As the novel coronavirus spreads, we are all faced with questions about how best to care for ourselves, and for others, in a public health crisis.
The relatively young and healthy may think they are unlikely to get sick or worse, to die, from this. And according to experts, they would be right. Statistics from around the world show that with each additional decade of life, the risk of fatality from Covid-19 increases. Some numbers indicate that those over 80 may have as much as 10 times the risk of dying as those in their 50s.
But even those who wouldn’t suffer dire consequences from infection—or even exhibit symptoms—could still expose more vulnerable people, whether the elderly, uninsured, undocumented, or unwell, to the disease.
In the absence of a vaccine or treatment “social distancing,” or limiting non-essential gatherings, is one way to slow that spread. Of course, in a growing list of places including China, Italy, and New Rochelle, New York, government-issued quarantines, curfews, and other restrictions are already in effect. And some employers and schools have already mandated work- or study-from-home, removing the pressure of deciding whether to keep ourselves or our children home.
But for many others, how to proceed responsibly becomes something of a personal moral quandary. Experts and everyday citizens alike are using epidemiology, ethics, and lessons from past pandemics to help us decide how and when to isolate ourselves.
Jim Thomas is an associate professor of epidemiology at the University of North Carolina and was the lead author of the American Public Health Association’s code of ethics—a document that balances the value of individual independence against societal interdependence, when it comes to public health.
“We lose some of our autonomy by being in a society,” Thomas said. “And we take on obligations by living with others.”
The obligation for a sick person, or someone who knows they have been have exposed, is clear, said Thomas: Stay home. “Let’s say you’ve attended a conference where somebody tested positive,” he said. “I would be seriously considering staying home from other events because I could be infected and not know it.”
The obligation for someone healthy, in what he calls a “low-risk” place with relatively few confirmed cases, is a little murkier. When we spoke on Tuesday evening, Thomas was driving with his wife to see the musical Les Misérables at a theater in Durham, North Carolina. He pointed out there were fewer than 10 cases in his whole state, but that if he were in Los Angeles like me, where the count was hovering around 19, he might behave more cautiously about going somewhere he might become exposed or infected.
“Where could I become infected, I could be a risk to other people. I could be a burden to the healthcare system,” he said. “There are other ways that I could affect society that I should care about.”
To Florian Reifschneider, a 29-year-old software engineer and web developer based between Frankfurt, Germany and Florida, the decision is clear.
Reifschneider is the creator of the Twitter hashtag #staythefuckhome, which he says has reached over 250,000 people in a single day. On his website staythefuckhome.com, which surpassed 1 million visitors on Friday, a”Self-Quarantine Manifesto” encourages people to wash their hands, avoid public transit, nix concerts and museums, forgo the office, and broadly—you guessed it—to stay the fuck home, within one’s ability.
“I realized that trusting in our governments to preemptively implement measures that could actually slow the spread of the disease was a lost cause,” Reifschneider wrote in an email Tuesday from Frankfurt. The German government had not yet shut down soccer crowds, he noted. (It has now.) “I had this idea, that maybe I could not only change the minds of my immediate network, but reach out and try to fight this pandemic on a global scale by informing, educating, and giving people a guide on how they personally can take actions that will actually slow the spread.”
The site launched on Tuesday morning, and has since been published in seven languages (eight, if you count the “safe for work” version for those not working from home).
“For me, it’s really not about not getting [the coronavirus] myself, but more so not spreading it to other people that might not be able to fight it off easily,” he wrote. “We should all really think about if our personal inconvenience is justification enough to endanger millions of people that have a higher risk of suffering greatly from this.”
Of course, staying home and avoiding public transit are privileges not available to everyone.
One of the ethical questions of quarantine and isolation, says Thomas, has to do with the accommodation we offer to others, “how we care for those who are the caregivers.” Those who are employers should be aware that workers may already have children home from school or vulnerable elderly relatives at home, and avoid punitive action against those who cannot come to work.
“And some of us will be employers too,” Thomas said. “If we have a small kid who has a nanny for example, then the nanny may need to leave. How are we going to care for her during this time when she’s relying upon our income?”
Visiting elderly relatives and friends, who may be especially reliant on others for company and care, is also a complicated question. The CDC suggests that those caring for older adults should try to obtain a backup supply of any medications they regularly require, and to help stock up on non-perishable supplies to cut down on shopping trips.
Of course, anyone who believes they have been exposed to the coronavirus or is exhibiting symptoms of a respiratory infection or fever, should stay away from a senior facility. The CDC suggests postponing visits in favor of letters, emails, and videoconferences. And healthcare workers should be screened and monitored as well.
Even for the experts, the logic driving self-isolation is not entirely definitive. “There’s so much unknown about this virus and, and how infectious it is, a lot of questions that remain—even questions about how fatal it is,” said Thomas. “Those unknowns are not helping us in making decisions about what is necessary.”
“It’s a personal one,” said Thomas of such decisions, “until your health department says it’s not personal.”
Thomas advises keeping an eye on the Centers for Disease Control and Prevention (CDC) for advisories, as well as state health departments. “They are often well-staffed and full of smart people,” said Thomas. “The best we have to go on is the advice we are given by the scientists who are doing their best to figure out how this thing works, and to have faith in their ability to work on imperfect knowledge. It will always be imperfect knowledge.”
But it’s up to us to listen to those experts and officials, even though many of the restrictions are “virtually unenforceable,” said Thomas. “A lot of the social distancing recommendations that are given are really down to self-enforcement and what people are willing to do.”
Shortly after Thomas and I hung up the phone, he sent me an email letting me know he’d just heard North Carolina’s latest guidance to mitigate risk of infection, which included limiting mass gatherings.
“While sitting in our car in the parking garage for the theater, my wife and I decided to forfeit the cost of the tickets and not attend the play” he wrote. “Now we are Les Mis. ☹️”