[Goose]

Goose, you may have been talking about either the patient who had a positive test, or a close contact.  I will presume you meant only the person with the positive test.

No MT, I mean exactly what I said. Track and trace basically won't work, particularly with this virus, if you do not also quarantine the close contacts. Some of those contacts may test positive immediately when contacted, and therefore become cases to track and trace themselves. That is simple. The close contacts that don't test positive must also be quarantined because they have a high probability of becoming positive.  When they do, they will spread the disease for several days (at least) before they become sick (if they ever do). This significantly defeats the purpose of track and trace. The "win" of track and trace is forcing only high probability subjects into quarantine, not the entire population as we have now. Some people will lose two weeks out of their life that will turn out not to have been necessary, but that is how it is. That is why determining who is a "close" contact is a bit of an art, not a science. People who get sick and test positive usually stay home anyway. It is the ones that aren't yet sick that will do the spreading.

I think you could ease what you described a bit:  The "county run facility" could be a hotel/motel/dorm, not a jail.

Yes, that is why I said facility. Not intending to jail people. Hauling them off involuntarily was only recommended when they refuse to cooperate (name contacts) and/or quarantine themselves. Most people will probably prefer to stay at home, which is fine IF they can/will met the quarantine requirements. However, people cooperate much more readily when they know they really have no choice.

The patient would be confined, but would have meals brought in, have bed, bathroom, TV, access to Internet & phone, etc.  No visitors (but families/cohabitants in quarantine would be kept together, and probably could remain until the last ends his/her quarantine).     It certainly is less onerous than being in a hospital the entire time (what China did).

Family members are a bit of a problem. If you all quarantine together, the quarantine has to be extended to ensure no family member got infected on the 13th  day of the last positive patient's original quarantine period. The incubation period is a bit unknown, but that would double the quarantine length most probably. Testing on day 13 won't help because the incubation period would not have passed. The quarantine therefore starts over whenever a family member who was negative tests positive. This naturally means that family members who are not sick can't go to work, but that would also be true if they quarantined separately. It just prevents the quarantine from restarting on everybody else.

A less optimal approach is to allow the individual to wear a location monitoring device to confirm that they stay home, as their choice rather than being moved to a county-run facility.   This has the risk of their infecting others that may come to the house (household members, food delivery, etc.) and they spread it further.



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But, we don't really know that the disease is being spread significantly by individuals who know they have tested positive.

Probably it isn't IMHO. It is people who aren't yet sick (close contacts of those who are sick) and some people who are not sick enough to get tested. These people just get on with their daily lives and in so doing spread the disease. The latter group we generally won't find except as a contact of somebody who got sick and was tested. This isn't optimal because there will be a significant delay in finding these people. We can eliminate the spread from the first group with track and trace pretty much for sure as they aren't sick yet and haven't spread the disease (yet).

So, I'm not sure I would yet support this approach.  I think the voluntary isolation in a county facility is a good option, but unless you know someone is leaving their quarantine, I'm not quite ready for involuntary movement to a facility.  I would support involuntary location tracking during quarantine.

Works for me, but remember, it is all of them, not just the ones who tested positive.

[Goose]

Goose, you may have been talking about either the patient who had a positive test, or a close contact.  I will presume you meant only the person with the positive test.

No MT, I mean exactly what I said. Track and trace basically won't work, particularly with this virus, if you do not also quarantine the close contacts. Some of those contacts may test positive immediately when contacted, and therefore become cases to track and trace themselves. That is simple. The close contacts that don't test positive must also be quarantined because they have a high probability of becoming positive.  When they do, they will spread the disease for several days (at least) before they become sick (if they ever do). This significantly defeats the purpose of track and trace. The "win" of track and trace is forcing only high probability subjects into quarantine, not the entire population as we have now. Some people will lose two weeks out of their life that will turn out not to have been necessary, but that is how it is. That is why determining who is a "close" contact is a bit of an art, not a science. People who get sick and test positive usually stay home anyway. It is the ones that aren't yet sick that will do the spreading.

I think you could ease what you described a bit:  The "county run facility" could be a hotel/motel/dorm, not a jail.

Yes, that is why I said facility. Not intending to jail people. Hauling them off involuntarily was only recommended when they refuse to cooperate (name contacts) and/or quarantine themselves. Most people will probably prefer to stay at home, which is fine IF they can/will met the quarantine requirements. However, people cooperate much more readily when they know they really have no choice.

The patient would be confined, but would have meals brought in, have bed, bathroom, TV, access to Internet & phone, etc.  No visitors (but families/cohabitants in quarantine would be kept together, and probably could remain until the last ends his/her quarantine).     It certainly is less onerous than being in a hospital the entire time (what China did).

Family members are a bit of a problem. If you all quarantine together, the quarantine has to be extended to ensure no family member got infected on the 13th  day of the last positive patient's original quarantine period. The incubation period is a bit unknown, but that would double the quarantine length most probably. Testing on day 13 won't help because the incubation period would not have passed. The quarantine therefore starts over whenever a family member who was negative tests positive. This naturally means that family members who are not sick can't go to work, but that would also be true if they quarantined separately. It just prevents the quarantine from restarting on everybody else.

A less optimal approach is to allow the individual to wear a location monitoring device to confirm that they stay home, as their choice rather than being moved to a county-run facility.   This has the risk of their infecting others that may come to the house (household members, food delivery, etc.) and they spread it further.



---



But, we don't really know that the disease is being spread significantly by individuals who know they have tested positive.

Probably it isn't IMHO. It is people who aren't yet sick (close contacts of those who are sick) and some people who are not sick enough to get tested. These people just get on with their daily lives and in so doing spread the disease. The latter group we generally won't find except as a contact of somebody who got sick and was tested. This isn't optimal because there will be a significant delay in finding these people. We can eliminate the spread from the first group with track and trace pretty much for sure as they aren't sick yet and haven't spread the disease (yet).

So, I'm not sure I would yet support this approach.  I think the voluntary isolation in a county facility is a good option, but unless you know someone is leaving their quarantine, I'm not quite ready for involuntary movement to a facility.  I would support involuntary location tracking during quarantine.

Works for me, but remember, it is all of them, not just the ones who tested positive.