Tyler Cowen takes a stand on quarantine in his latest piece for Bloomberg:
There has been surprisingly little debate in America about one strategy often cited as crucial for preventing and controlling the spread of Covid-19: coercive isolation and quarantine, even for mild cases. China, Singapore and South Korea separate people from their families if they test positive, typically sending them to dorms, makeshift hospitals or hotels. Vietnam and Hong Kong have gone further, sometimes isolating the close contacts of patients.
I am here to tell you that those practices are wrong, at least for the U.S. They are a form of detainment without due process, contrary to the spirit of the Constitution and, more important, to American notions of individual rights. Yes, those who test positive should have greater options for self-isolation than they currently do. But if a family wishes to stick together and care for each other, it is not the province of the government to tell them otherwise.
My view is that a voluntary quarantine cannot be effective in achieving any goal that has been mentioned for the lockdowns, at least not in the absence of more social cohesion than we possess. Take Illinois’s example. After two months of “stay at home” directives and businesses being shuttered, wouldn’t you think that the number of new cases would start declining? Not only are they not, they’re accelerating.
I think that from that you can only draw the conclusions that the tactics were doomed from the start, that something a lot more strenuous than a voluntary quarantine was necessary, and that the primary goal being served by the present tactics is political.
The most likely outcomes are either lifting the directives by gubernatorial edict (the same way in which they were imposed), soft rebellion, or hard rebellion. The governor appears to be backing himself into a corner rendering the first alternative less likely. I’m hoping for a soft rebellion, i.e. enough people start ignoring the directives that they become untenable.
Mr Cowen mistakes the key characteristic of quarantine.
The key is “out of home” — not the mandatory part. The US already has “home” and “mandatory” (subject to enforcement) quarantine for positive cases today.
There is data that voluntary out of home quarantine with partial compliance makes a big difference. Israel has a voluntary out of home isolation / quarantine program with about 30% compliance — the Ultra Orthodox and non-Jewish population do not participate. Israel did reduce their outbreak very rapidly.
Social cohesion is very high in Israel. The Ultra-Orthodox are quite clannish—they start out sort of self-quarantined. I cannot tell you what the situation among Israel’s non-Jewish population is but I suspect that the Israeli government doesn’t know, either. I’m suspicious of any numbers reported about them.
I’m not an expert at social cohesion in Israel.
I note the IDF at one point sealed off a whole Ultra-Orthodox community because the community refused to observe home isolation even while the community had a huge outbreak.
https://www.theguardian.com/world/2020/apr/06/calls-to-seal-off-ultra-orthodox-areas-adds-tension-to-israels-virus-response
The Ultra-Orthodox are cohesive — but they do not comply to temporal authorities.
Anyway — the key point is 30% compliance makes a big difference.
My point was not to compare groups within Israel but to contrast Israel with the U. S. I don’t think Israeli experience means much for the U. S. other than “if Americans were willing to be as compliant as Israelis” which we aren’t.
I do not know what the voluntary compliance rate would be here — because nobody has even tried.
If there were cash incentives, on-site medical care, free internet, and doctors said its a good way to prevent infecting your family, compliance maybe good enough.
Israel and other countries can rely on solidarity — here we rely on money.
Too many would take the money and then sneak out at night.
Lot’s of people still won’t wear their seatbelts.
Oh, oh, looks like I’m at my limit for Bloomberg articles for the month, but at Marginal Revolution he says he’s not making a legal argument, nor arguing against historical quarantines (like Typhoid Mary) of a smaller scale.
In any event, I think his due process claim is poor; the Constitution authorizes post-deprivation process in exigent circumstances, otherwise there be no quarantines. And historically I think the quarantine was at-home, initiated by placing a placard on the house announcing that someone on the premises had an infectious disease and forbidding anyone coming and going. If the person protested that she wasn’t infected, she would file a habeas corpus petition with the court and challenge any authority to detain her. One hundred years ago, the authority would be in the statute of the state and local public health departments. One issue that arose might be whether the least restrictive quarantine is being implemented to fulfill its purpose. I suspect that tended towards at-home restrictions, particularly since quarantines arose more prior to WWII when the U.S. had little administrative capacity.
I assume CuriousOnlooker would argue that he favors the least restrictive quarantine, which is isolation of only the infected person, as opposed to stay-at-home orders for everybody, whether or not infected, and which is in any case insufficient to preclude spread within the home.
Illinois: Last night Metro East Democrats voted 12 to 2 to reopen their county ahead of the Governor’s schedule. (Metro East is the Illinois portion of the St. Louis metro)
The Governor is threatening to withhold federal funds to city/local governments that defy his orders. Which is probably a bluff, but would hurt the people the funds were intended to help.
This morning he reportedly called the legislature to session, something Chicago Tribune columnist Rod Blagojevich urged his friend to do months ago. I think the Governor has played out his hand, even though his polling still looks good.
Thank you PD, explained it better then I could have.
I think Tyler is correct. What is the point of discussing solutions that are politically practical or acceptable?
For all those interested (probably none) we have summed up our experience with our first 700 pts. Outcome was death or discharge. We looked at mortality, intubations, length of stay, risk factors and some other factors. We divided this into 2 groups. (This looked only at pts admitted to the hospital.) One before we adopted our current protocol and one after. In the before group we found that mortality was a bit over 18%, after was a bit over 13%. We intubated about 23% before protocol and 8% after. (Mortality for intubated pts in both periods was the same.) Length of stay went from 7 days to 5 days. The one definite risk factor was age. Interestingly Hispanics had a lower mortality rate. I am guessing we just didnt have enough pts rather than assuming we did something special.
What we dont know is which part or parts of our protocol made a difference. Also, this is just one study and even though the p values were all under 0.002 what we did needs confirmation elsewhere and we will continue to track our own experience. Hoping to look at long term effects.
So, if our numbers are even close to being correct, I think this suggests that part of the value of flattening the curve was not to just have a lower peak rate for hospitals, but to also achieve fewer deaths.
Steve
“I think that from that you can only draw the conclusions that the tactics were doomed from the start, that something a lot more strenuous than a voluntary quarantine was necessary, and that the primary goal being served by the present tactics is political.”
Gee, wish I’d thoughta that……………
Now I’m not sayin’, I’m just sayin…….steves hero………..
https://www.zerohedge.com/markets/pandemic-computer-model-used-professor-panic-was-deeply-flawed-and-he-was-banging-radical
‘wouldn’t you think that the number of new cases would start declining? Not only are they not, they’re accelerating.’
Are they cases or are they positive tests? The ICU/ventilator usage and death rates IMO are the stats to look at. Also it seems pretty well established by now that the main mortality demographic are the elderly with co-morbidities trapped in the disease incubators called nursing homes.
‘The Ultra-Orthodox are cohesive — but they do not comply to temporal authorities.’
Because the state of Israel wasn’t founded by their Messiah. And no I don’t want to be around when He shows up. End of Days isn’t a time I’d want to try and live through (and I probably wouldn’t).
‘What we dont know is which part or parts of our protocol made a difference. Also, this is just one study and even though the p values were all under 0.002 what we did needs confirmation elsewhere and we will continue to track our own experience. Hoping to look at long term effects.’
Steve, the most important thing you and your staff did was quickly ADAPT to the situation and constantly work at improving it, which from your data point you did. Learning quickly from mistakes and more importantly not worrying about whether what you did or didn’t do made you look good or not. Hopefully there won’t be an autumn outbreak that will force you to have to tweak your protocols some more.
So on the word of the convicted felon who bilked a billion dollars out of investors we should decide Ferguson’s model has issues? At least my hero doesnt do jail sentences. Try again. (zerohedge should stick to goldbug mania. Much more convincing on that topic.)
Steve
The Worst Death Of All may not be from the coronavirus..
Something very fundamental is dying right now and each day that goes by it inches closer to its final demise. In all the talk of epidemiological models and projected deaths and all the discussion of unemployment and lost economic opportunity, we would do well to remember there are things more important. If we lose sight of the fact that the other is just as human as we are, we will reduce ourselves in ways that no economic recovery will be able to overcome.
The number of new deaths per day is rising. ICU/ventilator use for COVID-19 patients has been flat for over a month—so flat in fact that I think it’s an artifact.