How To Lift A Quarantine
With estimates of coronavirus deaths in the United States continuing to be revised down, politicians and analysts have begun considering how and when to open up the economy again. That good news is, depending on your perspective, good news, or it might be bad news if you’re CNN, because it “makes it harder for Trump to hold the line.”
President Trump said during Friday’s pandemic briefing that he’s considering how to begin resumption of normal activities, but also said he’s listening to more cautious health officials as well. “We don’t want to go back and start doing it over again,” he said, but, “You know what? Staying at home leads to death also…it’s very traumatic for the country.” The current guidelines for self-quarantine expire on April 30, so some decision will have to be made before then.
Former vice president Joe Biden has an op-ed in the Sunday New York Times about his “plan” to reopen America, though it isn’t so much a plan as a set of conditions that need to be met first. Biden’s three conditions are 1) a slowdown in new cases thanks to continued quarantines, 2) widespread testing, and 3) an increase in hospital capacity to respond to new outbreaks.
It’s striking, though perhaps not surprising, how Biden’s plan, as well as responses from Elizabeth Warren and Bill Gates, are all focused on things government can do rather than how they might consider what to allow again. Gates, in fact, wants to go even further, calling in the Washington Post for “a consistent nationwide approach to shutting down,” adding that “because people can travel freely across state lines, so can the virus,” darkly hinting at checkpoints at state lines.
This sort of blanket mandatory quarantine depends very heavily on public buy-in—which is already showing signs of strain—and however much it makes sense in the early stages, it’s not a good way to think about a gradual lifting of quarantines. Indeed, you “can’t just pick a date and flip a switch,” as Governor Larry Hogan said recently, but it’s time to start thinking about how we can safely start pushing up the dimmer.
This policy document from Morgan Stanley biotech analyst Matthew Harrison has been passed around a lot in the last few days, and it’s worth a read because its projections for a return to normalcy seem reasonable. They estimate that the first wave of people can return to work in early July, with a second wave of people returning to work about a month later.
The first wave contains, according to their analysis, both people who are low-risk and people who have developed antibodies. Therefore any return to work, by this logic, depends on widespread serology testing. But apart from that, if we are using the health profile of individuals to evaluate whether people can return to work—letting the young and healthy go—why not consider other categories, like occupation, mode of transportation, and others also?
This is the sort of data typically used by urban planners, rather than public health officials, but it should be taken into consideration by the latter. New York City, which has been the worst hit in America by far, is also at least twice as dense as any other city in the country, and much more dependent on public transportation. The measures that are smart and prudent in New York are likely to pose large unnecessary costs for other parts of the country. In Houston, a fairly large city, 80 percent of commuters go to work in their cars, alone—wasteful and not very environmentally friendly, to be sure, but an advantage in a pandemic. Houston is somewhat of an outlier in the other direction, but on the whole, the country is a lot closer to Houston than Manhattan.
A smarter way to evaluate risk would go beyond just considering health criteria like age and comorbidities; how we resume economic normal activity is just as important as who can. As the administration moves into weighing options for how to reopen the economy, one hopes that some effort will be put into studying these sorts of questions, to also include guidelines about the size and space of businesses and the potential for conducting business outdoors. Souks are safer than strip malls, and as unpleasant as a Southern summer can be, that humid air also seems to reduce transmission.
Even the credible appearance of government evaluating levels of risk across occupations and transportation options will help increase buy-in for measures that are still in force. What will not help increase public buy-in for quarantine measures are heavy-handed absurdities like tracking churchgoers in their cars during Easter services and banning the sale of seeds.