By Leslie Francis and Margaret Pabst Battin
This post is part II of a two-part series on pandemic control strategies in response to COVID-19.
New testing methods may allow us to avoid many of the inequities and injustices of the traditional methods of pandemic control, if we can deploy them quickly enough.
Far more extensive testing is already being put into effect in limited but promising ways.
The northern Italian village of Vò, working with researchers at the University of Padua and the Red Cross, tested all of its 3,000 inhabitants, including those who did not have symptoms. Using quarantine for those who tested positive made it possible to stop the further spread of COVID-19 in under 14 days. The strategy required a complete cordon sanitaire of this mountain town — no one going in or out — and was successful because at the time it was implemented, only 3% of the population had disease.
Seattle, Washington, is conducting a SCAN study of a population sample to trace the spread of COVID-19 in a large city with widespread community infection.
Testing is constantly improving, too, with point-of-care results now available in a matter of minutes or hours and methods that enable more and more people to be tested in a short time period.
At the moment, many parts of the world (the U.S. included) without adequate testing or treatment are forced to rely primarily on pandemic control strategies from earlier eras, or use those strategies in conjunction with whatever testing capacities are available.
Isolation, which must be draconian in order to be effective, can be horribly lonely. But with enhanced testing, we wouldn’t need to isolate people unless it were clear that they actually have the virus.
With widespread testing, there’d be a reduced need for physical distancing, especially global distancing that shuts down entire industries and wreaks economic havoc.
A contemporary cordon sanitaire could be permeable, allowing people who test negative on the most sensitive and specific tests to come and go through the barrier.
Quarantine that confines people who are not ill with those who are, thus incubating further spread, would be obsolete; only true positives, whether on a cruise ship or in a nursing home, would need to undergo quarantine.
And sheltering in place? It wouldn’t be necessary either, unless, as in the current COVID-19 pandemic, the disease had already moved far beyond our capacity to contain it.
As we develop and distribute more adequate testing, including multiple types of testing, as well as vaccines and effective treatment, we should be able to move away from primary reliance on earlier forms of pandemic control or use those earlier forms more judiciously in conjunction with testing.
If we’re going to continue to use them — quarantine, isolation, cordon sanitaire, contact tracing, and massive lockdown measures, including confinement to home — we need to be far more alert to the ethical challenges they raise. We don’t bell lepers anymore or transport people with leprosy to permanent quarantine-exile in remote places, though that’s because leprosy — Hansen’s Disease — is now a treatable condition, and we can now recognize the ethical wrongs in those early forms of control.
To get through the COVID-19 pandemic together, we need to think about how to employ modern testing and also immunization and treatment strategies when they become available. But we also need to be clearer about when we must still use the traditional strategies as well, with an eye toward reducing the ethical challenges of each.