Around the world, covid-19 lockdowns are ending — in some cases before the virus has been defeated, meaning that the risk of a second wave of infection is high.
But it is not inevitable. Many places, including South Korea and Hong Kong, have avoided lockdowns entirely and are now returning to something like normal conditions. Even when Hong Kong, where I live, got a second wave, we never went into lockdown, and now new cases are at nearly zero.
The key tool in these places’ safe reopening is not social distancing. Rather, it is contact isolation.
This policy, employed to various degrees in China, Israel and elsewhere, is a modern rendition of a strategy dating back to biblical and medieval approaches to leprosy and plague. Contact isolation is more effective than lockdowns and also less economically disruptive.
This is how it works: Most adults are permitted to return to work and routine activities, though masks, for now, should continue to be required. Anytime someone tests positive — regardless of symptoms — their close contacts are identified. The person with the positive test result and all of those contacts are then required to move temporarily into a government-run, hygienic, isolated environment — probably in a hotel or similar setting — until they can be ruled out as infectious. This process may involve testing if tests are available, or spending two or three weeks in isolation if the tests are not. For anyone who tests positive, the tracing program would extend to their close contacts, and so on.
In Hong Kong, many people get out of isolation in just a few days, thanks to the availability of tests. Daily tests per capita in America today are higher than in most countries with contact isolation programs, so it is likely that a similar pattern would occur among Americans.
This strategy is highly effective at breaking the chain of transmission, not least because contacts are presumptively isolated. Thus, contact isolation does not depend on mass testing but, rather, reduces the load on the testing infrastructure.
This system also encourages compliance because the centralized facilities would provide isolated individuals with all their basic needs (plus daily supervision so they would get treatment if they become sick). Food and medication can be delivered, WiFi would be free, and governments should provide financial compensation for lost work time. And, since covid-19 is much less dangerous to kids, families could choose for their children to be quarantined with them or separately, whichever they prefer. All of this would require legislation by state governments, but none of it is infeasible.
Alas, contact isolation sounds scary to many people. It conjures images of internment, stigmatization or family separation. But the truth is that the curtailment of our liberties would be minuscule compared with the society-wide lockdowns Americans have been enduring.
Contact isolation should be mandatory, but individuals who resist should simply be ticketed an amount sufficient to motivate compliance — not hauled off at gunpoint! Failure to pay tickets would trigger the kind of legal procedures we have for serious traffic violations. Some people would refuse, but the threat of fines and the promise of compensatory wages would work for most.
Notably, contact isolation does not require near-total compliance to be effective. Israel has pushed the spread of covid-19 to low levels with very modest amounts of centralized quarantining (just three main sites), alongside a stringent program for tracking carriers.
It’s hard to estimate how much isolation would be enough, but some basic math may be illustrative. Before social distancing measures, a person infected by covid-19 in America could be expected to infect an average of 1.5 to 2 other people. But that’s just an average: A “superspreader” might infect 100 other people, while many infected people might not infect anyone else, so tracking data indicates that more than half of coronavirus transmission is driven by fewer than half of infectious people. Even if this skew is quite moderate, average new infections per case fall to 0.7 to 1 (the level at which the disease will gradually vanish on its own, and the current level in most states) by isolating just 20 to 40 percent of infectious people.
With a few other measures, such as mask requirements — and given the fact that as summer begins, schools definitely won’t reopen soon — I estimate that contact isolation could enable the near-total reopening of businesses and moderate-size assemblies within six weeks. The better the isolation program, the sooner, and the fewer other measures will be needed.
How to make all this happen? Of course, federal and state governments would have to appropriate the necessary funds. Further, state and local authorities would need a manual for how to conduct contact isolation operations. That could be produced by the Centers for Disease Control and Prevention, which already operates 20 centralized quarantine facilities.
Any big new initiative like the one proposed here will likely encounter a lot of skepticism. Policymakers could overcome that by stressing how narrowly targeted and temporary these measures are — and how effective they can be. Contact isolation is a pathway to social reopening. We can be safe together again.
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