I'll open this by saying I know nothing about epidemiology or, really, medicine. This is classic blogging fodder: amateurish spitballing. The topic of today's spitballing is policies for a voluntary test-trace-and-isolate regimen for coronavirus. I'm not saying that we should adopt such a regimen from a medical perspective; instead, I'm looking at how we could implement such a regimen if we decided it was desirable.
If, as Robert VerBruggen has argued, public compliance with continued lockdowns is slipping, what's next? Many in the national media have fixated on testing. But testing alone is merely a diagnostic tool; by itself, it won't slow the spread of the disease. The celebrated economist Paul Romer has proposed mass testing (of up to 30 million Americans per week) in order to create confidence and diagnose the sick, but even his plan calls for some quarantine for the sick. Ezra Klein has a useful overview of some plans (including Romer's) to reopen the economy through more testing and tracing. They're pretty demanding. Avik Roy has another plan for reopening here.
Championed by many pundits as a model for responding to coronavirus, South Korea has implemented not just a vigorous testing regime but has also turned itself into a public-health panopticon, with government officials having massive (and warrantless) surveillance powers to identify those exposed to coronavirus and the authority to confine those sick with it. (See these pieces in The Atlantic and Lawfare for more on that.) Lyman Stone has suggested an ambitious mandatory quarantine regime.
I thought it might be useful to highlight some policy options for implementing a voluntary test-trace-and-isolate regimen. Why voluntary? As a political question, mandatory test-trace-and-isolate programs would probably require sweeping new legislation at the federal level--to revise privacy law, expand surveillance, etc. As the past couple months might indicate, even a historic crisis hasn't been able to break intense negative partisanship's hold on the Beltway. Plus, mandates might further polarize public debates about responding to coronavirus.
These voluntary programs would be, I think, a much lighter lift on the federal level. They would mostly involve spending money, something Washington is still quite able to do. And I would suggest that any money spent on a test-trace-and-isolate regimen could be well worth it. Even if you don't think such measures would save lives (that's a medical question), they would likely increase the feeling of public safety, which would help the economy recover. The fact that they are voluntary means that these measures wouldn't be as comprehensive as mandatory plans, but--in conjunction with each other--voluntary compliance could still have an effect.
Again, these are not policy proposals I'm endorsing from a medical perspective. Instead, I'm looking at some small-bore policies that could help lay the groundwork for a voluntary (that word again) test-trace-and-isolate regimen. (If that regimen is worthwhile at all is above this post's paygrade.) I use "would" in these proposals, but, again, this is spitballing--not a dogmatic program.
There are four components (so far) for this voluntary regimen: tracking; quarantine and sick care; protecting the vulnerable; and general diagnosis and containment.
Tracking:
Establish a voluntary COVID-19 tracking app that can be installed on smartphones. (Probably, this would be done in collaboration with major tech companies, since it seems unlikely that the U.S. federal government currently has the wherewithal to invent one de novo. Apple and Google have collaborated on a platform for this that government agencies could adopt.) People would not be required to install this app, but the federal government could offer certain rewards for doing so. It could even pay people some sum ($50/month?) in order to reward the use of this app.
This app would track the movements of every user. When each user was diagnosed, other users would be notified if they had been exposed to that person. Those people could then get tested. People who had an app report for possible exposure would be guaranteed testing (though ideally testing will be available to all who want it). Potentially, people also exposed could use this app to claim sick-leave benefits if they stayed home.
Municipalities would use data gathered from app or from interviews with the afflicted to notify public of possible vectors of exposure. Also, federal grants could help these municipalities hire more tracers to interview people with confirmed coronavirus to ask about their activities, personal interactions, and so forth.
Quarantine and sick care:
The federal government would pay for everyone who is diagnosed with COVID-19 to move into a voluntary quarantine area (such as a room in a quarantine hotel paid for by the government). These people could choose to bring their family members with them, including minor children, though that would not be required.
Those diagnosed with COVID-19 would receive guaranteed sick-leave pay, whether funded by the government or private insurance. We don't want people who are sick with coronavirus to show up for work.
It's up for argument whether or not those exposed to coronavirus but without a firm diagnosis should be given a chance for quarantine in a government-sponsored area. On one hand, that could further help minimize the risk of spread. On the other, crowding together people with and without COVID in a hotel might end up infecting a lot of people.
Protections for the vulnerable:
Coronavirus seems most deadly for the elderly, and a significant portion of coronavirus deaths have occurred in nursing homes, assisted-living facilities, and so forth. Erecting a cordon sanitaire around these institutions could help reduce the death-toll. Probably, state and local officials would have to take the lead here, though the federal government could apply this to VA institutions, too.
One approach would be to designate certain elder-care facilities as "COVID-clear facilities." Only those who are diagnosed to be free of an infection would be allowed to be treated there. Visitors would either be banned or strictly limited (though that would be the case for other facilities, too). Those who worked at these institutions would have to live in a COVID-clear dormitory (to be shuttled back and forth to work and not otherwise allowed to interact with the outside world). The only other people who could work in those facilities would be those diagnosed as having coronavirus antibodies. Because these people had developed immunity to coronavirus, they couldn't spread it to the vulnerable.
Staff without antibody resistance or unwilling to move to a voluntary COVID-clear dormitory could temporarily work at another facility. Moreover, untrained individuals with antibody resistance could be given super-quick training to work at COVID-clear facilities. They are many jobs at elder-care facilities that do not require years of training to do. (Probably, some medical-licensing requirements would be waived to do that.) Also, antibody-resistant staff or COVID-clear volunteers at other institutions could temporarily switch to work at COVID-clear facilities.
Similar combinations of COVID-clearing and antibody-only workers could also be used to protect important economic nodes (such as meat-processing plants).
General diagnosis and containment:
Temperature and/or pulse-oximeter checks at entrypoints of buildings, stores,etc.
Universal mask-wearing.
Reductions in mass gatherings.
More testing.
Other social-distancing protocols? (This isn't a post about social distancing, though that would still probably play a role in a voluntary test-trace-and-isolate regimen.)
