Kentucky Senator Rand Paul’s behaviour over the past two weeks is exactly what’s wrong with America’s response to COVID-19. Paul has a compromised lung, so he decided that he should be tested for the disease out of an abundance of caution. From the time of his test until he was confirmed positive six days later, Paul did nothing to protect those around him. On the contrary, he met with other senators, cast votes on the Senate floor, played a round of golf at a private club, and even squeezed in a few laps at the Senate pool.
In the countries that have contained the coronavirus outbreak, such irresponsible behaviour has not been tolerated, and even could have landed Paul in jail. As a physician (ophthalmologist), he, more than anyone, should know that if he was concerned enough about COVID-19 to be tested for it, he should have been equally concerned about the risk he was posing to others.
Containing the transmission of any infectious pathogen – especially one as contagious as COVID-19 – requires aggressive action. Defensive moves like closing businesses or social distancing are effective only when combined with rigorous, systematic efforts to get ahead of the spread of the disease.
In Singapore, South Korea, and other countries that have stanched the spread of the coronavirus, public-health authorities have followed a simple process. First, widespread testing has identified those who are infected even before they show symptoms (which many never do). Then, aggressive contact tracing has identified everyone with whom the infected person has interacted. Finally, everyone identified has been subjected to a mandatory 14-day quarantine.
This process not only contained the outbreak; it also avoided some of the extreme lockdown measures used elsewhere. Success lies in an uncompromising approach involving mass testing, contact tracing, and selective quarantining – all of which the United States (US) has failed to do.
In Singapore, the moment a person tests positive for COVID-19, a team of contact tracers is deployed. Someone sits with the patient for hours asking where he has been and with whom he has been in contact in the previous days. Others track down names, phone numbers, addresses, and anything else the patient can tell them that might help identify more positive cases.
The team then delivers its findings to the Ministry of Health, which corroborates the information through phone calls, CCTV footage, and traditional detective work like reviewing retail receipts or checking rideshare apps to find drivers and passengers who might have interacted with the patient.
Once the list of potential contacts is known, everyone on it receives a call, and those most at risk of having been infected are required – not asked – to quarantine themselves for 14 days. Depending on the closeness of the contact, some are moved to a secure quarantine facility, whereas others may be permitted to remain in their homes.
Earlier this month, a close friend of mine returned from Europe to Shanghai and lived through the quarantine experience. Three days after arriving in China, he received calls from the police, the Shanghai Municipal Center for Disease Control and Prevention (CDC), and the district CDC telling him that a passenger on his flight had tested positive. My friend and his wife were then put into controlled quarantine, in a hotel that had been converted for the purpose. They resided in separate rooms, received three meals a day (along with other amenities), and were prevented from leaving until 14 days had passed since the point of initial contact on their flight.
In China, quarantines are monitored through an app. Everyone receives a unique QR code showing their status – green if you’re clear of infection, yellow if you’ve been instructed to stay indoors, red if you are under quarantine. If you’re roaming the streets and your QR code flashes red, you will immediately be moved back to quarantine, or else you may face fines or jail time.
Singapore has taken this technology even further, launching a new TraceTogether app that people can download to help protect themselves and those around them. If a user passes within two metres of someone who is found to be infected, the app immediately notifies the user of the risk.
Since late January, when Singapore reported its first case of COVID-19, more than 6,000 people have been identified through contract tracing and put into proactive isolation and quarantine. Owing to these efforts, infections have been contained, hospitals have not experienced a major surge in new patients, and only three people have died of the disease.
By contrast, although the US has many of these methods at its disposal, it has failed to deploy them effectively. The Centers for Disease Control and Prevention has trained more than 3,600 disease detectives who are skilled in identifying those infected, tracing their history of contacts, and mitigating the wider risk to the community. But they have been unable to do their jobs, owing largely to early testing failures, which still have yet to be resolved.
Contact tracing is costly and time-consuming even in the best of times, when an outbreak is still small. With large outbreaks that have gone undetected because of a lack of tests, it becomes nearly impossible logistically.
But failure must not be allowed to follow failure. Tests are finally becoming available to more Americans. Widespread testing, together with exhaustive contact tracing and selective quarantines, can still help us wrestle the outbreak back under control. As Paul himself said when defending his reckless behaviour, “America is strong. We are a resilient people, but we’re stronger when we stand together.” True, but we are stronger when we stand together and act responsibly.