Thread by @CarlMinzner

(1/x) Large swaths of USA now adopting extensive lockdown orders paralleling those in Wuhan.

But Wuhan's response had another crucial element: central quarantine.

Read this for a crazy, only-in-New York idea for how to break the epidemic. Perhaps useful for others too.

(2/x) Note: my only expertise is as a China specialist who was in Shanghai in January, is currently in Taipei, and has watched this play out in country after country since.

If there’s any merit to this idea, actual public health specialists, please tear out whatever is useful.

(3/x) Wuhan in late January looked a lot like NYC today. Big outbreak, hospitals severely stressed, cases coming in from all over.

Quite different from other areas in China, where outbreaks were smaller + more contained.

(4/x) Wuhan went into citywide lockdown in January 23.

Initial advice in Wuhan was to tell people to stay at home if lightly sick. That's the same advice as in NYC today. On surface, it makes sense – you don’t want hospitals overloaded.

(5/x) But there’s a problem. Simply sending lightly ill people home in highly dense urban environment like NYC/Wuhan = infecting family, friends, & roommates.

And many who are lightly ill (or asymptomatic) think: “well, I don’t feel that bad, I'll still go out and around.”

(6/x) That's a problem. That’s how and why infections can keep surging even after cities shut businesses and adopt big mobility restrictions.

(7/x) Recognizing this problem, Chinese authorities shifted tactics in Wuhan. Within 1-2 weeks in early February, they built 20-odd mass quarantine isolation centers, able to house tens of thousands of people.

(8/x) In Wuhan, they stuck *all* lightly sick people in there for 14 days. Removed them from public at large. Allowed hospitals to deal with those with serious complications.

(9/x) Remember – for most of those (80%?) who get the coronavirus, it is a less serious affair. For them, being under mandatory quarantine or in an isolation center involves twiddling thumbs or watching Netflix for 14 days until you are totally clear of infection.

(10/x) But it is *crucial* to ensure that those folks do *not* infect others, or you feed into a loop of escalating infections.

And that's what can crush the health system.

(11/x) That seems to have been one of the key steps in breaking the back of the epidemic in Wuhan. Those mass isolation centers? Now all closed down. Took about 4-6 weeks.

(12/) My read is that New York is now moving in this direction. That’s why you’re seeing the mayor talk about using Javits Center as a makeshift hospital.

(13/x) Now, this is where New York is going to face two problems.

First, building space to house tens of thousands of lightly ill people for an extended period of time. Big mobilization challenge. China pulled it off. Can NYC?

(14/x) Second, Americans aren’t going to like the concept of mandatory quarantine. Calls up black-and-white photos of thousands of people lying in beds in gymnasiums. And who wants to be separated from family and friends?

nytimes.com/2020/03/20/wor…

(15/x) Here’s where there’s maybe an opportunity to flip everything on its head – and maybe shaft the freakin’ coronavirus with a made-in-NYC response.

(16/x) NYC is sitting on thousands of empty, deluxe hotel rooms. Those could be opened, like, tonight.

Now, I know where you think I’m going. Government seizure orders.

Nope. Even more crazy.

I'm imagining hotels voluntarily opening themselves as quarantine centers.

(17/x) Imagine the low-paid Amazon delivery woman, Whole Foods employee, or nurse who has just tested positive and is terrified about what this means when they head home to live with their families in cramped apartments.

(18/x) Boom. They test positive, they go into the Ritz for 14 days. High-end restaurants organize staff to send delivery over.

(19/x) Mandatory quarantine suddenly isn’t such a horror for the infected. Also resolves their immediate fears for their families. If family members subsequently test positive, naturally they can move in as well for length of quarantine.

(20/x) Flips everything on its head too. Pairs NYC's most vulnerable - who are literally saving the city - with some of most luxurious (but currently empty) high-end property.

Do it right, NYC gets a whole WWII returning veteran vibe. Victorious GrubHub delivery driver, etc..

(21/x) Think I’m nuts? That’s EXACTLY what happened in China, when delivery guys shuttling food delivery in cities on lockdown became national heroes.

(22/x) Hotels need $$$ to make this happen? That’s what federal bailout funds should be used for – allowing hotels access to funds if they convert themselves overnight to quarantine centers.
nytimes.com/2020/03/20/opi…

(23/x) Need people to work in the facilities? As people come out of quarantine, immediately hire them to help tend to those still inside – after all, they’ve already been exposed.

(24/x) Want to make this even more fun? The current occupant of the White House personally owns properties that could do this. Challenge him to do so.

For a rich property tycoon who *dislikes* him, throw your own resources into this idea and give him a black eye.

(25/x) If for some reason anything like what is described above should ever remotely happen, could someone in Hollywood come up with a new movie about this entire episode to replace Miracle of 34th Street as the feel-good "NYC finds its heart" holiday film?

(26/x) I’m … stunned. Eyes tearing up a little.

Maybe this is how people around the world come together to figure out how to beat this thing.

(27/x) OK – a LOT of people think something like this is a good idea. Real experts. Infectious disease specialists. Historians studying how medieval societies dealt with the plague. And it looks like local authorities throughout the U.S. are gearing up to do exactly this.

(28/x) Here are some examples in case your community wants to also start thinking about this.

Florida:
tampabay.com/news/health/20…

(29/x) Los Angeles (h/t @scrivenix):

ktla.com/news/coronavir…

(30/x) New York

"The city’s other efforts included reserving 1,500 hotel rooms to potentially use for people with mild coronavirus symptoms or other illnesses, said Deanne Criswell, the city’s commissioner of emergency management."

nytimes.com/2020/03/20/nyr…

(31/x) And at least one hotel chain in India has publicly offered its own resort facilities. h/t @ngkabra

https://twitter.com/anandmahindra/status/1241622109752676352

(32/x) As many of us who are out in Asia can testify, the concept of designated quarantine hotels/isolation facilities can be used in different ways.

(33/x) First, they can be used for people who have *already* tested positive for coronavirus or are showing (light) symptoms into facilities until they get clear of the virus or need to be transferred for heightened medical care. That’s what Chinese authorities did in Wuhan.

(34/x) Second, you can create it as an option for those who *might* be infected, and who need to wait 14 days be sure they are free of the virus. Travelers coming in. Close contacts of those testing positive.

Taiwan has done that for the former. focustaiwan.tw/society/202003…

(35/x) Naturally, you do *not* want to mix those two groups. In the first one - everyone is DEFINITELY already infected. Not so in the second.

(36/x) Testing is a big problem. Ideally, you’d have effective testing in place and seamlessly combine it with either an effective monitoring/self-quarantine/quarantine hotel system, like South Korea. And in the United States at the moment, that doesn’t exist.

(37/x) But that shouldn’t stop local authorities from experimenting.

First, there *are* people throughout the country who have tested positive and want to self-isolate. But they have no option b/c don’t want to infect relatives/roommates. Figuring out how to help them is key.

(38/x) Second, even *absent* effective and widespread testing for the virus, medical professionals might be able to rapidly develop clear guidelines for quarantine/self-isolation. One example:

nytimes.com/2020/03/22/hea…

(39/x) One suggestion. Try to make the experience as positive as possible.

You’re trying to get large # of people who have tested positive – particularly those with light symptoms - to segregate themselves in quarantine hotels/facilities for an extended period of time.

(40/x) Most people want to do the right thing. They’re terrified about infecting their families and friends. And many need a place to stay.

But there’s probably going to come a point where some will think: it was just a light fever, I feel better today, why should I stay?

(41/x) Anything communities can do to make it a better experience would be good. That’s part of the original “14-days at the Ritz” suggestion. Others include:

Allowing families to move in together (households likely to be jointly infected)
Good wifi
Nice food
Toys for children

I’ll stop. This is where we need real public health experts.

Can you all come up with (or point us to) best practice guides specifically tailored to municipalities seeking to establish coronavirus quarantine centers/isolation facilities?

Perhaps the @WHO @CDCgov or @nycHealthy?

Tagging @Marriott @HiltonHotels @Hyatt @BestWestern @Radisson @LaQuintaResort @nyuschoolofmed @ColumbiaPS