Do you trust the government to protect you and your family from the novel coronavirus causing Covid-19? Centers for Disease Control and Prevention 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 means confining individuals known to have a contagious infection, usually as part of medical treatment. Quarantine and isolation can be voluntary or involuntary.
The CDC has broad authority — some say overbroad — to approve involuntary quarantines under final regulations governing domestic and foreign quarantine that were issued in January 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 credible 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 or treating people like criminals, not patients. That makes the target of disease-control efforts a person — instead of a pathogen.
But when individuals are viewed as potential threats to public health, they may feel unfairly attacked and stigmatized. And if people doubt what the government says, they may decline to follow even sensible recommendations.
Infection is not the only harm to the public during an outbreak. During the 2014-2016 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, or in some circumstances dismissed from their jobs. While the spread of misinformation, largely through the media, carries much of the blame, those who embraced, enforced, or advocated for overly strict quarantine measures certainly fanned the flames.
To gain public trust, health officials must be honest and transparent about what is and is not known about a disease outbreak, and provide useful recommendations for avoiding infection. Giving people credible information about what they can do is an important first step in facing an infectious disease outbreak.
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 social distancing, such as not going to school or work and avoiding places where others congregate.
Following such recommendations is almost impossible for day laborers who don’t get paid if they don’t go to work; for people with low-wage jobs; for people who don’t have paid sick leave; and others. 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 aren’t feeling well, because they need the money.
We need to make it possible for such individuals — who make up a large chunk of Americans — 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 quarantine settings because you still have to provide staff, food, water, medicine, and access to communication with friends and family. That’s not cheap. Just look at our prison system.
If we can give people the resources they need to stay home during a disease outbreak and avoid workplaces, schools, theaters, and other places where people gather, there would be fewer opportunities for people to fear that they could contract the virus. It would reduce the strain on our hospitals and health care systems. And most importantly, it would recognize and 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 voluntarily stay home, if it is possible for them to do so. This means preventive measures must include providing the resources that make it possible.
During the SARS outbreak, which first emerged in November 2002, the government in 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 itself can create resistance. If you’re afraid you’re going to get locked up somewhere, 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.
And quarantines aren’t without their costs. 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 HIV medications because of lockdowns and travel restrictions. The quarantine has also severely slowed China’s economy.
As the CDC and other public health agencies know, quarantine by itself may delay the spread of an infectious disease, but it cannot prevent or end any disease outbreak. It has not succeeded in the past and is ill-suited to the realities of the contemporary world.
A better way to fight infectious disease outbreaks is by creating a resilient population that is more likely to withstand potential epidemics. As my colleague Michael Ulrich and I wrote in the SMU Law Review in 2018, “Populations with good nutrition, high literacy rates, adequate income, and access to appropriate medical care, social services, and sources of reliable information are better prepared to understand the meaning of an outbreak and what to do in response.” They are also less likely to suffer severe illness if the infection spreads to them.
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.
Wendy K. Mariner, J.D., is professor of health law at the Boston University School of Public Health and the Center for Health Law, Ethics & Human Rights.
I the large majority of those infected with covid 19 disease will suffer mild symptoms why are draconian measures being adopted. Are we being told the whole truth. Listening to Mr Connor in China there are 3 stages the last being difficulty in breathing which frightened him and although a young man, has taken 40 days to recover. The chinese Doctor who discovered the virus died aged 34. Has it mutated and variants are infecting people that are more severe than the original or is the government being economic with the truth. I want to here more from those who have recovered.
It may be a huge beginning dose can overwhelm the healthy. Like with Maleria the health care providers weren’t taking precautions until they discovered that their loved ones had something else.
Iran is letting prisoners go a wise move.
thanks – going through all this right now in the “center of it”, in Seattle, WA in the USA…this was helpful to read. Major fears that we won’t ‘be able’ to go outside. This wouldn’t make sense to me, as I take long walks where I don’t interact with anyone, and stay more than 6 feet away from anyone…terrified of not being able to go outdoors.
Check on those who have this by ethnicity and those who have died by ethnicity. This should help determine whether it is a bio-weapon or not. I don’t think anyone is passing on this info.
Very wise words as far as I’m concerned quarantines can be quite useless in some types of quarantine methods any way
What I fear with COVID19 is locking people exposed but not sick up with people very sick, thereby causing people who either would have mild illness or no illness to get sick because of overwhelming exposure to a disease they may have been able to resist in the community at large.
It may have been a while since you were poor or worked for wages, but it’s not even necessarily fear, it’s a simple mathematical issue of subsistence for a lot of people.
“Fear of being quarantined itself can create resistance. If you’re afraid you’re going to get locked up somewhere, you may not want to admit you have an illness. You may not want to go to the doctor for fear of being reported.”
I think we are overusing (perhaps even abusing the concept of) the quarantine. It is not feasible to quarantine every single person who has come in contact with a person who was later diagnosed with COVID-19. For example, if a school student is diagnosed with the virus, you would then have to quarantine all the people they came in contact with (students, staff, family etc) and then all their families, and all the people they came into contact with (colleagues of the parents where they work, places they’ve dined, shopped etc.). It is more far-reaching than people realize and impossible to quarantine the entire line. We don’t do that with influenza (and the flu can be transmitted without visible symptoms). Best practice is what people should always do: practice good hygiene, stay home if you feel unwell or are showing symptoms of any illness.
Another excellent article! How can the public know what to do when the so-called information is constantly changing and others use it for personal or political agenda? That affects who I trust for information. The government/authorities should start with being truthful and giving real instruction/advice/help. Set the example and perhaps us peons will follow. :/
The reason information is constantly changing is because we are in an evolving situation with the coronavirus. More information is being learned about it as time goes on and more cases are confirmed. Stay up to date through websites such as the CDC and your local/state health department. I would discourage you (and others) from spending much time on social media discussing this as that can cause a lot of stress and fear which is unhealthy for your immune system.
Excellent points, Wendy. As do you, I too want to hear/read a description by Washington of what is meant when Trump or any govt official says ” The US is Ready!” Quarantine plans, if any are not adequate. As you bring up citizens themselves need to prepare for self-quarantine and social-distancing to the extend possible. If the President was confidently saying “we believe the risk is VERY low that any of you may be exposed to the virus. However, we urge you to be prepared to self-isolate for up to two months in the unlikely event that quarantine is recommended for your area. Stock up on all supplies you would normally need to go to the store for. Supplies you will be able to use in the future anyway. Just buy more of them now. Be prepared your children may need to home-schooled and you may need to work from home. ” Then I would feel much more confident.
Sharon, your local DOH disseminates information on how to prepare.
Hmm, it seems the author is talking of a dream work. There can never be a world where everyone is healthy, has good nutritions, educated enough to know what it means to have good health and good nutrition.
It seems the author is out of touch with reality, for a long as there are human greed, there will always be people with not enough food to eat. And what about genetics mutation that makes people had poor immune system.
In normal circumstances, what you say is very correct.
But over the years since genetic engineering we see increasing releases into the environment by accident.
AIDS came and strikes down millions of people every year. It has been multiplying now for over forty years.
Other previous escapes have been contained or nearly so.
This escape may not be so easy to put back in the bottle.
The time has come for a second international debate on genetic engineering and its safety.
At present we just get denials that the new illnesses are from ‘not so secure’ laboratories but world wide tragedies like this need exceptional measures to ensure the worlds future.
She makes some valid points. A forced quarantine would be quite damaging to not only the psyche of the country but also to the economy. A strict voluntary self quarantine will be near impossible for a vast segment of the working population, and some guidance and assistance from the Federal Govt. on how to accommodate that would be useful. Wandering off topic to the chronic ills of poor education, poor choices and mental illness is not one.
Are you seriously suggesting the HIV was created in a lab?
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