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Given the lack of critical assessment in the US media of China's massive quarantine, I think that there are many people in the US who would view it acceptable to shut down a major American city to prevent the spreading of an outbreak. However, I worry that no one is considering the consequences of such action.

With major parts of the economy no longer functioning, people would have difficulty with things like finding child care. This has trickle down effects, such as pharmacy staff staying at home with their children. This may lead to lethal consequences.

Examples of trickle down effects:

  1. Cancer survivors can't access health care (this is currently happening in China).

  2. Lack of access to medicine. This can be deadly to people with severe chronic conditions (e.g. heart disease).

  3. Lack of social support (e.g. no one is checking in on Grandma).

Question:

Do policy makers (in either China or the US) consider the unintended consequences of large quarantines? If so whose advising them and studying those effects? Is the decision to quarantine based off of a process or is it based off of an executive leader's 'intuition'.

My 'intuition' is that these unintentional effects may be killing more people than covid 19.

References:

Negative Effects

  1. NPR-critically ill

Positive Reaction to China's response:

  1. Donald Trump's Light touch towards China
  2. Trump says China is handling coronavirus 'professionally'

Yes, I've heard mild criticism of China's handling of this, but it generally doesn't focus on negative effects on quarantine. They generally focus on China's lack of transparency and lack of action.

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    Obvious effect: does the economy matter if everyone is dead? obvious counterpoint: not everyone will die, only 2-5%. Obvious counter-counterpoint: is it better to shut down a major city temporarily, or to straight-up kill 2-5% of people in it? – user253751 Feb 27 at 17:53
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    And you know that essential businesses remain open (possibly with restrictions) during a quarantine, right? They don't just let everyone starve. – user253751 Feb 27 at 17:54
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    "My 'intuition' is that these unintentional effects may be killing more people than covid 19": even if tht is true, it's not the correct measure of the benefit of the quarantine. The benefit of the quarantine is properly measured by comparing against the number of deaths expected with unchecked spread of the disease. In other words, for the quarantine to be judged ineffective, you'd have to find that "unintentional effects may be killing more people than covid 19" would kill in the absence of a quarantine. – phoog Feb 27 at 18:44
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    @user253751 the infection would spread beyond the city without the quarantine. China is very populous. 2% of the Chinese population is nearly 29 million people. The infection would also spread across the world. Maybe it's doing that anyway, but at the slower rate of spread we now have, health care systems will be able to cope more effectively, improving the survival rate. – phoog Feb 27 at 18:51
  • @user253751 It would become much worse if everyone get this disease, exhausting the medical resources. The current number in Iran is more than 10%, but I'm not exactly sure it's because of this reason. – user23013 Feb 27 at 20:25
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In the US there are two federal agencies the Centers for Disease Control and Prevention and the Federal Emergency Management Agency that have larges staffs of physicians, epidemiologists, public health, and disaster management professionals. Those staffs spend a lot of their time worrying about questions like this, and gaming out different scenarios, just like the military games out battle strategies. There is also a large academic community of public health specialists that study problems like this. See for example these academic papers:

Quarantine, isolation and the duty of easy rescue in public health

We address the issue of whether, why and under what conditions, quarantine and isolation are morally justified, with a particular focus on measures implemented in the developing world. We argue that the benefits of quarantine and isolation justify some level of coercion or compulsion by the state, but that the state should be able to provide the strongest justification possible for implementing such measures.

The Challenge Of Mandatory Evacuation: Providing For And Deciding For

Insufficient attention has been given to the ethical and legal questions surrounding mandatory evacuation in disasters and emergencies. We argue that mandatory evacuation orders entail a governmental duty both to provide for people and to decide for people: Government must trigger the provision of critical resources as well as vigorous and persistent efforts to persuade reluctant citizens to leave.

Of course the political powers might choose to not to follow the advice of their professional staff or outside professionals, but that comes with grave political risks if the situation goes south. The political powers might also receive contradictory advice from different groups of professionals. Which experts should they listen to?

There is also the chance that even with the best of intentions and the best available information, the experts will make the wrong call, or apply the "lessons of the last battle" in the wrong situation.

These are hard questions. For example, in In August 2005 Hurricane Katrina hit New Orleans and over 1800 people were killed. The governments of Louisiana and New Orleans we broadly criticized for not fully evacuating the city. Later in 2005 Hurricane Rita was projected to hit Houston and a mandatory evacuation was ordered. Dozens of people died in the evacuation of Houston, from heat stroke, accidents, and a tragic bus fire. As it turned out, Hurricane Rita struck Houston only a passing blow, and fewer people died in the storm than in the evacuation. New lesson learned: don't evacuate, shelter in place, evacuate only those most at risk. Then in 2017 Hurricane Harvey hit Houston, causing massive flooding, and requiring the rescue of thousands of people trapped in floodwaters. And afterwards everyone was asking Why Didn't Houston Evacuate?.

Predicting the future is hard.

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  • Good answer re. uncertainty. It would also be interesting to assess the efficacy of what China did do. when the Hubei quarantine was originally announced, there was a fair amount of skepticism at doing it at such a scale, even among the medical professionals - maybe not so much criticism as remarking that it had not been done before and that it was uncertain whether it would actually slow the spread. Seems to me that, with hindsight, it has, unless China is covering up their numbers - propagation rate is quite low, now. But, has this efficacy been confirmed? – Italian Philosophers 4 Monica Mar 7 at 1:10

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