Why Social Distancing Is Better to Fight Coronavirus Than Large-Scale Quarantine

You would have to be living under a rock if you have not heard of coronavirus (COVID-19) by now. It has prompted the shutting down of schools, travel bans, and tumbling stock markets that are likely to cause economic downturn of some sort. It is not that we have never dealt with pandemics before, but the last one was the 1918 Spanish influenza pandemic. While there were international trade flows a century, our world has become more interconnected since then, which makes the matter of COVID-19 all the more unprecedented. It depends on the country, state, province, or jurisdiction, but government officials have been imposing greater measures to slow down the spread of COVID-19.

Last week on this blog, I discussed how worried we should be about COVID-19. While there are reasons for concern, my conclusion was that there were enough factors to minimize the worry, something that the stock markets do not seem to take to heart. In any case, one of the things I had mentioned was the idea of "flattening the curve." If too many people catch the pathogen too quickly, it could overwhelm the hospital system, as we see in Italy. Since COVID-19 is a pathogen that is most commonly past by being less than 6 feet (2 meters) from someone or by respiratory droplets (e.g., coughing, sneezing), keeping one's distance is important. The non-pharmaceutical practice of keeping greater distance than normal to prevent the spread of a disease, known as social distancing, is vital as the world deals with COVID-19. The reason it is vital at the onset of an outbreak is because it could mean the difference between a lot of infections all at once (thereby overburdening the healthcare system) or spacing it out enough where we can handle it.

What does social distancing entail? Per the World Health Organization, it means maintaining an absolute minimal distance of 3 feet (1 meter). Measures have varied as to what sort of distancing that entails. In Maryland, which is where I currently reside, the Governor shut down restaurants, bars, movie theaters, and gyms yesterday, as well as public gatherings involving 50 or more people. My employer has told me that all employees (except the ones that have to be in the office) are working remotely until further notice. You can read more from the Atlantic or Vox on social distancing.

The academic paper that has been cited to prove the success of social distancing is a 2007 paper in the Proceedings of the National Academics of Sciences of the United States of America [PNAS] (Hatchett et al., 2007). According to the PNAS paper, Philadelphia did not impose social distancing at the beginning of the 1918 Spanish Flu, whereas St. Louis did. The per-capita death rate in St. Louis was less than half in Philadelphia as a result (see below) because St. Louis banned large public gatherings [of 20 people], shut down schools, libraries, playgrounds, and limiting of streetcars. One of the co-authors of the PNAS paper, Richard Hatchett (also worked for the Obama administration), said earlier this month that timing on these social distancing efforts matters greatly. If we can implement them before 1 percent of the population catches the pathogen, then the measures spread the disease much less.

Whether we have reached that stage is unknown since COVID-19 testing has been painfully slow. According to Dr. Marty Makary, who is a professor at Johns Hopkins, the number of infected, as of March 13, could be anywhere between 50,000 and a half million." The good news is that even if you take the higher estimate of half a million, that would only mean that 0.15 percent of the U.S. population of 327.2 million are infected, which means there is still time for social distancing to work. Also, if you want to read more on the positive potential of social distancing, read this policy paper from the CDC (Fong et al., 2020).

In either case, I am worried to see how other countries are handling this. Italy was just the first country to issue a nationwide quarantine. France and Spain have recently implemented quarantines, only allowing for such essential businesses as grocery stores and pharmacies to remain open. The difference between social distancing and quarantine is that of magnitude. There is a difference between isolating those who are sick from the rest of the population and throwing everyone in together. It is hard to give definitive impact, in part because the quarantining that Wuhan province of China or the country of Italy has imposed are historically unprecedented. That is why I am not citing a ton of studies like I normally do. But let me get into some postulating as to why going into the direction of quarantine, as opposed to major social distancing, is problematic.

As an article from FiveThirtyEight, the website maintained by statistician Nathan Silver, points out, there is not much historical evidence to find that quarantines actually work, especially given the enforceability issues involved. I find quarantines to be problematic because those who are not sick can be stuck with at-risk or already-infected individuals. Think of how the spread of COVID-19 on cruise ships has played out, and you get the idea.

I also think that quarantines do not have an end game in mind, at least without relying too much on creating a vaccine. Regardless of outcome, one could dig in their heels with a quarantine and continue to justify draconian measures. At least with social distancing, we see that they are most effective at the onset of a disease, which implies that there is a certain point in which we have minimized COVID-19 spreading it or we are screwed regardless.

The more major actions, such as cutting off other countries, also have major impacts on the economy because cutting off all of this international trade, especially when entire countries are doing it (as opposed to back in pre-modern times when it was just a single city), has its impact. Right now, global financial services firm Morningstar predicts that the global 2020 GDP will most probably drop by 1.5 percent, which is not terrible all things considered. At the same time, there is still reason for concern on the economy. The travel and retail industries are already getting hammered by some of these international decisions. The more that countries decide to shut out their economies from the rest of the world, the longer they will feel the economic impact. Economic impact is not just about "dollars and cents." It is about livelihood, the ability to afford food, healthcare, and education. Eroding purchasing power is eroding one's way of life.

As much as COVID-19 causes health issues, going to the extreme of quarantine is going to economically impact us all in a way that we have only begun to feel. Because we live in such a global economy, it will not only affect those who live in currently quarantined countries (although they will feel it most acutely). In short, such measures as social distancing are shown to be more successful than the more draconian measures.

How long social distancing last depends on when the United States reaches its peak, as well as such factors as whether or not spring and summer weather will provide some reprieve or how long the people can handle social distancing. What we, as a people, should continue to do is practice social distancing, wash our hands, work remotely if we can, and not cough or sneeze on people. Aside from that, we can only hope that social distancing measures will be adequate in the United States, and indeed other countries who are not overburdened like Italy, to slow the spread enough to minimize its overall impact.