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Quarantining cities isn’t needed. But a fast, coordinated response to covid-19 is essential.

Caitlin Rivers, PhD, MPH

By WWSG exclusive speakers Scott Gottlieb & Caitlin Rivers

Scott Gottlieb is a former commissioner of the Food and Drug Administration. Caitlin M. Rivers, an epidemiologist, is a senior scholar at the Johns Hopkins Center for Health Security.

Dramatic measures have been taken over the past week to fight the coronavirus epidemic in the United States. President Trump’s announcement of a ban on most flights from Europe, except for the United Kingdom, on Wednesday night came at about the same time the National Basketball Association suspended the rest of the basketball season. In New York on Tuesday, Gov. Andrew Cuomo (D) dispatched the state’s National Guard to New Rochelle, amid a major coronavirus outbreak, to enforce new rules closing large gathering places, such as places of worship and social halls, within a one mile “containment zone.”

No doubt similar steps will be taken elsewhere in the next days and weeks. The most appropriate are those, such as the cancellation of large indoor gatherings, that encourage social distancing. They will help mitigate the spread of covid-19, slowing it down and allowing medical facilities to deal with the sickest among us without being overwhelmed.

What is not needed in the United States: draconian use of the geographic quarantine, also known as a “cordon sanitaire” or just a “cordon.” Movement restrictions have been employed in large parts of China, and on Tuesday the Italian government placed the entire country on a lockdown, followed on Wednesday by an announcement that all stores except pharmacies and food markets would be closed. Italy now has more than 10,000 diagnosed cases, and its hospitals, especially in the north, are on the brink of collapse.

The United States isn’t in that dire state yet, and with the proper use of well-coordinated mitigation measures across the country, we can prevent that outcome. In any case, such cordons are blunt instruments that don’t do anything to achieve the necessary social distancing for the people trapped inside them.

There is still time to implement tough mitigation measures that would reduce the scope of a nationwide epidemic. But that opportunity narrows with each passing day.

In addition to stopping large indoor gatherings, mitigation includes closing schools and mandating telework. But right now, the steps are being undertaken in a piecemeal fashion. That’s not good enough. Local, state and national officials should move quickly to coordinate with public health officials on implementing these measures coherently.

Part of the coordination should include devising ways to offset the hardships they impose on cities, small businesses and vulnerable Americans whose incomes would be disrupted. Federal loans and grant programs could be vital to that effort.

Those damages would be dramatically more pronounced under mass lockdowns of cities or regions. Hourly wage earners would miss paychecks as businesses closed. People who rely on community programs and services would be left unsupported. Those with routine medical needs could be without access to necessary care. The impact would be akin to the disruption of a natural disaster that lasts for weeks and affects entire regions.

Beyond that, a cordon restricting the movement of Americans long accustomed to personal liberty would be likely to make such government interventions something to be feared and evaded, rather than measures taken to achieve shared goals. Having the public’s trust is essential in fighting a common threat.

Proponents of cordons point to emerging evidence suggesting that these cordons may have contributed to the slowing of coronavirus transmission in China, where heavily affected communities were locked down for weeks. But those cordons were combined with several other more classical mitigation efforts like those listed above. Measuring the relative contribution of each is all but impossible.

The coordination between government and public health officials should include benchmarks that must be met before mitigation measures can be lifted. Each city and state should be working from a common set of principles for assessing closure of schools, businesses and transit. It is important to give local health officials discretion to tailor measures to local resources and needs, but there should be general criteria to guide these decisions.

Eschewing the drastic measure of imposing cordons does not mean going lightly against covid-19. But the fight should target the coronavirus, and its spread, not the people it imperils.

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