Rather than fisking Ross Douthat’s latest New York Times column, I want to focus on one relatively short section:
Four key measures, on top of treating the ill and maintaining physical distancing, must be in place not just to slow the rise of Covid-19 cases, but also to bend the curve downward. These are: test widely, isolate the infected, trace the contacts of those infected and quarantine appropriately.
Of all these measures, the one that will require the greatest adaptation on the part of the American public is isolation and quarantine. Where this has been most successful it has required separate designated facilities to accommodate and monitor those isolated with mild illness and those subject to quarantine. We call this approach “smart isolation and quarantine†or “smart quarantine.â€
The United States needs to adopt smart quarantine as soon as possible. It will require us to endure new and difficult challenges. But the long-term benefits — fewer infections and deaths, a quicker return to work and “normalcy†— will far outweigh the short-term hardships.
There are three main challenges to building a smart quarantine system in the United States. First, we must vastly increase our capacity for testing and tracing contacts.
Second, we must create — and at times mandate — humane quarantine processes. With considerable success, China, South Korea and Singapore have tested far more of their populations and concurrently mandated tiered isolation and quarantine.
Third, American families will be asked to endure separations that are more difficult than what many have currently experienced. Family units are the hotbed of viral spread, and doing the right thing for your family simultaneously does the right thing for the community.
First, ignore the Chinese experience. We simply do not have enough information to know what it was. How many people have contracted COVID-19 there? How many died? How many were tested? What was the testing regime? We don’t know the answer to any of those questions.
Second, to the extent that there is any relationship between testing and cases or deaths, it’s a positive correlation.
Third, he’s flat out wrong in this claim:
the one that will require the greatest adaptation on the part of the American public is isolation and quarantine
We were already more isolated than any of the other countries before the outbreak.
Fourth, we are already nearing the number of tests per million population of South Korea, the most frequently cited success story. No country to date has tested its entire population. If that’s the plan, it presents a daunting logistical problem. Producing enough tests, administering them, processing them, reporting the results, and so on for a population of 330 million people are all enormous tasks. Not to put too fine a point on it but if that’s what’s needed we should declare defeat. We won’t accomplish it.
Quite in contradiction to Mr. Douthat’s claim, I think the most daunting problem of his four steps is contact tracing. We do not have the legal or civil infrastructure to support such a thing. Oddly enough, Google and Facebook are much better prepared for that than the federal government is.
I would propose a somewhat different plan:
- Stop testing for diagnostic purposes or, at least, limit such testing.
- Test a sample of the population sufficient to gauge the spread and intensity of the contagion. That is probably in the thousand rather than the millions.
- Test more intensively within “hot spots”. We don’t have the political or legal infrastructure for that. We should develop it quickly.
- Strongly discourage the media from spreading alarmist disinformation. Examples of this from recent days include the claim that grocery workers are becoming sick and dying of COVID-19 (the contagion or death rates among them is actually no higher than the general population), and spreading the lie that COVID-19 was created by the United States.
- Use the Defense Production Act more lavishly to produce protective equipment, ventilators, tests, and the materials to make more of them.
Experts, whether actual expert or self-proclaimed, need to adjust themselves to the facts. The United States is not a small, compact, densely populated, socially cohesive country in which the people will meekly comply with directives. We are a vast, sprawling, fractious country that prefers to confront problems head-on and throw material at them until something sticks.
Contact tracing (and testing) is well within existing state public health laws, done in particular for VD, TB, and food borne illness. The problem is state/county funding always finds other more pressing needs.
BTW, might want to add a few multipliers to number of tests needed. A clean result today is no guarantee for tomorrow.
You don’t need to test hot spots. You already know that due to population density and personal temperament the NYC’s and Miami’s of the world are going to be hot. You need to test outlying areas or travelers from to see if infection is escaping.
A point never mentioned: stipulate that a) no vaccine is on the immediate horizon, b) a critical level of non-compliance remains the rule of the day, c) effective marshal law is not in the cards, then, just about everyone is eventually going to become exposed and infected. There really is no firewall except for sufficient infection penetration that herd immunity starves the virus of potential hosts.
Our approach is a weak holding action at best, fundamentally ineffective at worst.
Most don’t get that sick. This Dr. using testing to predict who’s at risk to intervene early.
https://www.foxnews.com/media/california-doctor-develops-process-for-identifying-extreme-covid-19-cases-and-how-to-treat-them
Contact tracing of the type proposed here and imposed in South Korea is either illegal or legally unclear in the US.
For example; in South Korea, the authorities have the right to grab historical location data for a confirmed case (without warrant), and publicize it so the public can figure if they were in contact with the carrier. The information can be shared with other jurisdictions.
This probably violates HIPAA and other privacy laws in 100 different ways.
Congress should get on debating the legal aspects because without it, contact tracing won’t be effective since it is becoming established people are infectious for up to 5 days before becoming symptomatic and 20-50% of infections are asymptomatic.
That’s certainly my view. As usual Congress is the primary impediment to such a policy. The open question is whether any strategy could render it legal in the absence of declaring martial law. Once Congress has tried its hand, it will be the courts’ turn.
Basically, I think the entire idea is impractical here.
Since Congress wrote HIPAA; they have the power to amend it.
I doubt the courts would interfere unless there was gross abuse — judges are human too and I doubt they want to own the responsibility of managing an epidemic; or be blamed for causing one.
Do you really think the NSA HASN’T been doing this for the last 15 years? They’re been digesting the metadata for everyone with a cellular phone for that long, and probably had fantastic models to figure out who is in contact with whom (or is it the other way around?) for some time. There’s a lot of extremely powerful brains working with extremely powerful computers doing that work. The only thing is they’re not allowed to admit it publicly.
If they have, they haven’t been sharing the information with other agencies and if they did it would be a violation of the law. They aren’t supposed to be doing it at all without a warrant and sharing the information is an express violation.
How do I know they haven’t been sharing the information? Because it would be easily provable common knowledge if they had. That it isn’t means they haven’t.