Working with COVID-19

Living in the midst of an infectious disease pandemic is scary and weird, but it’s not entirely unprecedented for any of us. Since the dawn of the 20th century we’ve had a couple of polio pandemics, a half dozen flu pandemics, cholera, ebola, AIDS, and three corona viruses, SARS, MERS, and COVID-19.

We learn a lot from each one, but we’re never quite prepared for the next one. I’m continually amazed that so few younger people know the first thing about polio, but I was one of the school kids that lined up in the main corridor for a sugar cube infused with the Sabin vaccine a few years after I got the Salk injection. Better safe than sorry.

Each outbreak features a common set of villains: frauds, quacks, and poorly-informed people who maintain the disease is no big deal and the prevention – typically a vaccine – is the really scary part. And we always have snake oil merchants offering miracle cures that really are dangerous, as TV’s Dr. Oz is doing today.

Unexpected Heroes

The historical pandemic pattern was for a whole lot of people to die until the pathogen mutated into a less deadly (but perhaps more contagious) form. This may be happening with COVID-19 since the disease has spread outside of China.

We’ll see about that, but while we’re waiting we’re relying on therapies to reduce impact and vaccines for blocking it in the years to come. And we’re obviously relying on quarantines, a very costly and inefficient intervention that falls into the “tactics of last resort” category.

We’re stuck with hand-washing and quarantines in the US because we don’t have the capacity to test people before they develop symptoms. This is in part due to the widely reported failure of CDC and FDA to get tests into the hands of medical practitioners, but also because we don’t have any sort of a contact tracing program.

US ineptitude sets us apart from the nations that are getting the disease under control, public health heroes Hong Kong, Korea, Singapore, and, to a lesser extent, Germany. In the US, quarantine fatigue is setting in and the President is itching to send people back to work long before public health experts think the quarantine’s work is done.

Playing Catch-Up is Hard

By now, most people know that the Asian tigers who brought COVID-19 under control did so with massive testing, contact tracing, and mild social distancing. Singapore has an online map showing the spread of the infection from couple 0, who brought the infection from Wuhan, to the cases reported today.

Hong Kong and Korea also trace contacts and test all of the people known to be exposed. They strictly quarantine all the positives, and I do mean strictly. Infected Koreans have to download an app that records their location when they’re supposed to be in quarantine; offenders are punished with fines and/or prison:

South Koreans have broadly accepted the loss of privacy as a necessary trade-off.

People ordered into self-quarantine must download another app, which alerts officials if a patient ventures out of isolation. Fines for violations can reach $2,500.

By identifying and treating infections early, and segregating mild cases to special centers, South Korea has kept hospitals clear for the most serious patients. Its case fatality rate is just over one percent, among the lowest in the world.

Korea is injecting money into the economy and cracking down on church gatherings – a major infection vector – but it hasn’t closed bars, restaurants, factories, or offices. You can keep most of the economy running if you’re willing to track, test, and enforce meaningful quarantines.

Given America’s slow start, it’s going to be hard for us to catch up.

Dealing with Scale

Korea has a population of about 50 million people, about ten times the number as Hong Kong or Singapore. It started testing days after diagnosing its first case of COVID-19. The country enacted laws enabling it to deal with contagions immediately after the MERS pandemic in 2015. Korea was ready for COVID-19.

The US diagnosed its first COVID-19 case on the same day as Korea, but we weren’t ready. We lost valuable time developing our own test in a government lab while four private healthcare firms developed tests in Korea and the WHO’s COVID-19 test languished on the shelf.

So now we really have no idea how many people are infected or exposed. The policy of only testing people after they show symptoms – several days after they become contagious – means we can never catch up. That’s horrible, and it means that relaxing the quarantine will spread the disease like wildfire. But how do we catch up?

Here’s a Plan

The only way to get ahead of the disease is to test people before they show symptoms, back trace their contacts, test them, and enforce quarantines for people known to be exposed or sick. We need to get the tests into the field, but we also need to know who to test first.

So we need a coordinated response across every state for contact tracing. That’s going to take a rather massive supply of computer power because we effectively need a map of social contacts that goes back a week or two. It also means kissing our quaint notions of personal privacy goodbye, at least until we get out ahead of the infection. And it means training a lot of people on administering tests.

That’s all fairly obvious, but here’s where things get interesting: many cases are mild, so infected people could continue to work as long as they’re segregated from uninfected people. Many jobs can be done by teams of infected people as long as they’re not in direct contact with the rest of us. Infected people with serious cases are not necessarily any more dangerous to each other as anyone else, right?

And people who’ve caught COVID-19 and recovered can safely work with both infected and uninfected people.

You Can’t Do That!

Right, this is America so the plan I’ve devised in this little thought experiment will never fly: it means laying down enforceable rules, violating personal privacy, and segregation. That’s all obviously heartless, brutal, and wrong and sure to make all of our most sensitive and decent people shriek.

But here’s the thing: Silicon Valley is full of firms that are tracking our movements and recording our contacts today. This is how Google and Facebook make a living, and they’re going to keep on doing it whether their datasets and computer power are used to sell ads or to protect public health. So all of those crocodile tears about privacy, behavior control, and labeling people are meaningless.

We have the technology to get ahead of novel coronavirus, we just don’t have the vision or the will to put this tech to its best and highest use. Perhaps one day we will, but I don’t see anyone advocating for the kind of interventions I’ve laid out. Whether you feel this is a workable plan or not, discuss it with friends and family and get back with me.

Next time, I’ll share some of my decade-long experience working from a home office. We all better get used to that because I don’t see the US relaxing its state-by-state quarantines any time this year.