Yes, we really do need to quarantine

Scott Atlas of the Hoover Institution recently proposed lifting lockdowns in place for COVID-19 containment. His reasons are less than convincing.

SEM image of SARS-CoV-2

Atlas says that the low case fatality rate shows that lockdowns are unnecessary. But they’re low because of lockdowns, so it’s a bit odd to say the low fatality rate is evidence against them. By ensuring hospitals aren’t overwhelmed, the people who need care can get it. Early in the pandemic, before Italy locked down, they weren’t able to provide care to all patients. People died because the medical system didn’t have enough capacity to treat them.

This does bring us to a valid concern Atlas addresses: Although we’ve ensured sufficient availability of medical care for COVID-19 patients, many people are unable to receive unrelated medical care. This is not best solved by lifting quarantines. (To be clear, the lockdown orders — which, no matter what Atlas wants to call them, are not “near-total” – have exceptions for people travelling for medical care. There are, however, separate orders for medical professionals to reduce their practice; many institutions not subject to those orders have instituted their own similar policies anyway.) Instead, clear guidelines should be written to ensure that necessary medical care is still available. Any orders and policies that prevent people from receiving necessary care should be revised, not torn up entirely.

Atlas also claims that nearly all deaths from COVID-19 are of people who have underlying conditions. But that’s based on “fully investigated” patients; it’s easier to prove someone did have an underlying condition than to prove they didn’t. If we count deaths where it’s uncertain whether the person had an underlying condition, then people with confirmed underlying conditions fall to just 70% of the death toll (PDF). Some of the uncertain cases surely did have underlying conditions, so the real number is somewhere in between, but probably on the lower end.

Speaking of those underlying conditions, they’re actually pretty common. Atlas tries to argue that only a small portion of the population is high-risk, so the rest of us shouldn’t be quarantined, but it’s actually a lot higher. 40% of US adults have obesity, nearly 10% have asthma or emphysema (PDF), 45% have hypertension, and 10% have diabetes. Even considering that some of these conditions overlap, that adds up (even before considering less common underlying conditions) to a majority of US adults.

It’s also not enough to restrict quarantines to people who are personally at high risk. Atlas suggests that strict monitoring of household members of high-risk people is sufficient to protect those people. But SARS-CoV-2 is highly transmissible before symptoms appear, so strict monitoring would only be possible with testing. Even the fastest available testing method takes nearly fifteen minutes to confirm a negative result, and can only process a single sample at a time; the workload would be unmanageable if daily testing of a significant portion of the population were necessary.

Atlas advocates a “herd immunity” approach. (This is the same idea Boris Johnson had before he was put in intensive care for COVID-19.) As appealing as “fuck it, let’s just have everyone get sick” might seem, it may not be the best solution. Telling people to let themselves be exposed to a fatal pathogen so that they can “just get over it” tends not to be well-received. It might not even work: Some research has indicated that surviving infection does not confer long-term immunity. This is only preliminary research; it’s entirely possible that surviving patients do retain immunity. While the approach would certainly raise concerns anyway, suggesting it while we’re uncertain that it would even actually work at all is utterly absurd.

A critical fact that Atlas seems to elide is that there are not only the extremes of complete harmlessness and death. Many survivors face a long recovery period, and sometimes long-term organ damage. Even a “mild” case can be grim. Dismissing these risks, just because the patients survive, is cruel.

Lifting quarantine orders would be horrendously unjust. We’ve seen that already where orders have been significantly relaxed. People who have significant wealth, and even people who can continue working without personal presence, are able to keep themselves safe. Poor people are forced to return to work, regardless of the risk, or face losing state benefits.

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