Can Ebola Quarantine Possibly Work?
Karl Denninger is a popular economics blogger (and one who will never be invited to advise the Federal Reserve). Last week he provided some analysis of the proposal to use quarantine procedures to deal with Ebola risk: “On Ebola, Quarantines, and Similar.”
I’m sure you’ve heard that the Dallas Ebola patient’s family has been forcibly quarantined.
I’ve been pinged repeatedly since this story first broke on my views with regard to armed quarantines and similar, and some fanciful views (in my opinion) have been put forth, including by some folks that I hold in generally high regard and consider to be some of the more-thoughtful among us.
Let’s start with a few of the suggestions:
- Quarantine anyone coming into the country that comes from either a “hotspot” nation or where the origination point does not have effective quarantine regulations and powers. That’s a nice sentiment, but the quarantine requirement in this case would be three weeks. The first question is where do you put them since any could be infected and, if they are, you can’t reasonably condemn an entire hotel! You could force travelers to pay for this (obviating the expense issue that otherwise exists but that would immediately terminate all business travel to and from any place on your designated list as most business trips are for far less time than the quarantine period. Think long and hard before adopting such a position folks.
- Lock down the borders. Uh, how? Terminate all international inbound travel? Ok, go ahead and try that. Note that the individual in question lied about his exposure and thus risk and was not symptomatic at the time of the flight, which means there was no way in a reasonable period of time to verify whether he was lying or not. This is an intractable problem unless you lock down the border entirely because people can (and do!) originate somewhere, travel through a place in which there is a problem, officials there may cooperate (in exchange for a bribe or just simply on principle) with not stamping a passport and you can (in most cases) travel in and out of such areas without using a documented means (e.g. other than an airplane.) Both we and the affected nations are already screening people, including Liberia where this guy originated. Again, verification is impossible in the few seconds or minutes you need to both change your status and the amount of time you have to verify a passenger’s claims.
Ebola, thankfully, is a rather poorly-transmitted virus. It’s “N” value, that is, the number of people (on average) infected by a person who has it, is about 2. For comparison purposes this is about the same as HIV, but of course HIV infects people over a very long period of time where Ebola only infects people during the period from symptoms appearing until recovery (or death and proper disposal of the body.) To put some perspective on this measles has an “N” value of something around ten times that figure.
The bad news is that measles rarely kills but Ebola often does. But — one must be careful here because Ebola’s history is one from nations with poor health care in general and specifically, poor compliance with even basic sanitary considerations in the health care setting, say much less anywhere else. Measles is quite commonly fatal in the same sort of environment; fatalities in the 20% range are not uncommon in those parts of the world.
Denninger’s post seems reasonable to me. Any of us who have visited or lived in places in Sub-Saharan Africa know that is an entirely different health environment than what we take for granted in North America. I don’t want to lose that blessing through complacency, but the fact remains that we are simply not facing the same risks that Liberians and others face in Africa.
Of course, there could always be fluke anomalies. Read about the flu epidemic of 1918 some time if you don’t believe me. But then again, that was just “ordinary” flu—so such a disaster could come from anywhere as far as we know.
Denninger goes on to critique the CDC’s quarantine proposal which—don’t die of surprise at what I’m about to tell you—amounts to “security theater.” The procedure would make it look like they were doing something but be completely inadequate to really stop the spread of the disease.
While most of his advice is rather assuring, Denninger also points out that, if Ebola really was to take off in the United States, the only strategy that would make sense would be to get in a position to stay inside one’s own home for about six months.
Perhaps some of you are prepared for such a contingency. As I see it, you would need a supply of food, and probably water and electricity because it would be easy to see the utilities failing in such circumstances.
Lesser disasters are always possible. So if this Ebola scare is nothing more than that for most Americans, and it inspires us to be more prepared for disasters, then that would be a good outcome.