Short Wave - Coronavirus Is Here. Will Quarantines Help?

Episode Date: March 4, 2020

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You're listening to Shortwave from NPR. The new coronavirus is on the move, from China to Europe. Here in Italy, at this point, the country has been divided into three different areas. There is the red zone, the yellow zone, and then the rest of Italy. And the United States. Washington State remains the center of attention as the coronavirus spreads quickly. Researchers say the virus may have been circulated in the area for weeks undetected, and more cases are likely.

In New York, experts warn the virus will spread there. Cases keep popping up. And when they do, some governments are responding with one of the most powerful tools they have, quarantines. Dr. Nahed Bedelia knows a thing or two about quarantine. You are a person not only under investigation for potentially developing a disease, but you are a person whose trustworthiness is now come into question. You know, will you follow the rules and will you keep me safe from you? She's an infectious disease specialist and was quarantined twice after returning home from Sierra Leone during the Ebola outbreak there in 2014.

The sudden change that you see in people's faces. It's like you are a human, but all of a sudden you've become a threat to them. Today in the show, we'll talk about what quarantine actually is, why this virus is so good at evading it, and what steps the United States might have to take to contain the novel coronavirus. Dr. Bedelia is the medical director of the Special Pathogens Unit at Boston University. And so she's been paying close attention to this latest outbreak of the novel coronavirus and all the efforts to stop it. First, it's important to understand why this virus is hard to contain. A lot of the symptoms it causes are the same as what people experience when they get the cold or the flu.

On top of that, there's some evidence that people can transmit the virus before they have symptoms. and perhaps even after they feel better. And even if that doesn't happen often, it's still a problem when you're trying to track an outbreak. Because if you don't have symptoms, you're not going to come to care. And if you're not going to come to care, we won't know that you're sick and hence be able to do contact tracing, which is basically looking for anybody else you may have been in contact with.

We didn't really have a test for this virus until February. And initially in the States, we were only testing people who had traveled to places with outbreaks or people who had been in contact with somebody who had the disease. Now public health officials have expanded who can be tested, which is why all these new cases are making the news. Yes, I think that's playing a major role in the identification of some of the new cases. And I also think that's going to lead to new cases being diagnosed during this week in the United States.

Though, just to be clear, Dr. Bedelia says that doesn't necessarily mean there's a big spike in the number of people who are sick, we're probably just identifying more and more people because we're testing more people. And when these cases appear, local governments are taking action. In Kirkland, Washington, firefighters and first responders have been quarantined. But what is quarantine? So quarantining is the practice by which we separate those that we think may have had an exposure to a disease of interest from the rest of the community. And the reason to do that is because if they develop symptoms, we want them to be separate at that point from others so they don't transmit that disease to others. Gotcha, gotcha.

So individual quarantine obviously is a very different thing than mass quarantine, which is trying to quarantine huge groups of people. Tell me a little bit about that. They're a temporizing measure, right? I mean, if you have bleeding in your leg, you can cut off your circulation to stop deleting, but that's just a time. temporizing measure until you can figure out how to fix what's going on. And it's the same thing with quarantine. I think it works early on if you can sort of separate people in a smaller outbreak. It becomes much more difficult as the outbreak or the epidemic becomes bigger because now you're talking about a bigger group of people. Can you talk to me about some of the costs of quarantine?

Because, you know, they're not all economic, right? They're psychological and social tolls on a person or a community. Yeah, I'm glad you brought that up. But I mean, I think even before I start with the sociological aspects and the psychological aspects, I mean, let's just talk about the logistic aspects of it. The cost is a big thing because you now have a huge number of people. It's not just the direct cost of putting somebody in quarantine, but you are taking them, if they are a working adult, you are taking them out of the workforce. And if you do that for a massive number of people, you are basically halting entire economic sectors. But then there is the logistics cost and the aspect of it, which is if you quarantine people,

there needs to be a plan to basically feed them, you know, ensure that they get medications that they need if they get sick. So there's that element. And then there is the sociological and psychological aspects and the stigma because what you're being told is that you are potentially a threat to society. And so there's the figuring out the logistics of how do you sort of survive. within close quarters alone for a long period of time. And the second is the loneliness of it.

You know, I remember for me, I think, you know, for both of my stints of quarantine, I was desperate for a company. And so, of course, we recognize the importance of separating folks who may be at high risk of potentially developing this disease, but, you know, you have to take into account what else is going on in their life. and what kind of support do they need, psychological support that they need as they go through with it. What are some of the steps that we might see the U.S. government take before or instead of quarantine? So aside from having more information out there, I think some of the steps that you might see public health officials do is canceling or delaying large events,

such as sports games or concerts or conferences in areas where there is sustained number of cases. the other steps that public health officials may take is really encouraging folks if they have symptoms or if they're worried about it to contact their health care providers or, you know, if they're in a state that has a dedicated hotline to really sort of go through whether or not they should come to care or actually stay at home. If you're a healthy person who has symptoms, I think the best strategy is for you to stay at home until you get better rather than go to work or to go to the hospital. So I've also heard, people talking about school closings, which I think could be really tough, especially on parents who

maybe can't take time off to stay home with their kids, right? Yeah, I think that for every step that we take in the public health realm, there's going to be consideration of how we are going to mitigate the impact of those steps on people. And that's what helps us ensure that there is adherence to recommendations, right? And so school closings are an excellent example because you're not only asking that student to stay home, but you're asking that parent to stay home from work, who may or may not have the job security to be able to do that. So thinking through, you know, how you support parents who are going through that in a district where you close the school is going to be important. Right, right. Okay, so as a person who works in infectious disease,

who works in hospitals, has experienced quarantine themselves. Do you think the United States is prepared to quarantine large groups of people? I think we need a little bit of work on that. WHO actually has a wonderful guide that they released four countries as they're thinking about mass quarantines. And one of the things that I talk about is importance of community engagement and outreach to really explain to people why this is being done and the importance of it if it is being pursued. And so if we are going to do it, aside from the logistics readiness, I think one of the things to think about that the U.S. may have to do is massive amounts of community outreach to ensure that people understand or sections of communities understand why this is being done. The other part of this is we have to see, aside from quarantines, if they are pursued, we have to invest in behavior change and community engagement because that is more sustainable.

and probably in the end what's going to help stop the epidemic. Yeah. So I guess one of my questions is if we got to a point where we needed to do, you know, big quarantines in the United States, would it really be as effective here versus a place like China, which obviously has a different government set up? I think whether or not the mass quarantines in the United States work are, it's dependent on a few different factors, right? anything can work if you throw enough resources at it. If you're not willing to put enough manpower to make sure that, you know, something goes according to plan, then the question becomes,

is that the most effective way of spending resources? But regardless of whether or not we pursue quarantine, I think the important thing to know is what makes quarantine effective in certain communities versus not is the amount of effort you put into engagement with that community and the people that you were quarantining. education about why that's being done and ensuring people that there needs, both economic and logistic and ability to survive while in quarantine are met. Yeah. So I know there's been some back and forth about whether or not quarantine has been successful or not in this case,

whether or not global efforts have helped slow the virus at all or have been a waste of resources. How do you see that? I think majority of the attention has been on China, on whether or not the very sort of strict restrictions that they placed in travel and quarantining entire cities actually helped. As I mentioned earlier, I think quarantine is always a balance between individual taking away an individual's freedom versus the potential benefits that you might get from taking such a sort of step. Despite my own unease with massive quarantines, you know, I do think that there are people who would say that this heroic efforts, you know, and you could really call it a sacrifice on the part of the Chinese people because they did stick with that strict quarantine orders

that were given by their government. It did bias time. It didn't stop it, nor do I think at that point it would have been effective in stopping it, but did it buy us potentially more time to prepare here and everywhere else? And I think, yeah, it probably did. But it probably did. But it at what cost? And did we, more importantly, did we take advantage of that time? Dr. Nahed Bedelia is an infectious disease physician and the medical director of the special pathogens unit at Boston University. You've been listening to Shortwave from NPR. Today's episode was produced by Rebecca Ramirez with engineering help from Josephine Neonai. It was edited by Jeff Brumfield and fact-checked by Emily Vaughn.

I'm your host, Maddie Safaya. See you next time.