With vaccines slowly being rolled out across the United States, it appears the nation may be close to a turning point in the coronavirus pandemic. However, the daily case rate remains high, and new, highly contagious variants threaten to create clusters of fresh infections in the coming months. This makes it more important than ever that states bolster non-vaccine strategies — specifically, supported quarantine and isolation — in order to mitigate viral transmission.
Apart from vaccinations, quarantine (keeping exposed people away from others) and isolation (keeping sick people away from others) are the best ways to stop transmission of the virus. After a surge of infections early in the pandemic, South Korea adopted an aggressive policy of testing, contact tracing, and “supported” isolation and quarantine. This included identifying those exposed to the virus and providing support services so that it was feasible and affordable for them to stay apart for seven to 10 days. The government delivered grocery supplies and paid financial compensation to those in isolation and unable to work. They provided people who needed it access to quarantine facilities, with twice-daily check-ins to monitor their health.
The results have been spectacular. While the United States recently passed 500,000 COVID-19 deaths, South Korea — one-sixth of the US population — has experienced just 1,600 fatalities, without a single vaccination. Schools have mostly stayed open, and the South Korean economy has remained largely intact. If the United States had the same death rate as South Korea, we would have lost 10,000 Americans rather than over half a million.
South Korea is not unusual. Australia, New Zealand, Taiwan, Vietnam, and parts of Germany have successfully controlled the spread of COVID-19 through a combination of contact tracing and publicly supported quarantine. A meta-analysis of 51 studies showed the effectiveness of quarantine in preventing infection and death.
But throughout the pandemic, the United States has underutilized this intervention. Contact tracing has been inadequate across the country. Although Massachusetts has a robust contact tracing program, it has nickel-and-dimed the next step of supported quarantine, which is a key purpose of contact tracing.
A frequent reaction to the idea of paying people to stay home is that it is unaffordable. But that is not so. In fact, the opposite is true — supported quarantine turns out to be both affordable and a very good investment of public resources. Last week, we published a paper examining the costs and benefits of providing “wraparound services” in Massachusetts to enable those who are sick or exposed to COVID-19 to isolate or quarantine. We looked at paying a stipend of $50 per day (the same amount as jury duty) for seven days while they remained at home, plus supplying grocery deliveries and basic family support services. We assumed that 5 percent of individuals would require access to a quarantine facility, such as a converted hotel.
We found that assuming an average of 4.25 contacts per infected person, at least half a million Commonwealth residents would probably need to quarantine or isolate between now and August, a reasonable estimation for reaching herd immunity if vaccination continues apace. The cost of supported quarantine measures for this group could be mostly offset through lower transmission and savings on medical expenditures — which average $1,000 a day — reimbursed by the state. Even if supported quarantine prevented a small fraction of contacts from contracting and passing on the virus, the decrease in transmission rate would effectively pay for the program.
Massachusetts is slated to receive an influx of $8 billion in federal funding from the proposed $1.9 trillion stimulus package. In addition to $350 billion for states and cities, the House-passed bill provides $46 billion for testing, contact tracing, and mitigation, particularly in medically underserved areas. Even if the final amounts are reduced in the Senate, the state will probably be in the position of deciding how to spend resources to protect communities where COVID-19 remains stubbornly high. Massachusetts is backing away from contact tracing and has not announced any plans to make it easier for people to stay home if they are exposed. That is a mistake.
Many people can’t afford to quarantine or isolate for the CDC’s recommended seven to 10 days due to lack of income or the need for help with child care, food, or rent. Low-income or minority communities are among the hardest hit. Rather than backing away, the state needs to double down on contact tracing and make it practical for those who have been exposed to the virus to stay home. By acting now, it can lower transmission rates and save hundreds of lives over the coming few months.
Linda J. Bilmes is a senior lecturer in public finance at the Harvard Kennedy School. Dr. Margaret Bourdeaux is research director of the Program in Global Public Policy at Harvard Medical School.