This post follows up on my last post the proposes to change the focus away from quarantining the potentially infectious and instead toward isolating the ones most vulnerable to severe or fatal complications. Allow the disease to spread where most people will have at worst mild systems they can treat themselves by staying home. The better strategy is to isolate the vulnerable from exposure until there is lower infection risks either from the epidemic finishing its course or from the introduction of effective vaccines or greatly improved treatments.
This proposal is more practical than the current approach of trying to contain the spread of the disease. I may be wrong, but the following is my intuition
- It is impossible to identify every infectious person to quarantine
- Testing can not be done globally and frequently enough to catch an infection when it occurs
- Identification by possible contact will inevitably lead to unnecessary quarantines and possibly even multiple quarantines, removing those people from participating in their various non-domestic roles.
- Unless the person actually tests positive for the disease, it is uncertain when it is safe to leave quarantine. Safe release is also uncertain when a negative test follows a positive one.
- Evidence shows that the epidemic has reached a scale where the goal of containment is impossible. Even the chances of slowing the spread are rapidly reducing
- The number starts low but rises rapidly over time
- A good portion of those in quarantine need some form of outside support to take care of them while they recover on their own
- Meanwhile, it is easy to identify the most vulnerable to getting severe to fatal complications
- They are older than 50 years old or
- They have already known health conditions of hearth disease, respiratory disease, diabetes, hypertension, or cancer.
- This population does not require repeated testing to confirm their vulnerability status
- They can qualify for isolation from the rest of the population as long as they are not infected and remain uninfected. Once infected, they need to become part of the population that the remainder needs to be isolated from.
- The number starts high and decreases slowly over time.
- Isolation requires less logistics because they are otherwise healthy and can take care of themselves. For example, providing supplies to them does not expose the suppliers to risk of being infected and precautions to prevent outside infection are easier with methods such as disinfectants and double wrapping.
Whether I am right or wrong, I think it is productive to recognize that there is a choice. Currently, it seems all focus is on the quarantine approach with no real modern evidence it works. We’re basing quarantine practices on older traditions developed before there were modern data gathering techniques to confirm its effectiveness. Certainly, the concept is intuitive: keep the infectious away from the not-yet infected so that the latter can stay that way.
Is there any modern data that proves that the scheme actually works? There are practical limits for how well we can keep the infectious from being able to infect. People can infect when they do not have symptoms. The infectious agents can persist on surfaces even after disinfection efforts, allowing the infection to spread. For the current epidemic, it appears that all of the practical quarantine measures do not contain the spread and do not even slow the spread below exponential growth levels.
Quarantines are expensive to enforce and to support. In addition, they cost the wider community by the loss of their ability to participate especially if they have little to no symptoms. The operation of even the most advanced economies still depend on lots of manual in-person labor to maintain things, to keep supply chains running, to handle the refuse, running farms, keeping utilities running, etc.
If we don’t keep things operating, we will see a larger calamity of a break down of everything. I suspect the first to start to fall apart will be the communications networks of cell phone and Internet networks. The rest of will rapidly fall apart from there.
To keep everything running, we need a certain level of workforce. I recognize a lot of people are not needed in these roles, but most who are needed have specialized qualifications who are not easily replaced if they are prevented to work despite the full ability to do so.
It is inevitable that there will be a point where we must abandon the hope of containing the spread through quarantines. Our best hope of minimizing the number of deaths and of those needing intensive care is to isolate the ones most at risk if they were infected. Instead of removing from the economy those who are suspected as being infectious, we instead remove those who have known preexisting conditions or age.