Evans says quarantines and misinformation could worsen epidemic
During the Ebola epidemic that killed more than 11,000 people in western Africa from 2014 to 2016, Asst. Prof. of Nicholas Evans began researching ethical and effective public health responses to life-threatening infectious diseases.
Afterward, he edited a book on lessons that could be learned from the Ebola outbreak, Now, with the spread of a new strain of coronavirus, COVID-19, Evans is warning against mass quarantines as largely ineffective and miserable for those subjected to them.
recently sat down to talk about the dangers of government overreaction, viral misinformation and racism, as well as positive signs that China鈥檚 government and public health authorities in the U.S. have learned important lessons from past epidemics.
Q: Many people are reassured by the mass quarantine China has imposed on the city of Wuhan and Hubei province to prevent the spread of COVID-19 鈥 but you say it鈥檚 not effective. Why not?
A: The Chinese government unequivocally overreacted to the outbreak by quarantining more than 50 million people on Jan. 24, when the disease had only sickened . All of the resources China has deployed to impose and maintain the mass quarantine would be better invested in increasing the capacity for testing, bringing in more health workers and setting up more isolation units to treat people confirmed with the disease.
Also, the mass quarantine in China could trigger an economic recession that would hurt millions of people there and around the world 鈥 without significantly slowing the spread of the disease. Mass quarantines are typically only effective when a disease can be transmitted by people before they have symptoms, and there鈥檚 little evidence that鈥檚 the case with COVID-19.
Q: But isn鈥檛 that the basis for the quarantine?
A: We really don鈥檛 know if COVID-19 can be transmitted by people before they have symptoms, but the current belief that it can is a myth started by a paper in The New England Journal of Medicine. The authors said four people in Germany had been infected by a Chinese woman with no symptoms, but they didn鈥檛 interview the woman.
Germany鈥檚 public health agency debunked their conclusions. The woman, who had come to Germany for a conference, had symptoms similar to a cold. She did what you or I would have done: She used fever-reducing medicine and possibly other over-the-counter medications, and then she powered through two days of meetings.
That鈥檚 typical of most people who get the new coronavirus: Their symptoms are similar to a bad cold or the flu. Of the 72,528 confirmed cases in China as of Feb. 18, fewer than 20 percent are severe, and about 2.3 percent result in death, according to the . By comparison, in the U.S. every year.
In China right now, it鈥檚 winter, many people have colds or the flu, and their symptoms may be hard to distinguish from the new coronavirus without adequate testing. So people with colds and flu and people with milder cases of the new coronavirus are probably being put in quarantine with folks who have no illness, which could actually increase the rate of severe disease and death in Wuhan and Hubei.
Q: What is an appropriate public health response when authorities learn that someone has been infected with COVID-19?
A: A good example is what happened here in Massachusetts when the learned that a UMass Boston student was infected. They isolated him and monitored his symptoms carefully. They determined who had been in close contact with him, and monitored those people for any symptoms.
They communicated the case clearly; they did not downplay the seriousness of the disease, but said nothing to cause panic; they treated the patient with dignity; and they treated the patient鈥檚 contacts with the same respect. That鈥檚 the gold standard.
The West African Ebola epidemic of 2014-16 supplied us with a lesson in how effective this kind of response can be. When Ebola crossed into Nigeria, the government did two simple things. It gave a cheap oral thermometer and a prepaid cellphone programmed with the number of the Nigeria Centre for Disease Control to everyone who had come in contact with one of the Ebola patients. Then it asked each person to take their temperature twice a day and report it by text or phone call. If a person鈥檚 temperature spiked, they were to go to a hospital immediately.
Nigeria ended up with only 20 Ebola cases in a country of 100 million people. There鈥檚 no reason that the worst of the new coronavirus outbreak can鈥檛 be blunted by similar measures.
Q: What is China doing right?
A: The Chinese government has come a long way in the international sharing of information since the SARS epidemic 20 years ago, which it actively covered up. Now, it鈥檚 doing well in terms of sharing genetic sequences, epidemiological information and clinical information.
At the federal level, information has moved rapidly. At the city and provincial level, in the early days of the outbreak, there was much more resistance to sharing information, because lower-level officials feared the personal and political consequences of reporting bad news.
This is something the party in China is coming to terms with: Their international reputation, which they take very seriously, is being compromised by their political infrastructure.
Q: What ethical values should guide our individual behavior during this outbreak? News reports say that some people are buying up face masks 鈥渏ust in case,鈥 and others are avoiding anyone who looks Chinese in public places.
A: First, looking Chinese is no evidence that someone came from or has ever been to China, and it鈥檚 certainly not evidence that they have the virus. The best way to protect yourself and others from infection is to stay home if you鈥檙e sick and, if you鈥檙e not, to wash your hands frequently and avoid touching your eyes. It鈥檚 also important that employers and schools not penalize people for staying home when they鈥檙e ill.
Face masks aren鈥檛 effective at keeping the person wearing the mask from getting infected; they only help keep an infected person from spraying saliva droplets everywhere when they sneeze or cough. I tell my students that if they don鈥檛 already have symptoms and they鈥檙e looking to waste their money, it would be better to just set their dollar bills on fire instead of buying masks, when people who need them could be buying them.
Q. With so much information out there, what鈥檚 the best way to stay informed about this new virus?
A: If you want reliable information, visit the website or the website. will almost certainly have reliable information about the disease, too. Don鈥檛 spread rumors and misinformation on social media.