New York Has Natural Ways To Quarantine The Sick, We’ve Used Them Before, Why Aren’t We Using Them Now?
New York City has been down to under 500 new cases a day since the middle of June, and though that success seems shaky the last week or so as cases rise elsewhere in the country, generally speaking, we’re doing ok.
But much of the city is still shut down. No bars, no nightlife, no indoor dining; shopping malls closed, museums still closed, no theaters. The reason, according to Gov. Andrew Cuomo, is that the rest of the country has seen a spike because of opening these things. I think this indefinite shutdown of some of New York’s most important business is bad for the city, and contributing to some of the crime we are seeing. So the question is, how do we get COVID-19’s infection rate down even further so we can start opening up that part of the economy?
As we see the few hundred new cases each day, my mind wonders: where are these infected people going? Are they self-isolating? Are they quarantining? Is anyone watching them? Or are we just leaving it up to the honor system and hoping they don’t go out and infect other people? Did the 350 cases a month ago go on to infect the 350 who tested positive yesterday and are we just in a never ending spin cycle that will continue until we’re all vaccinated?
When we talk about what other countries have been doing successfully, we talk about lockdowns and contact tracing and mask wearing, but one thing that is being done, especially in Asia, that has shown much success is centralized quarantining.
South Korea, China, Hong Kong, Singapore and Taiwan are all enforcing central quarantining measures to citizens or foreigners who test positive, providing a place for them to go and isolate away from others until they’ve recovered and are no longer contagious.
The mistake that we have been making – AND ARE STILL making – is not isolating the sick. We’re still sending them home to isolate where it just isn’t possible to do so. I don’t know if we can legally do forced quarantine, but that is the only way.
New York City has long utilized its unique geography to control infectious diseases.
As studies now show, the primary place people get infected is inside the home, and in New York City and other places around the country, household size has been an indicator of how bad an outbreak can be, probably for the reason that the virus is being transmitted within households. And we’re still letting it happen.
New York City is offering hotel rooms to isolate as an option, but early indication is only a handful of people are taking them up on the offer. Mandatory isolation is perhaps not Constitutionally possible, just as other mitigation efforts like closing state borders isn’t, but if it were, it would be extremely effective.
And there is a precedence for this. Obviously Typhoid Mary is the most well-known. She was quarantined on North Brother Island – a small island in between The Bronx and Queens – for years due to her being an asymptomatic career of typhoid. Now Mary Mallone’s situation was quite different as her quarantine was indefinite and she refused to cooperate with authorities, but to forcibly quarantine someone for two weeks should be something we’re able to do.
New York City did build hospitals for cholera and smallpox on islands in order to isolate the sick from the general population, The ruins of a former smallpox hospital can still be seen on the southern end of Roosevelt Island. Hart Island in the Long Island Sound off The Bronx because infamous early in the pandemic for the mass burials of COVID-19 victims there. The island itself was actually used to quarantine infected New Yorkers during a yellow fever epidemic in 1870.
In March, I suggested transforming Governors Island, which can comfortably house 5,000 people, into a quarantine zone. New York’s geography allows us to utilize islands, which can put infected people in a place where they are physically distanced from the rest of the population until the time they are contagious has passed. Governors Island is large enough to provide accommodations for:
- very sick in buildings repurposed as hospitals
- mildly-ill in buildings repurposed as convalscent homes.
- asymptomatic in buildings repurposed as “hotels”
The seclusion of the island also allows for those who are symptom-free or recovering time to walk around outside and get fresh air and sunlight rather than be completely isolated and essentially imprisoned – one fo the concerns many have about centralized quarantine. (Even in Korea, you are banned from even leaving your hotel room for two weeks). Converting North and South Brother Island and perhaps Fort Totten and Fort Wadsworth – old out of commission forts in Queens and Staten Island respectively – into overflow quarantine space would allow us to further contain and manage an outbreak in the city without resorting to shutdowns.
But I think not having a plan to isolate the sick – and continuing to not have a plan for a long term – is wrongheaded. New York City has long utilized its unique geography to control infectious diseases. It’s odd that we’re not doing it now. If this pandemic is truly going to last more than a year, we need to have a real plan on how we will isolate infectious people going forward, so the rest of us can actually move on with our lives.
Unless, of course, officials and experts don’t expect it to last quite that long, which is a theory I’ll explore in another post soon.