more suffering for the working class. It’s hard to know exactly what will happen 12–18 months out, but we can assume that with no federal involvement, unemployment and debt will rack up. We don’t want that either.

There are many reasons to believe why it’s important for governments to enforce such strict quarantine rules on its population, but evaluating the economic impact to many businesses, the government also must assume responsibility and enact effective policies to minimize the impact, whether through a federal stimulus package, tax cuts, or other proposals. But in the meantime, strict quarantine rules must be in place to decrease the infection rate.

So long as the basic reproduction number for COVID-19 is > 1 within a country, we must dutifully abide by social distancing rules. Once the government administers rigorous testing, implements isolation measures, and the number dips < 1, then the administration can reevaluate relaxing the restrictions on businesses and using zoning rules to let people out of their homes. These changes should be gradual, because even if the reproduction number decreases, the population is not immune to the disease prior to the discovery of a vaccine. Therefore, it is likely that resurgence of the virus will start again in late autumn. If factories and businesses were to open, it should be done so with caution, with slow and steady increase of the number of people operating in the same space.

Option 4: Imposing even stronger measures will likely not have a significant impact to what we currently see now. Therefore, more attention should be placed on producing masks and ventilators, opening new testing centers, developing symptom medication, and evolving vaccine research. In the meantime, the government should put forth greater effort to mitigate the negative economic impact from this pandemic.

The moral of the story is…

Quarantine is absolutely essential to public health and ensuring the safety of vulnerable populations. However, we must not ignore the economic consequences that could cause even greater pain and suffering for the years to come. Hence, it is of utmost important that the federal government aids the economy while strict quarantine measures are in place.

What they can do:

  1. Emergency payroll tax cuts and / or universal basic income for people making under a certain threshold

  2. Emergency corporate tax cuts and / or income to affected industries (e.g., travel, SMBs, restaurants)

  3. Bridging loans to small businesses

  4. Fiscal stimulus package for large affected businesses (e.g., factories, travel industry)

  5. Expansion of unemployment insurance benefits to freelancers and the gig economy workers or independent contractors

  6. Enforce mandatory medical coverage for independent contractors by employers

So how did quarantines even become a thing? To understand the concept of “quarantine” requires analysis of its historical roots. The earliest recorded reference to quarantine emerged form the Biblical book of Leviticus:

“the priest is to isolate the affected person for seven days. On the seventh day … [the priest] sees that the sore is unchanged and has not spread in the skin, he is to isolate him for another seven days.”

Examples of this concept began taking effect in the 700s in the Islamic empire to isolate patients with leprosy. The inception of the term “quarantine” began a few centuries later in Venice. The Venetian State was a pioneer in establishing regulation and isolation practices that included quarantine, defined as isolation ranging from 14 to >40 days. In response to the severity of the Black Death of the 14th century, which claimed an estimated 200 million lives, Venice implemented trading restrictions. Any suspected shift must wait 40 days before docking in its ports. This waiting period became known as the “quarantinario”. Fast forward to the the 17th and 18th century, when the plague mades its way to shore, Venetians quickly activated an inspection system and local movement controls and isolation. Infected persons were held in “lazarettos”, which were isolation institutions. Its efforts successfully decreased the spread of the plague epidemic.

In the late 18th century, yellow fever reached Philadelphia and spiraled the city into turmoil. The governor called for stricter quarantines and vessels inspections. Following the outbreak, public health laws and water supply improvements were carried out to improve the city’s sanitary conditions.

In 1944, the Public Health Service Act established the first federal government’s quarantine authority. Quarantine stations are located in a variety of large cities in the United States, under the CEC’s National Center for Emerging and Zoonotic Infectious Diseases. This division is able to detain, medically examine, or conditionally release suspicious individuals and wildlife.

Quarantine has been used for centuries (SARs, Ebola, H1N1, etc.) due to it effectiveness in preventing the spread of contagious diseases. Quarantine and isolation are two distinct concepts: isolation refers to the “separation and restricted movement of ill persons who have a contagious disease”, whereas quarantine refers to the “restriction of movement or separation of well persons who have been exposed to a contagious disease”.

The current quarantine measures are arguably the most global it’s ever been historically. European Union instituted a 30-day travel ban on nonessential travel to at least 26 European countries. In Africa, travels bans have been implemented in Ghana, Kenya, Morocco, Namibia, and South Africa. A handful of Latin American countries are no longer accepting foreign nationals from any country. I arrived in Argentina 2 days before the country barred entry and exit to and from the United States. Nepal and India both suspended visas for foreigners, and a slew of quarantine measures are enacted in Asia, from China and Japan to Cambodia and the Philippines.

Historically, quarantines have been successful in minimizing contagion. In the case of COVID-19, we will need more time to determine whether the measures in place have successfully curbed its spread. After strict isolation measures in China, Hubei has reported no domestic cases of coronavirus for the first time since the outbreak. Whether the rest of the world will follow a similar progression towards curbing the virus is to be determined.

For the purpose of this article, I will not go into detail on the impact of COVID-19. A good post on COVID-19’s 18-month trajectory and impact on society, refer to this medium post.

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© 2020 by molly liu