The essential Ben Thompson on isolation and quarantine

…while I have written about Taiwan’s use of cellphone-enforced quarantines for recent travelers and close contacts of those infected, I should also note that every single positive infection — symptomatic or not — is isolated away from their home and family. That is also the case in South Korea, and while it was the case for Singaporean citizens, it was not the case for migrant workers, which is a major reason why the virus has exploded in recent weeks.

Here’s the thing, though: isolating people is hard. It would be very controversial. It would require overbearing police powers that people in the West are intrinsically allergic to. Politicians that instituted such a policy would be very unpopular. It is so much easier to let tech companies build a potential magic bullet, and then demand they let government use it; most people wouldn’t know or wouldn’t care, which appears to matter more than whether or not the approach would actually work (or, to put it another way, it appears that the French government sees privacy as a club with which to beat tech companies, not a non-negotiable principle their citizens demand).

So that is why I have changed my mind: Western governments are not willing to take actions that we know work because it would be unpopular and controversial (indeed, the fact that central quarantine is so clearly a violation of liberties is arguably a benefit, because there is no way people would tolerate it once the crisis is over). And, on the flipside, that makes digital surveillance too dangerous to build. Politicians would rather leverage tech companies to violate liberty on the sly, and tech companies, once they have the capability, are all too willing to offload the responsibility of using it wisely to whatever government entity is willing to give them cover. There just isn’t much evidence that either side is willing to make hard choices.

That is from Ben’s Stratechery email newsletter, gated but you can pay to get it.  There is currently the risk that “test and trace” becomes for the Left what “chloroquine” has been for Trump and parts of the political right — namely a way to make otherwise unpalatable plans sound as if they have hope for more than “develop herd immunity and bankrupt the economy in the process.”

To be clear, I fully favor “test and trace,” and I’ve worked hard to help fund some of it.  That said, I wonder if we will anytime soon reach the point where it is a game changer.  So when people argue we should not reopen the economy until “test and trace” is in place, I increasingly see that as a kind of emotive declaration that others do not care enough about human lives (possibly true!), rather than an actual piece of advice.

Comments

Would doing central quarantines really be that unpopular? I dont know anyone that would rather stay home and infect their family than quarantine at a hotel for a few weeks. I think main reason people with COVID dont already do this is the cost. Most people, especially people who live in crowded multi-generational households, can't afford it. Let's try having the government offer to pay for quarantine hotels for anyone infected, and make it voluntary, see how many people sign up. I would bet that most people would, especially anyone living in a household with family members of a at-risk demographic.

That and right now, I could go a week or two with some quarantine peace and quiet.

That and right now, I could go a week or two with some quarantine peace and quiet.

Right now protestors in their cars are being denounced and people are being arrested on playgrounds in rural states, but the NYC subways continue to run and a CNN commentator with a famous name gets to walk around with his family while infected and fight with some guy with no consequences. Everyone would assume that isolation would be enforced in the same slanted way.

"Right now protestors in their cars are being denounced"
Freedom of speech by both sides is wonderful.

"people are being arrested on playgrounds in rural states"
Federalism is wonderful. Your governor and mayor should know you better than distant DC pols.

"the NYC subways continue to run"
As they do in Seoul, Tokyo, Taipei, and the whole world over. Having essential services available during a pandemic is wonderful.

"Freedom of speech by both sides is wonderful."

The lack of self-awareness when you make this particular statement is priceless.

In case there was any doubt that isolation would be a matter of political hostility and special pleading....

Even more hilariously this guy is probably pure riff raff who thinks he’d get top shelf treatment because he as a co-exist sticker.

Meanwhile I make two calls and I’m going to be out of quarantine in fifteen minutes.

IANAL but quarantine is _old_. It is entirely possible that there are laws already in place authorising compulsory treatment of e.g. typhoid carriers that could be used to enforce isolation after contact tracing.

Strategy decisions need to be delayed until after modeling the consequences of alternatives, but "not until test and trace is practical" seems to be one end of a range of reasonable candidates for relaxing lockdown, with the other end being "not until we have enough safety margin that if this blows up again we can clamp down before the health service is swamped" Perhaps the best option within that range is a political and economic decision. The UK five criteria don't seem to mention test and trace explicitly, although they do talk about enough tests and PPE in place, so they seem closer to the "as long as the health service survives" end.

The Public Health Service Act is a United States federal law enacted in 1944. The full act is captured under Title 42 of the United States Code (The Public Health and Welfare), Chapter 6A (Public Health Service).

The act clearly established the federal government's quarantine authority for the first time. It gave the United States Public Health Service responsibility for preventing the introduction, transmission and spread of communicable diseases from foreign countries into the United States.

Shame that no one in the Trump Administration seems to have been aware of the law, or even able to organize an effective quarantine involving air or ship passengers.

It's way too late for test and trace. We are now closing in on a million known cases (should pass that mark within a week), and possibly millions of unknown mild or asymptomatic cases. The ONLY way test and trace could be possible is with some sort of tech industry magic wand - within the next two weeks Google announces their magic bullet which instantly identifies every person that those million people have come into contact with in the last three weeks, voila.
The only path forward is to reopen the economy with reasonable precautions to minimize the spread and then just handle the caseload. About the same number of vulnerable people are going to die either way (just spread out over a longer period with the lockdowns), so we might as well not ruin the economy in the process.

+1, Also, of Tyler's quote "hope for more than develop herd immunity and bankrupt the economy in the process", it seems that only the latter is going on. I don't know why more temporary hospital space (segregated away from other parts of the hospital) has not been more widely constructed. The whole conceit of the lockdown was to flatten the curve (not reduce the area under it). Then for some reason the play book changed and the implicit goal seems to reduce deaths to zero. It's not like the economy would have been going full speed ahead due to natural social distancing, but that also means the pandemic wouldn't and won't blast through the country like it did in the early part.

Also as noted yesterday, many, many deaths are linked to nursing homes, and most of the cases have been in the New York City area. We don't need to be making policy based solely on these localized impacts.

Yes, I actually had someone argue with me on facebook the other day saying that we should stay under lockdown until there's a vaccine, and fuck the economy, because that's just a bunch of billionaire's profits and the government can totally afford to support everyone for a year.

“Only when the last tree has died and the last river has been poisoned and the last fish has been caught will we realize that we can not eat money.” — Chief Seattle

You can't destroy the planet and still save the people, because we inhabit the planet and we'll perish. But you can't destroy the economy either, because we inhabit the economy. We are the economy.

Maybe only after nothing is available anymore at any price will these cargo-cult folks realize that you can't eat helicopter money.

"... and the government can totally afford to support everyone for a year."

That's someone with a deep ignorance of how an economy works. I guess in his minds the grocery store shelves magically fill themselves and will keep doing so as long as the Treasury Department has running printers.

Hazel makes some good points here. Test and trace is a good idea with 1000 cases but an impractical idea with a million cases.

Tyler’s point about waiting for test and trace imposing a long delay on reopening our economy is valid.

We live in a free society, and this is a blessing, not a curse. Mandatory quarantines will generate a backlash here.

I suggest that we can solve the Coronavirus problem with measures that are voluntary and not too expensive.

R was 2, but stay at home orders and social distancing brought R below 1. So R can be below 1 without test and trace.

We only need R below 1. We do not need to pay more to drive R to zero. We only need to cut the original R in half.

Government could offer voluntary hotel quarantine.

Test and trace could be voluntary, not mandatory. When someone tests positive, ask this person to list his contacts and notify them himself. Or offer to help. The vast majority of people will cooperate. We don’t need perfection. We just need R below 1.

Trace people by phone. If someone doesn’t answer their phone, leave a message and move on. Do not send tracers out to knock on doors. We don’t need perfect tracing.

I wear a mask and cloth gloves in public. These are voluntary actions. I see a lot of other people doing the same thing. My actions reduce R.

Some employers measure temperatures of all employees and everyone else who comes in the door. Those with fever over 100.4 are sent home. This is cheap and should be encouraged in all businesses.

We can drive R below 1 with measures that are voluntary and economic.

Agree. And the lockdowns are really imperfect in terms of who is ordered to shutdown. You have things like landscapers being shut down, but state-run liquor stores and lotteries are open. People are unable to utilize local information to make rational choices. Markets are unable to converge to an optimum. This is central planning, and it's broken.

+1. Worse still, society is dividing into those who can afford to live in quarantine, and those who can't. A pure class system, where the lower class works and some die so that the privileged can live safely removed from the virus. Morally, this is not sustainable.

Isn’t the economy already ruined? Sure, lifting up on the lockdown/reopening parts of the economy will make the economy less bad, but it seems doubtful to me that “reopening” the economy brings back enough jobs to keep the unemployment rate below 15% (my back of the envelope calculation, using 164.5 million people as the labor force in February 2020, is that right now we are at at least a 20% unemployment rate already).

Americans always do the right thing - after exhausting all other options.

Listen here Jack, let me set you straight. This thing isn't going anywhere. Back in my day we didn't call it covid whatever; we called it the "Shanghai Shivers". I used to know a guy, went by the name Cornflake Jackson. Ol' Cornflake used to play guitar down at the pool hall. Here's the deal, fat: if Cornflake Jackson says the Shanghai Shivers, "Ain't no thang" you can take that to the bank, buckaroo. That's how I know you're full of shit. I'd punch your daughter straight in the mouth.

That you are plagiarizing tired memes instead of tired Labour leaders. We like your actual idiocies, like this one - “We should challenge students in these schools. We have this notion that somehow if you’re poor, you cannot do it. Poor kids are just as bright and just as talented as white kids."

“Wealthy kids, black kids, Asian kids — no I really mean it, but think how we think about it.”

You are comedy gold Joe, just trust yourself. You might not be able to top Trump for pure entertainment value, but even Trump could not get a majority of Americans to vote for him in 2016.

Comparing "test and trace" with "chloroquine" is completely unfair.

Chloroquine is inexpensive and was/is being touted as a potential treatment for those with little recourse.

Test and trace is inordinately expensive and is requires monitoring of the entire populace. Further it is completely ineffective in a country as large as the US with the US's case load, at least with current technology.

So not comparable in any way.

Ben can be essential. But only I and I alone can be excellent.

"It would require overbearing police powers that people in the West are intrinsically allergic to. Politicians that instituted such a policy would be very unpopular."

This is why to this day Americans can bring Pepsi onto a plane and laugh at the idea of having to take their shoes off at the request of some airport rent-a-cop.

Reopen the economy. Anybody who tests positive will shipped off to concentration camps. America will come back.

Have a look at Australia for how much opposition compulsory quarantining is generating. Virtually none

Australia and New Zealand’s economies are a joke. Australia’s economy is smaller than Iran. Everyone in Australia already knows it’s a Potemkin country keep afloat by natural resource extraction. Guess what isn’t closed in Australia? Basically you aren’t smart enough to be participating in this conversation.

Damn! He saw through our facade! I told them they should have put electricity in more places than Sydney!

Of course, the US must be a failed Potemkin country rather than a successful one, as mineral extraction was the same percentage of GDP -- up until the price of oil crashed.

Lol this is completely false. It’s 8 percent to 1.5 percent. Eighty percent of the economy is service and government workers. So like I said Australia is kept afloat by mining. And not even high IQ technical marvel extraction like fracking- nope Stone Age pit mining. You country sucks sorry.

Is not the balance of evidence that we have a new disease in society. It's not that bad, unless you are already pretty old and sick. It's kind of a shock at first but the predictions of how wide spread it might be don't seem to be coming true, notwithstanding all the body bags.

We have a lot of messy compromises where we put prices on lives. They are different prices for different groups. Pretty low for drug addicts and the mentally ill. Higher for others. Nobody explicitly admits those prices, but you can kind of estimate them from government policy.

Part of the struggle now is to face up to a new price on life. Currently we are making it really high for the Covid vulnerable, but people are getting tired of that and sooner or later we are going to just accept there is a new way that mainly old people might die. Naturally the numbers each year will fall as immunity spreads, how they compare to the flu is a bit hard to tell yet, but perhaps not so different.

To watch the beginning of the Tea Party II: Viral Bugaboo.

Contrary to the first paragraph, all detected cases in Singapore are isolated, whether they are Singaporeans or migrant workers. The problem is that many of the infected migrant workers were asymptomatic or barely symptomatic. Such cases are likely to be much less contagious than fully symptomatic cases, under normal living conditions. But when 10-20 people are living in each dormitory room, with shared bathroom facilities, it seems that asymptomatic or barely symptomatic infections can trigger an explosive outbreak, which becomes hard to control even when detected (symptomatic) cases are actively removed from the population.

You say an all-expense paid quarantine in a decent hotel for 14 days will be unpopular? Not so sure. It comes down to communication: you tell the people why this is needed and its benefits, then people will follow.

Luckily for us, we have the best communicator in this world. Right?

A black velvet Trump painting would look glorious in UV light - and probably do a tremendous number on the virus in your lungs.

The teachers are — I’m married to a teacher, my deceased wife is a teacher. They have every problem coming to them. Make sure that every single child does, in fact, have 3, 4 and 5-year-olds go to school. Not day care, school.
Social workers help parents deal with how to raise their children. It’s not that they don’t want to help, they don’t know what to play the radio, make sure the television — excuse me, make sure you have the record player on at night, the — make sure that kids hear words, a kid coming from a very poor school — a very poor background will hear 4 million words fewer spoken by the time we get there.

Good job Joe, swing for the bleachers using your own millions of spoken words. You will always be better than any memesters, though never as good as Trump when it comes to stream of something resembling consciousness presentations.

I gave up on test and trace a long time ago. It's just too hard to scale. You're not going to have every American take an RT-PCR test every morning before work and get a result in 5 minutes. I think it still takes 24+ hours to get a result. We're a long way from home and that's 3 months into that pandemic.
It's a point solution diagnostic tool. It has its place but not for large scale and immediate results. I am simply extrapolating past results into the future here)
There's one universal homogeneity to this epidemic it seems to me . It's that it has peaked and is on the decline in every country in the world in the span of 8 weeks or less, regardless of policy used to combat it
It's like a natural resonance. All I can think of is that there may just be a lot of asymptomatic/unsusceptible people who don't have antibodies, but have a very strong innate system. They can be infected briefly but don't shed the virus and are not contagious . The primary immune response would be through cell mediated immunity.
https://en.wikipedia.org/wiki/Cell-mediated_immunity
These people don't show up in a PCR_test or aB test. They are the true zombies ( just speculating)

Reaction? That is something else. People, most of the time and in most places, know essentially how to react when faced with a new contagious disease. This emphasis on policy seems more than a bit misplaced. Cruise ship bookings would be down dramatically at this point, as would the number of people going to movies or eating out.

Central quarantine worse is worse if it is blanket, no loopholes type of quarantine. That said, not that much worse than isolation at home.

On a practical level - if a person is detected with COVID-19, say a week into their infection, there is a good chance they have infected others in their household already. No need for central quarantine.

Or, if they are a single parent with young children, those kids are unlikely to suffer ill effects of the virus, then no need to use central quarantine.

Probably the way to get to central quarantine would have been to stagger it. So the first step is to mandatory quarantine foreign arrivals, as Australia is currently doing. You come into the country, you are immediately quarantined in a hotel for 2 weeks. Quarantine is all-inclusive, state covers hotel, food, etc.
Next step is to offer it as a voluntary option, if you get a positive test here is the 5* hotel you can move in (and here is the suite if you want to bring your kids) .
Then you require that you have to go in if you have no dependents living with you, and so on.

The main thing is to manage perception, it has to look like a holiday in a 5* hotel than prison....

Another problem with the testing mantra is that the tests are too inaccurate. I have a post about this issue scheduled for Friday morning

The tests are clearly too inaccurate for Taiwan or South Korea to use for testing and tracing.

It seems that Japan achieved similar results with not much testing or tracing. So is there any reason to believe it was important for either Taiwan or South Korea?

It seems that the Japanese do not have a very good overview of what is going on currently, so yes, it does seem to be important to the results found in South Korea.

Getting lucky for a while is one thing, actually keeping spread contained is another. The Russians are providing yet another example of what happens when you cannot stay on top of the virus.

A lot of the issues with tracking, tracing, anonymizing, etc are problems that computer scientist have thought about for years, not some sort of "magic bullet."
Ed Felten of Princeton gave a summary of the tech behind test and trace and the issues and solutions surrounding it.

https://youtu.be/miOgq5Q5EC0

You seem to be saying that you know a thing is true Tyler, but you're second guessing yourself because it might be judged as political.

Haven't we learned the danger of that?

Truth, and best policies, should come first. Vague conjectures about slippery slopes should always come last. If at all.

Specifically on test and trace, as far as I know it is the only path forward. No one has suggested any serious alternative.

So the only plan is the best plan.

I have read that to effectively use test and trace to contain spread of SARS- Cov-2, the US will need to hire and train 300,000 contact tracers. It will also need to run some multiple of the tests that it is now performing.

Getting to that point could take months. Right now it seems to only be Trump’s die-hard supporters protesting stay at home orders. But within the next month tens and tens of million people will start to run out of money to buy their groceries and pay their bills. The shelter in place orders have a limited amount of time before we see mass protests from a whole lot of people. So we need plans for what comes next, even in the absence of a robust test and trace regime.

Right now governors around the country are announcing plans to gradually lift restrictions in their states. That kind of talk buys more time for shelter in place orders, as a public that believes that the orders are limited in duration can tolerate them for a longer time.

The cowardly lion of Lansing has already backed down. Seems like the real polls must be showing something a little different than the AstroTurf polls.

Glancing above I do see some people arguing we don't need test and trace, but I would say look at the numbers.

This is an extremely virulent disease, one that American-level social distancing can barely control if at all.

As I mentioned the newer thread, if you cannot really control through distancing, then opening just gives the disease gas.

If you want to open without an explosion of cases, you have to do it in a staged way and with test and trace.

I'm just saying with the doctors are saying

https://twitter.com/hjluks/status/1253642606518480896?s=19

You know, there's a uh, during World War II, uh, you know, where Roosevelt came up with a thing uh, that uh, you know, was totally different than a, than the, the, it's called, he called it the, you know, the World War II, he had the war the War Production Board

Perhaps "test" by itself could work. If a particular store or company could test the workers and customers that came in each day--expeditiously and cheaply--then that little piece of the economy might open safely. Instead of a "boil the ocean" strategy that is test-and-trace, a "create your own island" approach centered on test alone.

Added bonus: this would work with the market (producing and selling tests and test machines), relying on the government only to sign off on the efficacy of the tests.

This would widely expand the areas uninfected people could go to. And it would protect people who can't afford to shelter in place.

I think test and trace is only "boil the ocean" if you imagine it done on foot. When it's done Mechanical Turk style, it probably hits some mid-line on efficiency and effectiveness.

Are we a competent technologically advance country? Why aren't we making tracing an anonymized Mechanical Turk task? All contact identification by cell phone number, all messages by text, all the Turk worker sees is the hashed name.

I suspect this would violate medical privacy laws.

Why? Anonymized data does not disclose any medical information about any known person, and if the Mechanical Turk only sees the hashed name, they can't use that information outside the system.

The anonymized letter might look something like this:

"This is a semi-automated health advisory. All data is anonymous and privacy protected.

Our data shows that your phone was at Joe's Pizza on April 24th at 2:00 PM. Be advised that a confirmed COVID-19 case was in that location between 1:00 and 3:00 PM on that day.

We recommend that you limit your contacts and self-quarantine for 14 days (etc.)

Please do not reply to this email, or give anyone from this office any more personal information.

If you are experiencing any suspected COVID symptoms text 1-888- COV ID19. Your privacy will be protected."

This presumes that you work back from confirmed cases through Apple/Google COVID APIs and don't need to ask people their contacts. Your phone already has the breadcrumbs.

I think something like that is possible, and probably we will do. The "boil the ocean" is to create a bureaucracy that will run this panopticon, on a national or even a state scale, in a very short time before the virus' exponential growth overwhelms the system, in a way that is efficient, and effective. Can you think of anything comparable the government has done in the past? I can't, and this outside view makes me pessimistic.

...”a kind of emotive declaration that others do not care enough about human lives (possibly true!), rather than an actual piece of advice.“
Impugning other’s motives - mind reading- is the most childish & time-wasting if argument techniques.

Why is the cultural left obsessed with testing and tracing infectious diseases?

test and trace is both unworkable and pointless if more than 10% of the population is infected

I am really surprised by ignorant comments here. Test ans trace is the only alternative to lockdown. This is not a political statement - this is what literally every health care professional keeps saying since late January. I guess it is indicative of current stupidity-inducing media environment when any statement is seen as a political one.

Test and trace includes both tracing contacts and mandatory quarantine of confirmed cases. As some people mentioned, when number of cases gets really large, tracing becomes somewhat less important and quarantine becomes more important. The good thing is that we need only one system to implement both steps - phone location data allows to both track contacts and monitor self-quarantine in efficient, scalable way, which is very easy, cheap and fast to implement. The bottom line is that taking location data history from infected people is critically important step. Without it test and trace will not work. Manual contact tracing is ridiculously inefficient and probably not even implementable. Anybody who opposes efficient test-and-trace approach (with digital contact tracing) eventually increases probability of economic collapse from lockdown.

You keep hiding from the flu. The red states will get this economy restarted. Just don’t coming surging south for food when yours runs out. If you can’t handle the flu you definitely can’t handle an armed Texan.

people just don't want to face reality... cannot even identify asymptos, definitely cannot trace >10% of population... test and trace is completely pointless

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