Should The U.S. Follow China's Example Of Mandatory Quarantine Centers?

NPR's Steve Inskeep talks to NPR Beijing correspondent Emily Feng, and Harvey Fineberg, former head of the National Academies of Medicine, about quarantine options that the U.S. may want to consider.

STEVE INSKEEP, HOST:

Let's follow up on a big idea for managing the pandemic - two former public health officials on this program yesterday offered plans for containing the coronavirus. An army of contact tracers would find and isolate people who were exposed. People considered at risk typically are told to quarantine themselves at home. But that creates a problem, as COVID-19 survivor Christy Karras of Seattle learned earlier this year.

CHRISTY KARRAS: I woke up feeling as though a Mack truck had hit me. I had a fever, aches and pains. My husband had already started showing symptoms. He had a fever. So I was trying to avoid getting sick from him. So I actually quarantined him in our basement. That was not successful.

INSKEEP: She contracted the disease from her husband, which is a common experience. Quarantine at home often does not protect other people who live there. The desire to avoid that result has prompted a question - should the United States build more facilities for quarantine outside the home? Should governments mandate that people go? That's what China did. So to learn what the experience is like, we contacted NPR's Emily Feng, who reported on mandatory quarantines in Wuhan.

EMILY FENG, BYLINE: It would begin with a knock on your door. Local community officials went from house to house checking on people for symptoms, taking temperatures. And if you were suspected of having the virus, you were brought to one of these 16 makeshift central quarantine centers that were built in Wuhan, the Chinese city where this virus began. You would get a test. If you were tested positive, you'd stay until you got better. And these quarantine centers were staffed by a couple of doctors, nurses. But you were kept away from your family, and you were not told when you could leave, and you were not able to see people during that time.

INSKEEP: Were you ever able to get a look inside one of these centers to see what they were like?

FENG: Two weeks ago, yes, the Wuhan government - who is very eager now to show off the recovery the city has made after this epidemic - took a number of foreign journalists, including myself, to one of these quarantine centers. And it really was just this converted public space. They had put hundreds of beds in there. It looked kind of like a gymnasium. There were pictures on the walls that patients had painted during their time there. There were no bathrooms. So it was port-a-potties and showers outside of these quarantine centers. But they very much were just big spaces where you could hold a bunch of people and administer to them all at once.

INSKEEP: Did the people who were sent into these centers approve of them?

FENG: At first, there was some reluctance. I talked to people in early February, when this campaign began, and they did not want to send their loved ones to a makeshift center where they didn't know when they would see their relatives again. One person even told me that she suspected these were places where you just sent people to die. But for the most part, people were so desperate for medical care at the worst point of the epidemic in China - this would have been early to mid-February - that they had been asking for a hospital bed. And to get a bed, even in these quarantine centers, was better than nothing.

INSKEEP: What do Chinese officials say now about the value of these mandatory quarantine centers?

FENG: The doctors I spoke to in Wuhan say central quarantines and building these makeshift treatment centers was the turning point in controlling the epidemic. It flattened the curve. It bought authorities time to treat existing patients. And that was the main reason why Wuhan was able to contain the epidemic. I was able to speak to one doctor. His name is Dr. Wong Singh Weng (ph). He's a vice director at a big hospital in the city. And this is what he said.

WONG SINGH WENG: (Non-English language spoken).

FENG: He said one of the biggest defeats in Wuhan was, first, allowing sick people to go home in quarantine. Usually, one family only had one sick person, but they would go home and infect everyone. So doctors in Wuhan now say they're telling all the other doctors in European, American countries to impose central quarantine treatment centers and not send people home.

INSKEEP: So that's how China quarantined many people, as reported by NPR's Emily Feng. Now Americans are talking of quarantine outside the home. Harvey Fineberg, who once ran the National Academy of Medicine, says the U.S. has one distinct advantage.

HARVEY FINEBERG: So we have a lot of empty hotels in the United States right now that could be utilized in a very positive way to help shorten the duration of this pandemic.

INSKEEP: Those hotels also factor in the plan released this week by the two leading former health care officials.

FINEBERG: If we had comfortable infirmaries - imagine that you could go to a hotel that, otherwise, people would pay good money to spend a few days on a holiday, be well cared for, be separated so that you were protecting your family. You were protecting your parents. You were protecting anyone in the household who is especially vulnerable. Being able to monitor in a safe environment, being able to protect others in the family would probably contribute to shortening the chain of transmission. And the whole idea in controlling the pandemic is to stop transmission at the front end, from one patient to another.

INSKEEP: Can the government force people to go into quarantine outside the home?

FINEBERG: In principle and in law, states have very wide authority about protecting the public and public health. When I was practicing medicine, I would sometimes require a patient with tuberculosis to be institutionalized in a tuberculosis sanatorium because they were a threat to others in the community, and they would not voluntarily do so to protect others. So there is this authority. The question is how to use it or whether to use it.

INSKEEP: Is it possible to push for this at a time when there are already protests against social distancing and some governors starting to reopen their states?

FINEBERG: If we have the proper leadership and we have a consistent message from our political leaders, from our health leaders, from our civic leaders, I believe that the public will understand what's at stake. We will have instances of home transmission to vulnerable persons who, in turn, get severely ill or die. We will see with our own eyes what the risks and the problems are. And under these conditions, with all of us paying attention, all of us recognizing the hazard, I think many of us would be prepared to do our share.

INSKEEP: Harvey Fineberg is a former head of the National Academy of Medicine and now directs the Gordon and Betty Moore Foundation. His is one of many voices in an emerging debate over how best to quarantine people who are infected.

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