Coronavirus: Dancing with Myself
How Isolation and Quarantine change the game in the Fight Against COVID
“ Those who were seen dancing were thought to be insane by those who could not hear the music” — Friedrich Nietzsche
In the absence of a vaccine, isolation and quarantine are the most effective actions we can take to slowdown the spread of the Coronavirus— to decrease transmission rate (R). Without these measures, testing and tracing efforts are wasted resources. Research based on the 2003 SARS Epidemic in Hong Kong and Singapore suggests, that quarantine, social distancing, and isolation of infected populations can contain the epidemic. Another study goes one step further and states, that transmission rate and isolation effectiveness have the largest effect on R.
Can we really fight the Coronavirus, just by sitting on our couch at home and in parallel isolating the infected people? Can it be that simple?
Let’s start with the basics — what’s the difference between “isolation” and “quarantine”?
Isolation is when a person is infected with a communicable disease, and is separated from people who are healthy. In Coronavirus terms: Someone with a positive test result gets isolated.
Quarantine separates and restricts the movement of people who were exposed to a contagious disease to see if they become sick. In Coronavirus terms: Someone who could potentially be sick gets quarantined until you know if they are sick or not.
Normally, you wait for symptoms to show up over a certain period to determine if a quarantined individual is sick or not. The Coronavirus has an added twist — high rates of asymptomatic and mild cases combined with a long pre-symptomatic period make effective quarantine that much more important. A positive active case or immunity test is the ONLY way to know for sure if someone had the Coronavirus or not — we can’t just wait for symptoms to show up.
This is important. From the perspective of a country or region — quarantine has become the tool that was needed in the absence of a high enough level of testing to separate people that MIGHT be sick from people that AREN’ T sick.
If you think someone is sick, but you can’t get to them to test them fast enough, you put them into quarantine.
But what if you think EVERYONE might be sick? As cases in every region around the world increased dramatically — the probability that any given person walking down the street MIGHT be sick increased more and more, at a faster and faster rate. Test capacity of countries around the world quickly became overrun- only able to test those people with symptoms. We know there’s a huge proportion of people who have mild symptoms or any symptoms at all, if you can’t catch those cases, you have no way of knowing who is sick or not sick.
When there’s no way of knowing who is sick and who is not sick, the only option is to assume that everyone might be sick— and mass quarantine becomes the only answer.
Depending on where you live, this might have looked like Shelter in Place, enforced lockdowns, or something else of that nature.
The goal is to decrease the total volume of people on the streets so that the probability of someone out and about being infected gets low enough to slow down the infection rate. This mass quarantine has a scale — ranging from enforcing social distancing laws all the way to the aggressive quarantine measures that we saw come out of China. Make no mistake, these are all versions of quarantine — on different levels. The attempt is always to separate and restrict the movement of people who were exposed to a contagious disease to see if they become sick.
Mass Quarantine (The Hammer) is not a long-term solution. In theory; A country can increase testing capacity and contact tracing to the point where they will start to sort people into groups
- Those who ARE SICK and need to be moved into isolation
- Those who have a higher probability of being infected (close contacts of those in isolation, for example) and need to stay in quarantine
- Those who have low enough chance of being infected that they can go back to their lives.
The idea is to use testing and contact tracing as a way to sort through a large group under mass quarantine into the smaller groups listed above, to start the dance. If a country is not at this point, it’s probably not a good idea to get rid of mass quarantine.
Why should people quarantine or isolate at all?
The way Coronavirus spreads according to latest publications is mainly via droplets, for example sneezing or coughing. Imagine you are sitting or standing close to a person that is infected. The person sneezes or coughs a couple of times during a conversation you both have. It is only a matter of time, until the droplets reach your face, if you do not keep the required distance. To prevent this in the first place from happening, contagious people should be isolated, to not spread the virus to healthy individuals.
Remember the conversation from The Hammer and the Dance regarding R? Here is why isolation and quarantine are crucial measures to contain the outbreak of an epidemic:
On the left side of the chart, you can see the exponential outbreak of a disease. The dotted line on the right side shows how strict isolation and quarantine can prevent or stop the outbreak. If you stop the transmission of the virus through isolation of infected people and quarantine of potentially infected people, it is a possibility to reduce the reproductive factor R. When R is below 1, mathematically you have contained the outbreak.
How have countries implemented quarantine & isolation successfully? Let’s look at a sample:
South Korea’s success factor: isolation & quarantine
South Korea is a role model when it comes to isolation and quarantine. The country learned from SARS and implemented laws to be able to act quickly during an outbreak of a disease. It is called the South Korea INFECTIOUS DISEASE CONTROL AND PREVENTION ACT.
This is what the law states in the event of an outbreak:
People “with infectious diseases and persons likely to be infected by infectious diseases […] shall comply therewith:”
- Providing personal information (name, address, cell phone number)
- Records of medical treatment & travel history / immigration
- Possibility of location of people via cell phone service provider
How have other countries around the world reacted to Coronavirus in terms of Isolation and quarantine? Here are the four main differences between Asian countries compared to European countries and the USA:
- Fast response time of case isolation and quarantine
- Early quarantine of travellers coming from China
- Use of mobile phone service providers & apps / wristbands
- Infrastructure and manpower in place to sort out administrative work & call people during isolation, visit at home and reinforce measures
The following table provides a comprehensive overview of the country-specific measures and their reinforcement:
Countries like South Korea, Hong Kong, Singapore and Taiwan had a dress rehearsal during the 2003 SARS outbreak. By applying those same lessons to their approach in handling the Coronavirus outbreak, these countries have shown us that it is possible to control the spread using isolation and quarantine. We saw that early isolation of infected people, tracing of possibly infected people and quarantining can prevent from using the Hammer.
And it is not too late to do this! In fact, it is never too late — the earlier you can start, the less the economy is impacted. Countries can still shift from the Hammer to the Dance and apply in parallel to the Hammer the right counter-measures.
Testing, tracing, isolation and quarantine are the main measures to take to prevent an outbreak and to control it. More information on testing and tracing will be available soon!
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This article was written by Genevieve Gee, Elena Baillie and Christina Mueller.
This article also available in German
