[Goose]

It also seems that family transmission could vary quite a bit based on socioeconomic conditions.  Many families have no effective way of isolating a sick family member, especially in a packed household where multiple people must work in high-exposure jobs.

For sure it is and has been. Take a look at
https://www.smchealth.org/health-officer...-statement

No matter what one thinks about the causes of this non compliance, it appears that it has very significantly impacted the ability of San Mateo County to mitigate the epidemic by tracking and tracing. It appears they have somewhat given up. I have been trying to get clarification on this issue, but my county supervisor has been kind of busy with 50% of his district evacuated. I will restart the effort on Monday.

That health officer said, "Try getting compliance with isolation and quarantine when the infected person is the breadwinner for the family and the family will be out on the street if they don’t go to work. "

One of the things that stood out to me about the Swedish situation is a national law granting 2 weeks of sick pay to everyone, and with the pandemic, the gov't stepped up to make sure the pay is 100% salary and no doctor's note is necessary anymore.  They've made it much easier for the breadwinner to stay home when infected.  There's also some relief if the sickness lasts more than 14 days as well.

I think San Mateo County could do that. However, I think the problems are that 1) there is no way the infected person can isolate at home. There isn't enough room, and 2) there are other people in the household that want/need to go to work. They aren't sick (yet), but they are exposed and should quarantine. They won't do that, and getting economic coverage for those people from the county will be a hard sell, at best.  There are too many people involved and they don't have COVID-19 (so far as we know). On top of that, many people in this situation want nothing to do with the government in any form. They may be perfectly "legal", but others in and around the household may not be. Not worth the risk. That precludes sending them all to a hotel to quarantine, even if the facilities were made available. That is why SMC Health is so frustrated.

[Goose]

It also seems that family transmission could vary quite a bit based on socioeconomic conditions.  Many families have no effective way of isolating a sick family member, especially in a packed household where multiple people must work in high-exposure jobs.

For sure it is and has been. Take a look at
https://www.smchealth.org/health-officer...-statement

No matter what one thinks about the causes of this non compliance, it appears that it has very significantly impacted the ability of San Mateo County to mitigate the epidemic by tracking and tracing. It appears they have somewhat given up. I have been trying to get clarification on this issue, but my county supervisor has been kind of busy with 50% of his district evacuated. I will restart the effort on Monday.

That health officer said, "Try getting compliance with isolation and quarantine when the infected person is the breadwinner for the family and the family will be out on the street if they don’t go to work. "

One of the things that stood out to me about the Swedish situation is a national law granting 2 weeks of sick pay to everyone, and with the pandemic, the gov't stepped up to make sure the pay is 100% salary and no doctor's note is necessary anymore.  They've made it much easier for the breadwinner to stay home when infected.  There's also some relief if the sickness lasts more than 14 days as well.

I think San Mateo County could do that. However, I think the problems are that 1) there is no way the infected person can isolate at home. There isn't enough room, and 2) there are other people in the household that want/need to go to work. They aren't sick (yet), but they are exposed and should quarantine. They won't do that, and getting economic coverage for those people from the county will be a hard sell, at best.  There are too many people involved and they don't have COVID-19 (so far as we know). On top of that, many people in this situation want nothing to do with the government in any form. They may be perfectly "legal", but others in and around the household may not be. Not worth the risk. That precludes sending them all to a hotel to quarantine, even if the facilities were made available. That is why SMC Health is so frustrated.