From research I did on New Zealand: 14 days isn't long enough if people are isolating together- live infections get passed to housemates partway through, who are still contagious when the 14 days are up. So either you have to truly isolate everyone, or extend it by some number of days for each additional person.
Also, I assume you mean "14 days, unless they test positive or show symptoms", but then you have to figure out how to test and verify symptoms for everyone.
This could work in theory but to separate everyone you have to separate everyone, including the elderly from their caretakers, mothers from their babies, comatose patients from doctors and prisoners from each other—all at the same time. Plus animals, as Bucky mentioned.
Fortunately, quarantining everyone is overkill. It is more efficient to do contact tracing and testing, and then quarantine only those who test positive or were exposed to someone who tested positive. Countries like Taiwan did this successfully. They quarantine everyone entering the country and have had the pandemic under control for ages. You can walk around Taipei like it's 2018.
As others have pointed out, there are some practical issues (people quarantining in groups that are hard to subdivide, and the rare but not nonexistent longer-than-14-day incubation being the obvious ones). But the generator of this is valid: strong virus-control measures concentrated into a short time work better than weaker measures over a longer period. Ie if you can do A, B, and C, each of which reduces R by 0.4, doing them all at once is much better than doing them one after another.
This makes me wish we could do experiments with alternate lockdown strategies, like: Instead of having things open at 1/4th capacity, we have them open at 100% capacity and every few weeks they're all closed for a week.
This wouldn't work perfectly and you'd inevitably miss people every time, but "everyone gets a week off every 6 weeks" seems way easier to get buy-in for than everything being mostly closed endlessly.
It would be better for parents, since they would be off of work the same week their kids don't have school, and it would be predictable.
It would be better for businesses, since demand would move the week before and after the scheduled lockdown.
It's unclear if it would work well enough, since you might just end up with huge cycles of infection rates dropping for a week and then jumping all the way back up as everyone starts singing at bars the week after, but it seems worth a try.
I think this is the best proto-plan.
Yeah, I was thinking about a similar thing. (My version was 2 weeks off every 2 months; plus contact tracing; plus ban on gatherings of over hundred people.) With the schedule known months in advance, people could at least plan their lives. If you can't do something right now, but you know you will be able to do it 2 weeks later, it's usually not a big problem.
Building infrastructure and setting up preparations for doing this throughly could be an interesting safeguard against future pandemics worse than Covid. But I think there's a big problem with continuing to run hospitals and care-taking facilities, and care-taking in general.
I think it is almost certain you would need to do this repeatedly
I guess the question would be how long respite would this give you before having to repeat.
Say we're going back completely to normal after the firebreak. Doubling times with the English strain were a little over a weak with the fairly strict December measures. With no measures say it speeds up to doubling every 4 days. This might be optimistic given how fast the original strain spread early in the pandemic.
If we have 10 cases that we've failed to eradicate then we get to 10,000,000 cases in about 11 weeks. So we have to repeat this 4 times a year?
Since the virus grows exponentially (when R>1), and it seems unlikely that it'll be actually eradicated (due to outliers on infection times, groups who isolate together, but slowly transmit it among the group, and simple leaks in enforcement/adoption), it's best to think of this kind of intervention as "how much does it reduce the infectious population"?
It seems likely that, with the vaccines rolling out (too slowly, but happening), any significant reduction in the spread makes the final herd immunity (actual end-game for this) contain a higher ratio of vaccinated to formerly-infected, and a lower absolute number of dead and a lower amount of long-term impacted. So you get much of the value, even if the disease is only set back a few months, not fully eliminated.
Which means, you can look at the reasons that this isn't happening (in most US and EU regions) even enough to slow the spread, and just extend them to why we haven't shut down enough to stop it entirely. I think 4 is a very hard constraints, with 3 being close, and they give cover to the violators of 1, making policing effectively impossible. I also think you have to dive pretty deep into 1 to explain who's doing the policing, and why they're willing to go out and police (which does mean shooting and being shot at, right?) rather than staying safe at home.
I agree that you have identified the key problems. 1 and 2 appear to me so unsolvable as to be indistinguishable from impossible, and any other issue I can think of is gated through one of them.
I have an extremely strong prior that any plan which requires an entire population to change their behavior at once is fundamentally wrong and not worth considering. Although I do note that plans involving a fraction of the population changing their behavior, or an entire population changing their behavior over time, are still worth considering.
I think this is a major obstacle: Natural reservoirs. Covid-19 is transmittable between species.
I keep thinking about how if at any point we were all able to actually quarantine for two weeks1 at the same time, the pandemic would be over.
Like, if instead of everyone being more or less cautious over a year, we all agreed on single a two week period to hard quarantine. With plenty of warning, so that people had time to stock up on groceries and do anything important ahead of time. And with massive financial redistribution in advance, so that everyone could afford two weeks without work. And with some planning to equip the few essential-every-week-without-delay workers (e.g. nurses, people keeping the power on) with unsustainably excessive PPE.
This wouldn’t require less total risky activity. If we just managed to move all of the risky activity from one fortnight to the one before it, then that would destroy the virus (and everyone could do as many previously risky activities as they liked in the following fortnight!). It could be kind of like the Christmas week except twice as long and the government would pay most people to stay at home and watch movies or play games or whatever. Maybe the TV channels and celebrities could cooperate and try to put together an especially entertaining lineup.
How unrealistic is this? It sounds pretty unrealistic, but what goes wrong?
Some possible things:
1, 2 and 7 look like the clearest problems to me. I don’t know enough to say if 3, 4 or 8 are real obstacles, and it seems like the US federal government has sent out a lot of money already, so 5 could at worst be solved by doing this thing at the time the money was sent out. 6 seems true, but I’m not sure if the length it would need to be is out of the question, if the other questions are solved.
7 is pretty bad even in a community without dependent people, because it requires active effort from everyone to protect themselves within their houses, which seems much less likely to be ubiquitously complied with than a request to not go to effort to do something (i.e. more people will find the energy to stay on their sofas than will find the energy to set up their room to prepare food in it for a fortnight). Then the dependent people who really need to stay with someone else seem even harder to get the end-of-fortnight risk down for. I could imagine dealing with these problems by spreading people out as much as feasible and requiring longer quarantines for pairs. But the difficulty of that—or need for extending the length of the whole thing—seem quite costly.
On 2 and 7, even if you don’t actually stop the pandemic, and you have to have another occasional scheduled ‘firebreak’ in activity, once cases had built up again, it seems like it could hugely reduce the human cost, without more total caution (just moving the caution in time).
(Also, if you did it for four weeks instead of two, you would only end up with cases where two failures met, i.e. where someone improbably got covid during the first two weeks, then improbably passed it on to another person in the second.)
On 4, One way you might swing this is to have many of the people who work during the two weeks then do their own hard quarantine in the following two weeks, where they can be replaced by some of the workers with similar skills who were at home during the main round.
Many of these depend on scale, and location. For instance, this can clearly often work at the level of a group house, and is probably too ambitious for a large and ideologically diverse nation (especially one that isn’t really organized for people to consistently wear masks after a year). Could it work at the level of a relatively anti-covid city? (The city would then have to limit or quarantine incoming travelers, but that seems doable for many cities.) A small town? A small college campus? A highly religious adult community, where the church was in favor? There are a lot of human groups in the world.
Have I got the main reasons this wouldn’t work? Is there some good solution to them that I haven’t seen?
Has anyone done something like this? There have been lots of lockdowns, but have there been time-bounded almost-total lockdowns scheduled in advance, with huge efforts to avert people needing to take risks during that particular period (e.g. treating moving risks to the time earlier as great compared to running them that week)?
Or however long it takes a person to reliably stop spreading covid, after contracting it. ↩