To understand the value of lockdowns, consider this thought experiment: this pandemic would grind to a halt if everyone in the world except essential workers stayed at home for two weeks. Doing this would deprive the virus of the chance to infect anyone outside a household. Anyone who be struck ill by SARS-nCOV-2 would develop symptoms by the end of the two week period. You would keep the households where it showed up on quarantine for an additional two weeks. Testing would dramatically expand nearly everywhere in that time period to confirm cases.
Many governments and economic elites are flinching at taking such a brutal hit to their economies. Elsewhere, in places like the Philippines, publics are critical of “community quarantine” that increasingly looks indistinguishable from martial law. Here we’ll discuss and share two strategies: one an alternative to a ‘hard’ lockdown, the other a practice that needs to happen anyway.
Hard lockdowns are legally enforced curfews using police, military, or paramilitary forces to keep everyone indoors. They were used across China with different degree degrees of rigidity. Generally, all shops but hospitals and pharmacies are ordered closed while restaurants and grocers are allowed to deliver (or customers to pick up take out). At their most extreme, one member of a family was allowed to go out to purchase groceries. Italy has imposed similar orders, followed by India a few days ago.
The lockdowns are often accompanied by a ban on inter-city and inter-provincial travel. The Philippines is now implementing a very decentralized version of this approach but more militarized. There are armed checkpoints at provincial borders across Luzon and Manila commuters need passes to travel between different neighborhoods. The decentralized approach mean people have difficulty understanding the overall policy and we’re starting to see a worrying amount of food wastage.
Because we understand how dangerous it would be to let COVID-19 reach the rural provinces and smaller cities outside the National Capital Region, we are extremely sympathetic to the reasons for this lockdown. We think there’s another way, though.
Hong Kong, Macau, Taiwan, Korea, and Singapore have so far managed outbreaks better than most other places without any formal lockdown order. Korea, in particular, is being regularly cited as somewhere with a massive outbreak that never went on lockdown. But to say there wasn’t some form of lockdown would be misreading what happened and is still happening.
What happened in Korea appears to be similar to what happened in Hong Kong: people and businesses didn’t need to be told to stay home, businesses ‘knew the drill’ and told workers to work remotely. At the peak of the Korean outbreak, Daegu felt like a ghost town. As would have happened in Hong Kong, the public and private sector accurately perceived the risks and reacted accordingly in a timely way.
In addition to collective public response, you can’t enter a clinic or hospital here without having your temperature checked and signing a health declaration form that has legally binding criminal consequences for lying. Gyms, too, have tempature checks at the door and close their doors when authorities tell them a confirmed case has recently visited. A high-end supermarket in Central is closed now merely because a confirmed case when shopping there.
Measures like this can be called a “soft lockdown.” Arguably, you don’t need militarized checkpoints and ‘Shelter in Place’ orders if you close schools and send the vast majority of workers home. Singapore, in fact, hasn’t even closed their schools because of vigilant efforts to keep sick teachers and students at home. A sufficiently alarmed and informed public will be staying home without being compelled to.
Furthermore, while the videos are certainly hilarious, we are deeply skeptical of some of the measures we’ve seen in Italy. Given that Hong Kong health authorities describe “close contact” with COVID-19 infectees as fifteen minutes at a distance of less than six feet without a mask, there doesn’t seem much empirical basis for prohibiting dog walks and jogging. The only context hard lockdown orders should be considered is when health officials determine:
- they need to move quickly
- for instance in ‘red zones’ (see: Wuhan, Lombardy, NYC)
- when current confirmed numbers don’t represent how far an outbreak has spread (see: India)
- a public isn’t sufficiently alarmed enough to take social distancing seriously
- the private sector won’t send their workers home without being compelled to.
It would be wrong to read this as recommending taking a more relaxed approach to COVID19 suppression. In truth, we think everywhere in the world should be in some form of lockdown but the Chinese model isn’t the only way to do it. Start with depriving the vast majority of people of a reason to leave the house for anything but healthcare.
Centralized Stratified Quarantine
Recently published data from Wuhan also questions the impact lockdowns had in suppressing COVID-19 compared to centralized and stratified quarantine. There had been a plan since the first days of the outbreak to separate and quarantine suspected and confirmed COVID-19 patients based on the severity of their symptoms. Isolating suspected cases and their close contacts from the general population appears to have had far more impact than keeping the general public away from each other.
The problem was that the outbreak overwhelmed hospital capacity and it wasn’t implemented until early February, when facilities like dorms and hotels were converted into fever clinics and quarantine sites. Home quarantine in hot zones does not, in retrospect, appear to be a humane or effective strategy in ‘red zone.’ Before centralized quarantine came into place, many infected people were placed in home quarantine where they infected family members and had far worse health outcomes.
Massive efforts should be made now identifying and retrofitting designated quarantine sites. Even more than the excesses seen in hard lockdowns, we fear that hasty centralized quarantine in localities that aren’t preparing now might look like internment camps. This scenario becomes more likely as frontline doctors and nurses around the world running out of PPE gear to fight this virus. There will be fewer hospitals and fewer medics to treat COVID-19 patients if this crisis isn’t resolved soon.