DO YOU TRUST the government to protect you and your family from the coronavirus called Covid-19? Centers for Disease Control and Prevention (CDC) officials say more cases are inevitable in the United States, although they can’t predict how many and when they will appear. President Trump says the risk is low and “We’re very, very ready for this.’’ But what does it mean to be ready?
The emergence of a new infectious disease often prompts governments to consider quarantines. Officials in China recently turned to this drastic option, blocking most travel into and out of the city of Wuhan, the center of the Covid-19 outbreak. As cases appear in other countries, they, too, are thinking about quarantine.
The term “quarantine’’ means restricting the movements of individuals who have been, or might have been, exposed to a contagious disease. Although it is often used interchangeably with “isolation,’’ the latter generally means confining individuals who are getting medical treatment for a contagious infection. Quarantine and isolation can be voluntary or involuntary.
The CDC has broad authority — some say overbroad — to approve involuntary quarantines under regulations that were issued in 2017.
Before resorting to the Draconian measure of involuntary quarantine, I think we should make it unnecessary. Two complementary efforts can make that happen: providing information the public can trust; and making it possible for people to comply with disease-avoidance recommendations without excessive personal or financial cost.
So far, public health recommendations focus on asking people to protect themselves by washing their hands and covering their coughs. While this is good advice, it puts the onus on the individual. Threats of involuntary quarantine often come next, which looks a lot like blaming the victim: punishing people for getting sick. That makes the target of disease-control efforts a person instead of a pathogen. And when individuals are viewed as potential threats to public health, they may feel unfairly attacked and stigmatized.
During the 2014-16 Ebola outbreak, hysteria, politicization, and some states’ rejection of CDC recommendations created more harm than the disease itself. People were threatened by law enforcement and public officials. Children were bullied in schools. Individuals were not allowed to work and some were dismissed from their jobs. Misinformation carries much of the blame, but those who enforced or advocated for overly strict quarantine measures certainly fanned the flames.
To gain public trust, health officials must be transparent about what is and is not known about an outbreak, and provide useful recommendations for avoiding infection.
Asking people to protect themselves is necessary to help prevent the spread of infectious diseases like Covid-19, for which there yet is no vaccine or cure. But it isn’t sufficient, because not everyone can comply with recommendations like not going to school or work and avoiding places where others congregate.
Following such recommendations is almost impossible for people who are paid only for days they work. For many Americans, a few days of lost wages can mean not being able to pay the rent, buy food, or afford medications. They may feel compelled to go to work even if they feel sick.
We need to make it possible for such individuals to stay home. That means providing some source of replacement income or job security, either through the private sector or the government.
Would that be expensive? Yes. But it is equally expensive — and may be even more costly — to put people in institutional quarantines, which require staff, food, water, medicine, and access to communication with friends and family.
If we can give people the resources they need to stay home during an outbreak and avoid workplaces, schools, theaters, and other places where people gather, there would be fewer opportunities for people to fear the virus. It would reduce the strain on hospitals and health care systems. And most importantly, it would reward the sacrifice that people voluntarily make to protect the community.
People don’t want to make other people sick. They will comply with credible recommendations and stay home if it is possible. This means preventive measures must include providing the resources that make it possible.
During the SARS outbreak, which first emerged in 2002, Singapore provided economic assistance to individuals and businesses affected by the quarantine; in Hong Kong, individuals received daily material and financial assistance. The CDC’s 2017 regulations don’t mention these legitimate concerns; they only allow the CDC director to authorize payment for treating people who are involuntarily confined in a quarantine facility.
Fear of being quarantined can create resistance. If you’re afraid you’re going to get locked up, you may not want to admit you have an illness. You may not want to go to the doctor for fear of being reported. If you are told you can’t leave your city, you might flee. That’s what happened in China during the SARS outbreak. A rumor that the government was planning a large-scale involuntary quarantine caused nearly 250,000 people to leave Beijing.
The Wuhan quarantine has had numerous unintended effects, some of them fatal. People were unable to reach sick, elderly parents in the city, let alone take them elsewhere for treatment of chronic conditions like heart disease and cancer. The United Nations AIDS agency recently announced that one-third of people in China who are living with HIV were at risk of running out of their medications because of lockdowns and travel restrictions.
As my colleague Michael Ulrich and I have written, even in a reasonably resilient population like the United States, limiting the spread of a novel pathogen depends on public trust in government recommendations. But trust goes both ways. Government must also trust people to follow reasonable recommendations. And it can do that if its recommendations are reasonable and credible and people have the means to voluntarily comply with them.