This is a question my class asked, and we interrogated about #nCoV2019 today. This is what we found—and bear in mind we’re talking primarily about consequentialism this week, so we’re still in that lane. Sorry to my Kantian and adjacent peeps ;-) [thread]
A quick problem with this view is that “freaking out early” doesn’t really track stopping things in their track. At least, by any realistic measure of most if not all health systems in the world. Diseases move faster than surveillance.
(If you want to fix that problem, get your friends to support government investment in healthcare. That goes wherever you are. Universal healthcare is a public health issue.)
But a bigger issue is that many public health measures are not net-benefit absent further context, and are highly implementation sensitive. Liberty-limiting measures in particular.
There’s a few ways a public health measure could go:
1. it works;
2. it works, is very costly, but still net-positive;
3. it is ineffective;
4. it is net-negative.
Quarantine typically occupy 2-4 depending on the context.
1. it works;
2. it works, is very costly, but still net-positive;
3. it is ineffective;
4. it is net-negative.
Quarantine typically occupy 2-4 depending on the context.
The big challenge is that we have a lot of examples of quarantine failing, but not a lot of them succeeding. One finding from the 2009 flu showed quarantine was not effective, and suggested trying other strategies. ncbi.nlm.nih.gov/pmc/articles/P…
(IMO, if you can't justify this stuff with pandemic flu, you It's hard to justify any other time.)
An editor's note in a report in MMWR stated that quarantine in Beijing during SARS may have been effective, but that they over-quarantined by 20,000 people—or 2/3 of the quarantined population. cdc.gov/mmwr/preview/m…
A study of the Canadian SARS quarantine showed that the number of people you needed to quarantine to prevent a single case—not a death, just a case—was 7-8. ncbi.nlm.nih.gov/pmc/articles/P…
For a disease with a fatality rate of around 2-3%, the number needed to quarantine to prevent a *death* is going to be very, very high indeed. washingtonpost.com/health/coronav…
To make things worse, another study stated that compliance with quarantine by Ontarians during SARS was only about 57%. Toronto quarantined 100 people per case, way more than necessary, and as a result, folks started busting out.
ncbi.nlm.nih.gov/pmc/articles/P…
ncbi.nlm.nih.gov/pmc/articles/P…
In Hong Kong’s Amory Gardens, most famously, officials who showed to quarantine folks found the place half-abandoned. embopress.org/doi/full/10.10…
Consider now the experience in Western Africa during the 2014 Ebola virus disease outbreak. Those restrictions placed huge burdens on the communities. journals.plos.org/plosone/articl…
At times, those restrictions—as can be the case in any quarantine—were incredibly violent. theguardian.com/society/2014/a…
Ultimately, where there was to be success, it was with community engagement. Even that success is probably only partial, and to be really successful would require more. cdc.gov/mmwr/preview/m…
The scars of quarantine, finally, run deep - in Hong Kong, there have already been clashes with police about the creation of quarantine blocks in advance of #nCOV2019. cnn.com/2020/01/26/asi…
We should work hard to stop outbreaks. But even though it seems intuitive to just crack down harder, and earlier, that’s not the case. At best, you’re creating more fear for no, or very little gain. At worst, driving people away from healthcare and make things much worse.
Public health officials can’t be cops. What we need is better communities of health, and that doesn’t come from freaking out and busting heads. Any effective reform of public health must necessarily also be just.
