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.

The other side of Qatar | Nov 2015

Upon the discovery of natural resources in its opulent desert land, Qatar transformed. Enormous amounts of wealth were injected into the state as Qatar prudently invested the gains from its resources into its economy and infrastructure, avoiding the “resource curse” that trapped many nations. However, growth requires implementation which ultimately requires labor. Certainly, the small population of Qatar is not sufficient for the ever-growing demand, and with the new rising wealth and standards of living, few natives would want to work low-skilled jobs such as construction and cleaning.

This issue plagues many oil-rich nations such as Qatar, the UAE, and Saudi Arabia. The high demand for labor to support their vast development plans begins a series of recruiting at developing countries such as India, Nepal, Malaysia, Egypt and other Middle Eastern nations, where desperate workers, many who suffer from malnutrition, sick family members, or exorbitant loans, flock there. They trade in their souls in hopes of making a few dollars to send back home, and their labor, unsurprisingly, is exploited at the lowest cost.

As Qatar prepares for construction for hosting the 2022 FIFA World cup, the demand for foreign labor in low-level jobs such as construction is on the rise, and there is no shortage in supply for these positions. A 2013 study published in the Journal of Arabian Studies states that over a fifth of migrant workers in Qatar are paid “on time only sometimes, rarely, or never”. Furthermore, those who do get paid earn 1.2% of an average citizen’s annual income. However, the article “A Radical Solution to Global Income Inequality: Make the U.S. More Like Qatar” by Eric Posner and Glen Weyl proclaims Qatar is actually reducing “global inequality” since it pays workers up to five times the amount they normally make back in their home countries. The claim is true on a purely salary-based standpoint; however, it fails to consider that the minimal pay comes at the cost of freedom, individual rights, and safety.

Aside from the poor pay, migrant workers also suffer from decrepit housing conditions. The migrant camps, located in the outskirts of the city, where low qualified workers live in are regarded as a form of ‘dormitory labor regime’ (Ngai & Smith 2007). Tristan Brulee, who spent nearly 2 months living inside a labor camp to study daily interactions, described them as “places where no one would ever choose to live given the desolate environment of the industrial areas where camps are located and the often overcrowded and filthy condition in the camps themselves”. In these areas, the roads are neglected and unpaved, with abandoned cars and rubbish lying around. Furthermore, these migrants are clearly separated from the rest of the city and are devoid of political rights. It is impossible to obtain Qatari citizenship, due to the tribal nature of the closed political system. The value of these migrants’ lives are so low, as they are deprived of space, freedom, control, and right to live a decent life. As Tristan puts it, “The camp itself is a device that deprives men of choices”.

Migrant workers take on a variety of different jobs depending on their skill level and gender. Some, like a man I met from Cameroon who holds a degree from a Western university, is the manager of a coffee shop. Another, from Ethiopia, quit his job as an accountant to become an Uber driver, since it has “more money”. But many unskilled workers are exploited, trapped under contract in Qatar, and face shams and corruption in their home countries. As if the hardships they face in their native country isn’t bad enough, these workers are constantly overcharged and deceived by greedy recruiters.

Their pay in Doha may exceed the amount they would have earned back in their home countries, but their struggle to stay alive, find jobs, and send money back to their families certainly should not be neglected. Recently, there have been increasing media attention from other countries regarding the treatment and conditions of its migrant labor population. News sources, from BBC, The Guardian, Human Rights Watch, and Amnesty International have been monitoring the labor issues in Qatar, pushing the government in Doha to take more action on the problem. Although some advancements have been made, a large portion still remains to be addressed.

It is an unfortunate fact that countries operate in a manner that fulfills their own selfish needs without considering the implications of their own actions. Qatar, a nation with such an optimistic economic standing, easily turns a blind eye to human rights issues like labor exploitation. The US is no exception, and its history in Venezuela, Ecuador, Iran, Panama, etc. is solid proof.

Until wealthy countries are able to put aside their own self-interests and actively work towards solving issues that plague the poorer lands on this planet, our true growth potential will forever be stinted.

Personal aside on Doha

Although my research in Doha only lasted two weeks, I was able to appreciate the greatness of the nation that retains its rank as the country with the highest GDP per capita.

The city I see if I set foot in Doha 30 years ago, and the city I see today are so incredibly different that I would probably not even recognize the pictures from 1977 as Qatar. This country has transformed from a fishing industry into a stunning, modern magnet, attracting foreigners from all around the world. Unlike other resource and oil rich countries that failed to invest in infrastructure or create a sustainable goal, Qatar successfully developed its hydrocarbon resources into a vision for the country.

In 1971, the Forth Field, which is the world’s largest non-associated gas reservoir, was discovered. It took 20 years to unlock the potential of this reserve, and during this time, Qatar focused on developing domestically and channeling its exports. Starting off with exporting liquefied natural gas to Japan in 1997, Qatar relentlessly scaled upwards, establishing itself as a trustworthy and flexible partner and supplier. In 2003, it constructed the Oryx GTL, the world’s first commercial-scale gas-to-liquid fuels, and throughout the 1990s, the state uncovered vast amounts of reserves. Qatar has 25 billion barrels of proven oil reserves and the world’s 3rd largest natural gas reserves, and output at current levels are projected to sustain for 56 years. Oil and gas account for about 85% of export revenues and more than 50% of GDP. Today, Qatar is the largest exporter of liquefied natural gas and gas-to-liquid fuels in the world. Its ability to monetize its natural resources allowed for its economy to boom and attain the world’s highest GDP per capita.

According to the 2015 Country Report, Qatar’s real GDP growth should average 6-7% between 2012 and 2015, increasing each year. The International Monetary Fund and the World Economic Outlook database in 2014 projects its GDP to be $227 billion in 2015, with the GDP per capita to be $94,744. Beyond oil and gas, Qatar is continuously diversifying its portfolio, investing in financial institutions, scientific research and development, airlines, and education. Qatar University, Qatar Airways, the Qatar Financial Centre Authority, and Qatar Science Technology are just a few examples of the vastness of Qatar’s recent development.

A high demand for labor accompanies this incredible growth and development, drawing thousands of expatriates, especially from lesser developed countries such as India, Nepal, Bangladesh, Malaysia, and the Philippines. Even with the immigration flood, a labor shortage persists in Qatar and the unemployment rate remains only .3%. As of November 2014, Qatar’s total population is 2,269,672 and growing. Qatari nationals number about 278,000, with the other 88% of the population non-Qataris. Indian workers represent the largest foreign nationality, with a population of about 545,000, and Nepal follows close behind at 400,000. Foreign workers constitute 94% of public-sector employees and 100% of private-sector jobs. A population pyramid according to GSDP in 2011 shows that Qatar is approximately three quarters male and one quarter female.

The awe-inspiring photos of Doha displayed in magazines are no comparison to the naked beauty of the city. The buildings, meticulously designed by expert architects, is a magnificent work of art by itself. From the Museum of Islamic art, the entire industrial center of Doha is within view, and as my friend from Qatar University puts it: “the best view oil can buy”. The Villagio, the largest mall in Qatar, is crowded with rich foreigners, designer labels, an amusement part, a skating rink, and a man-made canal that extends from the center, where visitors can tour in a boat.

On the northern side of Doha lies The Pearl, a four million square meter artificial island built to house foreign nationals. One two bedroom apartment in this area can amount to 16,000 riyals a month. The day starts early for the working population – usually around 7am, but the majority of people get off around 4/5pm. The night is filled with a wide range of activities, from cultural shows at Katara, family activities at the multitude of malls, and excellent food at the Souq Waqif.

Life is seemingly slow-paced and relaxing. The average salary is 17,144 riyals/month, and some professions such as a construction project manager earn as much as 350,073 riyals/month. However, a large portion of the population do not enjoy the same luxurious amenities as the others, as you have learned from above. A city's exterior may be magnificent, but until it is able to correct its toxic internal systems, it will not shine.