To help flatten the curve in the Covid-19 outbreak, officials at all levels of government are asking people to stay home. Here's what’s worked, and what hasn't.
On March 25, Hong Kong closed its borders to non-residents to fend off a second wave of Covid-19 cases imported by foreign visitors. The territory has managed to contain the spread of the virus since its first case of coronavirus was identified on Jan. 23.
Now, at the airport, residents returning to Hong Kong are handed an electronic bracelet, and mandated to stay home for a 14-day quarantine. The bracelet is connected to a phone application, called StayHomeSafe that uses a technology known as “geofencing”: users walk around their homes to configure the device. Once calibrated, the system is able to detect if users leave the predefined zone.
“The bracelet is sending a signal that the phone can pick up,” said professor Gary Chan, director and founder of the tech company Compathnion that created StayHomeSafe.
The device — used for 32,000 people as of March 25 — had some glitches, but overall, it’s working, he said. If the user breaches the quarantine rules, the police or health authorities immediately receive a notification. The risk? A HK$25,000 fine ($3,200) and up to six months in jail. If someone breaches it several times, he or she can be taken to a quarantine facility, Chan said.
With no vaccine and no treatment, experts agree that social distancing measures are the best that can be done to curb how fast the virus spreads, and to try to ease the burden for health-care systems. Governments across the world have a wide range of strategies to make people do the one thing that can save lives at the moment: stay home.
China and South Korea have managed to “flatten the curve” of the epidemic, with South Korea tackling the disease earlier and thus limiting its number of total cases compared with China. Three neighboring places: Hong Kong, Singapore and Taiwan, have managed to keep their number of cases low by enforcing strict quarantine rules for those who test positive, those exposed, and, more recently, all travelers or returning residents. This has been enforced by an extensive reliance on technology, and a trove of open information. In these three countries, detailed information about every Covid-19 case, such as location and connection to other cases, is available to the public.
The epicenter of the virus has now shifted to Europe and the U.S. With the massive volume of new cases identified daily, it is too late for a mixture of isolation and targeted self-quarantine. Most countries have adopted some degree of lockdown — sometimes triggered by a refusal of the population to respect social distancing measures — or the realization of government officials that they didn’t act quickly enough.
Angela Sutan, professor at France’s Burgundy School of Business and director of its Laboratory for Experimentation in Social Sciences and Behavioral Analysis, stresses that quarantines with defined endings are easier to enforce than complete lockdowns. In a lockdown, “you underestimate the risk of being a carrier. In quarantine, you get that you’re the risk,” she said.
Overall, once the virus started spreading beyond China, most countries in Asia were prepared. Europe and the U.S. were not.
Those who were prepared
“When it first started, the situation was very worrying, even in Singapore,” said Zhi Peng Lee, or “ZP,” a data scientist who developed a dashboard tracking every Covid-19 case in Singapore, and now Taiwan. “We’ve been through SARS, so I was afraid this situation would be very bad.”
In Hong Kong, Taiwan, Singapore and South Korea, the 2003 SARS outbreak has left scars. “Since SARS, they have contingency plans in place, so the citizens were educated about it,” ZP said. When the epidemic broke out, “kids were coming back from school and kept repeating ‘wash your hands’.”
Well before SARS, in 1976, the Parliament of Singapore enacted the Infectious Disease Act that grants public health authorities the right to test anyone and treat anyone who is suspected to carry an infectious disease. It also grants the right to carry a post-mortem examination of anyone who has died from an infectious disease, and forces citizens to respond to all questions asked by public authorities to help the gathering with of data to prevent the spread of a virus. During the SARS outbreak, the Act was amended, and tougher quarantine restrictions were put in place. Someone with a legally binding quarantine order (QO) — a mandate to isolate oneself — is given a QO Agent, who checks in via video calls every day. A quarantined person also has to check her temperature three times a day. Singaporeans now returning from at-risk places are issued a “stay home notice” (SHN), that is also legally binding, can get phone calls from public health authorities, and can be asked to share their location via GPS on their phones. They can also get a home visit from the police. If not respected, the consequences can add up to S$10,000 ($7,015) and/or six months in jail, and subsequent breaches can be punished more harshly.
For foreigners who do not respect the order, consequences are worse: A permanent resident had his permit to stay in the country revoked after he breached his SHN, and an exchange student at the National University of Singapore (NUS) was sent home after she lied about the places where she had recently traveled. NUS even terminated the exchange program with her school. The state relies on efficient contact tracers, who are in charge of finding all the people a contaminated person has been in touch with, and contacts them to mandate self-quarantine. Confirmed positive cases are linked to one another, and the data are made available to the public. On his website, ZP makes the information available as a network map.
In Singapore, a quarantine or stay home order really means what it says: not leaving your home under any circumstance, not even to go grocery shopping. Family members and friends are expected to pitch in with food delivery, otherwise people struggling can call a government number to ask for help.
In South Korea, where the cases have been more numerous but the curve seems flattened so far, there is no bracelet for inbound travelers — South Korean borders are still not closed, except for travelers from Hubei province in China — even though travelers from Europe and the U.S. now have to quarantine for 14 days, and all travelers from Europe have to get tested upon arrival. South Korea has been enforcing mass testing, contrary to many other countries — like the U.S. — where testing abilities are still lagging.
But South Korea, just like Hong Kong, is also using mobile tracking intensely. Upon arrival at the airport, travelers have to install an application on their phone that tracks their location in real time. Charlène Flores, a French photographer based in Hong Kong, who is covering the Covid-19 crisis in South Korea, installed the app on her phone when she flew in. It registered her location dozens of times. She also had to do a daily self-diagnosis, and answer multiple questions, such as whether she’s had a fever or not. People in quarantine use a different app, or for those who can’t, phone calls are used to make sure the quarantine orders are respected. The openness of the data, however, has created problems, and people have been harassed for testing positive for Covid-19.
But overall, when asked, people have been following the rules: “There are occasional cases where people run away, but predominantly, they are following,” Chan said.
Those who were not prepared
In other countries, it has been considerably harder to give locals a sense of urgency. The intense usage of mobile tracking is controversial, and privacy concerns are many, raising the question of how invasive the government can be to safeguard public health.
“It’s true that over here, people don’t have the same confidence in institutions and in following orders,” Sutan said. For example, “In France, people are experts at interpreting everything, and if there’s a small breach [in the rules], people will jump into this breach and exploit it."
Overall, governments were unprepared for what was coming their way. “The problem was a confusion in communication, things were not made clear enough,” she said.
The U.K. announced nationwide closures and lockdown measures last week, after most countries in Europe had already put them in place. U.K. government Chief Scientific Adviser Sir Patrick Vallance discussed on Sky News the much-debated idea of “herd immunity” — having the population build up immunity by getting infected. In short, the U.K. has “been a case of how not to communicate during an outbreak”, Devi Sridhar, a University of Edinburgh public-health specialist told the Atlantic.
On March 27, Prime Minister Boris Johnson tested positive for Covid-19 and started self-isolating, telling the Brits to “stay home, protect the NHS [National Health Services] and save lives,” in a video he posted from his Twitter account.
Over the last 24 hours I have developed mild symptoms and tested positive for coronavirus.— Boris Johnson #StayHomeSaveLives (@BorisJohnson) March 27, 2020
I am now self-isolating, but I will continue to lead the government’s response via video-conference as we fight this virus.
Together we will beat this. #StayHomeSaveLives pic.twitter.com/9Te6aFP0Ri
In France, President Emmanuel Macron was still going to the theater a week before declaring the situation a national health emergency. The government also insisted the first round of the nationwide municipal elections take place, despite Macron having given a televised speech four days prior, saying that the country was facing “its worse health crisis in over a hundred years.”
In New York City, Mayor Bill de Blasio went to the gym on March 16, after New York state Governor Andrew Cuomo recommended everyone stay home. One of de Blasio’s spokespeople said that “the mayor wanted to visit a place that keeps him grounded one last time,” according to Business Insider. On March 23, de Blasio demanded hundreds of ventilators and hundreds of thousands of masks on CNN, saying that New York City would otherwise run out of supplies within a week. He even asked individual citizens to send ventilators to the city, if they happened to have one.
Several states in the U.S. have ordered a lockdown, like New York City, or a stay at home order, like California. Most schools are now closed. In Europe, all countries but, Sweden and Germany have implemented nationwide lockdowns, even though some are looser than others. India, South Africa, Jordan, Kuwait and Argentina have as well.
In France, anyone who wants to go out has to have an ID and a “self-authorization,” a paper stating the reason for being outside. Valid reasons are grocery shopping, going to the pharmacy, getting medical care, or daily physical exercise. Without a valid document, fines go up to 135 euros ($149) from 35 euros two weeks ago, and can be increased upon repetitive infringements. On the first full day of the lockdown, the police delivered 4,000 fines across France, according to France 24.
Most countries are setting the penalty higher, hoping this will persuade residents to stay home.
In Spain, people risk fines between 100 and 600,000 euros depending on “the severity of the infringement,” and jail time, too.
On March 25, Italy issued stricter legislation, and people testing positive for Covid-19 caught outside of their homes can face five years in prison. Fines can go up to 3,000 euros. During the first nine days of the lockdown, 40,000 fines were issued to people venturing outside without a valid reason.
At the local level, mayors have been tackling the issue in their own way: by yelling at those still outside to go home. In a video that went viral, Antonio Tutolo, the mayor of Lucera, Italy, declared “These [redacted] hairdressers who go from home to home to fix women’s hair, what the [redacted] are they for? What is the damn point? But do you understand that coffins are closed? Who will see all these beautiful hairstyles in the coffins?”
Sutan, the Burgundy School of Business professor, said that she believes the respect — or not — of quarantine and national lockdown orders lies in people’s relationship to authority. In China, amid an authoritarian regime, people had little choice but to comply with the massive lockdown measures imposed on regions like Hubei, where residents even have their temperature taken upon entering buildings or restaurants. Police wear smart helmets that are able to detect someone’s temperature from afar, and drones are used to make sure people stayed home.
The question remains, of course, whether countries that have been using an arsenal of technologies to make people comply during the pandemic will stop using them once the situation stabilizes. In an article published in the Hong Kong Free Press on March 24, Shui-yin Sharon Yam, assistant professor of writing, rhetoric, and digital studies at the University of Kentucky, wrote that “safeguarding public health has historically been used as a justification for mainstream institutions and government authorities to stigmatize, monitor, and regulate the lives of marginalized people – such as immigrants, racial minorities, LGBTQ+ people, and people living in poverty.”
In the meantime, technology and testing are proving useful in containing the outbreak. Flores, the French photographer living in Hong Kong, traveled to South Korea via London on assignment and tested positive for Covid-19. She’s asymptomatic but will spend 14 days isolated in a Seoul clinic.