Introduction

It is becoming apparent that some people are becoming restless in light of the current stay-at-home orders. Some of this reaction is pure foolishness, and highlights a failure of our educational system to produce mature adults whose rational faculties are able to master their passions. On the other hand, some of the arguments against universal compulsion to stay-at-home are clearly acknowledged as reasonable, since various exceptions are made as to 1) who must stay at home (e.g., 'essential' workers are exempt) and 2) when anyone can be granted an exception (e.g., anyone can go out to get groceries). The question arises, then, as to whether we have done a perfect job in delineating these exemptions, or if some improvements can be made. This essay argues for some improvements.

One of the grounds for lifting the current restrictions is the negative impact that such restrictions are having on the economy. Counter-balancing such complaints is the observation that lifting the ban will spread the disease and lead to deaths. This leads to the rejoinder, "So how do I live without money?" and to the reply, "How do you earn money when you're dead, or in jail for [attempted] manslaughter (or worse)?" Apparently, then, we are faced with a decision of 'your money or your life', or 'your livelihood or your life'. And, as long as the situation is painted in these black-and-white terms, no progress will be made, and conflicts are sure to arise. I think we can do better than that.

Background

It is known (as least by those who are reasonably informed—not a safe assumption when dealing with America's civic leaders) that COVID-19 is typically not life-threatening to those who are young and do not have underlying conditions that it might exacerbate. Were it not for the highly contagious nature of the virus that leads to the disease, we might consider allowing such people to take their chances with it. But, since the virus is highly contagious, we worry that these healthy people might pass it on to those who are more vulnerable. This worry is greatly intensified when we add in the consideration that the virus has a long incubation period (apparently up to 2 weeks before symptoms develop), and, in some patients, the symptoms that do develop may be so slight as to go unnoticed. This means that people can unwittingly spread the disease, thinking that they are in perfect health. The stay-at-home orders, then, emerge from reasonable and compassionate concerns for the vulnerable.

An additional element that has been taken into consideration (and it is a national disgrace, given what we pay for medical care) is the current limit on hospital capabilities: if too many people get sick at one time, hospitals will not have the personnel and equipment to treat them. This will leave some patients out in the cold, many of whom will die. This would be a real tragedy, and a real shame, because many of those deaths would have been prevented if the capacity to treat patients had been adequate to the crisis. The stay-at-home orders, then, also serve to slow the spread of the disease so that the need for hospital resources does not outpace their availability.

Another item in the national disgrace column is the issue of testing. There are two kinds of test: one detects the presence of the virus or the disease, the other detects a person's ability to produce antibodies to combat the virus. The first type of test shows whether or not a person is currently infected with the virus, the second type shows whether or not a person has been infected and recovered. Both tests may produce false results, and a false sense of security. In the case of the first kind of test, if it accurately shows that you do not have the virus, it very quickly turns into little more than a history report: you did not have the virus at the time the test was taken, but you may have caught it 15 minutes later, you may even have caught it in the course of taking the test. If it takes days to get your test results back, the information is nearly useless. With this type of test, you have to keep on getting retested, and we don't even have enough tests to cover a statistically significant portion of the population, so talking about these tests is currently a waste of time. They only help with hospitals' triage efforts. In the case of the second kind of test, if the test accurately shows that you can produce antibodies, then you can reasonably claim to be immune to COVID-19. This, however, does not mean that you—your hands, your clothes, your things—are not a carrier of the virus: your immunity does not make you safe for those who encounter you because being immune is not the same as not being a source of contagion. Here, again, the tests are not readily available, so, until that situation improves dramatically, talk about such test is just talk.

The final piece of the puzzle is the financial impact. Already, some emergency measures have been taken, and, already, questions are arising as to who gets to be bailed out, and who, among that group, deserves the money—as is typical in this country, the rich and connected have, again, ended up first in line, while the genuinely needy have been burdened with red tape, delays, shortages, and, in this case, 'grants' that are likely to turn into loans. At any rate, the government can't simply keep on printing checks and accruing debt (or, if it can, perhaps it shouldn't: the real cost will catch up with us sooner or later)

Proposed Solutions

On the solution side, there has been talk of trying to to track people and assign them a likelihood of carrying the virus. The traditional model for doing this is to interview patients with the disease and do supplemental detective work to determine when and where they, most likely, picked up the virus, and then find out who they have been in contact since (an inexact science). This is a slow process, and, since, the virus apparently spreads a lot faster, it has ended up providing data for historical analysis, but has not been very useful for preventing the spread of the virus (stay-at-home orders have been much more effective).

Some of those who are looking for a faster tracking system have suggested using the spying capabilities of social media, smart-phone apps, and the like: since the location of smart-phones can be tracked, and the phones are usually in the possession of their owner, they can say where the owner is, and where they have been at any time that the phone has been operational; by comparing location and time data from all users, it is possible to identify if/when any person, A, has been in close proximity to any person, B, and, if person A is identified as having COVID-19, then all smart-phones that have been in close proximity to A's smart-phone can be notified. This system achieves the goal of speeding up tracing, but it has drawbacks:

• People who do not have smart-phones, or do not use the required apps, will remain a wild-card;
• As expressed above, smart-phones track themselves, not their owners, so misplaced phones, unused phones, phones with dead batteries, and the like will either be providing false information or information with important gaps.
• Will the phones report a person in a car and a person crossing the street in front of them as being 'in contact'? How about a person in the car next to them at a traffic light? How about people on opposite sides of a wall in, say, an apartment building—they may be less than a foot apart? How will these 'false contacts' be filtered out? By annoying alerts that ask you to manually confirm if you were just in contact with person X? Get two hundred of those in the course of an afternoon, and see how likely you are to disable the app, or to just start ignoring it.
• And how will other false locational data—the results of technical glitches, hackers, user errors—be handled?
• And how will the system be implemented? If voluntary, what use is the system when half the people you encounter don't use it? If involuntary, how do we get smart-phones to everyone, how do we insure they stay charged and with their owners, and what do we do with those ornery persons who simply refuse to participate?

A further, but fundamental, problem with tracking efforts is that they rely on testing, which, as was discussed above, would be problematic even if accurate tests were readily available. Yes, we know that those who are in the hospital with COVID-19 are infected, and probably have been for weeks, so quarantining their contacts makes some sense, but those who are in the hospital are a small fraction of all the people carrying the virus around, so targeting only their contacts leaves the vast majority of carriers free to roam about and spread the disease. Such a partial solution will only induce a false sense of security that leads to widespread contagion.