I think it’s become fairly apparent that effective federal and even state responses to this pandemic are not going to happen in the short term. I had a discussion over at Greg’s blog where I pointed out that effective local responses are still perfectly possible in most places. So let’s take a brief look about what that might look like.
We’re going to look at this from the perspective of a small or medium size city that is:
- Politically independent (has its own government and police force)
- Reasonably geographically separated (not a suburb of a much larger metropolitan area)
- Reasonably wealthy (such that the measures I’ll suggest are affordable without external support)
- Not yet heavily infected
Let’s suppose it’s about 80,000 people, 20% children and 15% seniors. First let’s figure out what the impact on the city would be without effective response. We’ll conservatively guess that about 60% of the population would eventually be infected, with a hospitalization rate for kids, adults, and seniors of 2%, 20%, and 35%, and a case fatality rate of 0%, 0.5%, and 6%, respectively. That would give us at the end of the epidemic 156 dead adults, 432 dead senior citizens, and 192 hospitalized kids, 6,240 hospitalized adults, and 2,520 hospitalized seniors. That’s not great. Depending on how big your local hospital is and how bad the cases are, the death rate could be higher if those infections happen too fast.
So. Suppose you run this city. What can you do about it without federal or state help?
Let’s assume you have access to at least some testing capacity. If you’re like most places, it’s under-used right now. Let’s say you’ve got 100 tests per day that aren’t needed for testing of healthcare workers or new patients. Use that capacity: Randomly choose households in your town, call them up and read this script:
Hello. My name is X, with city Y. We’re running a testing program to help our citizens know whether they’ve been infected with the new coronavirus. We’ve chosen your household to be a part of this program. If you’re interested, bring at most two members of your household to the local hospital tomorrow and give them this ID number: #. Thanks.
At 100 tests a day, you’re randomly testing 0.125% of the population. Just this level of random testing is enough to spot a new outbreak by the time it gets to the size of ~500 people or so. That’s small enough it’s still containable.
Set up your own local contact tracing team. Once you’ve spotted an outbreak from random testing, a sick patient presenting, or a lead from another jurisdiction’s tracing team, you’ll want to figure out how much it’s spread and contain it as soon as possible.
Take your index patient and interview them: figure out how long they’ve been infectious. Where do they work, who do they live with, what shops have they been to. You’re trying to figure out who else could have been exposed to them while they were infectious. Once you’ve got potential links you call them up too and do the same thing: are they sick or showing any symptoms, were they at location X at time Y, and who have they been in contact with since then.
Recommend self-quarantine for all these folks and refer them for testing.
Basically all of this can be done with volunteers. You’ll need a script for each stage, volunteers with phones, and interpreters. In some cases you’ll want some boots on the ground as well. You could find underemployed public employees who want to help or just ask around in the community. There’s lots of people out of work who would be interested in helping. I’d look specially at librarians and public school administrators, but lots of people can be useful here.
Regulations to Help Tracing
You can do tracing with just phone work, but some additional regulation will make it easier. In particular we’re looking for things that will make it easier to see when two people were close to each other at the same time. Workplaces generally have timesheets that will let you see overlapping employees, but shops don’t keep track of customers. So ask them to: require that they keep a paper ledger that customers and employees need to sign into with the date and time when they entered the shop. A book like this costs ~$10; just buy one for every shop in your town and pick them up/drop them off weekly.
Intra-household infections are hard to stop with self-quarantine. So offer your citizens an alternative to getting grandma infected. Find some hotels in the area. They’re likely to be nearly empty. See if they’ll donate rooms for quarantine, or maybe offer a tax rebate for them. Set them up for quarantine of infected or contacted citizens. Make sure there’s food delivery and internet service available.
Then when you do your contact tracing and you tell someone they were in long contact with a known infection, you say “If you’re worried about infecting your family members, we can put you up in the hotel for free.”
All of the above measures are meant to keep the infection from spreading widely in your town, but you’ll have to keep the number of new infections that you get from outside down as low as possible. So impose some simple travel restrictions: restrict entry to your town to residents or essential workers. Put some police or volunteers at the main roads and screen entrants. You could make it easier by doing something like mailing out a couple of stickers to put on the windshield to every household. Then cars with the sticker can get waved past.
Strength of these restrictions probably depends on how common the infection is in your local area. If your town has an airport or is near an airport, you’ll want to be a lot more careful, especially with long-distance travelers.
Other Public Health Measures
Standard stuff that everyone knows already should be kept up: have people wear masks outside, encourage social distancing, close schools, ban large gatherings. Try not to be a jerk about it; voluntary compliance is a lot better than forced compliance. That means, for example, having your cops hand out masks to people who don’t have them instead of roughing up those who aren’t wearing them.
There’s no reason why sensible and mostly voluntary restrictions like these can’t let your town open its stores and factories and keep its economy going while also keeping the coronavirus from running rampant.