Returning to work and school after the coronavirus is urgent and necessary. Virtually all public health officials agree on the three capabilities necessary to reopen society:
- Availability of tests to identify those actively infected and capable of infecting others.
- Exhaustive contract tracing to identify those exposed and potentially infected.
- Self-isolation of those exposed until they are no longer likely to infect others.
The requirements for testing and contract tracing are the subject of much public debate. But missing from the conversation is another step central to our ability to reopen—the “Q” word, controlled quarantine.
Identifying those exposed to the virus is important, but we make a grave mistake by stopping short with the recommendation only to self-isolate.
We know what works from the experience of East Asia. Those exposed to the virus are placed under controlled quarantine.
The preferred method is to isolate all those exposed in a special facility, for example in a single-occupancy hotel room.
There, those in quarantine are allowed only fleeting contact with staff dressed in full hazmat gear for fourteen days from exposure.
During that time, they are required to monitor and report their temperature and symptoms twice daily. Their status is monitored, recorded, and reflected on a personal QR code, green for clear, yellow for those exposed and not yet cleared, and red for actively infected.
Identifying those exposed to the virus is important, but we make a grave mistake by stopping short with the recommendation only to self-isolate.
They are also required to disinfect all urine and feces after using the toilet and before flushing, as the COVID-19 virus is also transmitted by the oral/fecal route. Entry to all public spaces is dependent upon having a green QR code and normal temperature, measured on entry.
Conditions of self-isolation are far less stringent. As practiced in the U.S., those exposed and even ill may reside at home, preferably in a separate room.
The chances that they will expose others in the household, despite precautions, is very high.
Those exposed who are not ill often feel free to enjoy a walk around the block, a visit to a local grocery store or even a run in a nearby park, all activities that may expose others should they be pre-symptomatic or even asymptomatic.
The consequences of avoiding strict and controlled quarantine of those exposed will be prolonged person to person transmission. Rather than the epidemic reaching a peak and quickly subsiding—as has been the case for most East Asian countries—the infection rate will plateau and remain high for a prolonged period.
We may flatten the curve via self-isolation only to find we have to climb again, though this time not to the top of a mountain peak but rather a long flat ascent, glimpsing the downslope only at a distance. That is what is happening in Europe and seems to be happening in high incidence cities in the United States today.
We have the hotel space needed—the great majority of our hotels stand empty.
What is absent is the will to utter the “Q” word and put controlled quarantine into action. Even the most ardent advocates of testing and contract tracing have not yet committed to such a move.
Without quarantine, our suffering will only be prolonged, along with the continued disruption of our lives and livelihoods.