shelter in place

There are several states that have instituted mandated shelter in place orders due to the Covid-19 pandemic. Minnesota may be among them soon. There are those who object to shelter in place practices either because they don’t think they are necessary, or because they feel that they infringe upon the individual right to freedom of movement. Because of the success of vaccines and other aspects of modern medicine that make pandemics such a rare event, pandemic and quarantine case law is relatively sparse within the United States. But a key part of that success has been mandatory vaccine laws. It is through that lens which we should view the shelter in place issue.

One of the most feared childhood diseases was diphtheria, which was often called the “children’s plague” and the “great strangulator” because it literally killed the tissues inside the throat until the dead tissue built up enough to close off the airway. It also caused tissue cellulitis and necrosis in other areas of the body, sometimes leading to permanent nerve, tissue, organ and brain damage, gangrene, amputation, coma, and death. Diphtheria infected 1 in 5 children each time a wave came through every 3-5 years, and 1 in 7 of those infected children died. That’s a 3% death rate – similar to that of Covid-19, but it’s not at the moment killing children. We now mandate DPT vaccinations (the D stands for diphtheria, P for pertussis – whooping cough, and T for tetanus) because a 3% diphtheria death rate was considered unacceptable. If we had a vaccine for Covid-19 we could mandate that vaccine. But we don’t have one yet – so to protect the population this one time, for a temporary amount of time, we have to mandate social distancing and staying home unless you have an essential need to go out.

It’s more inconvenient than a vaccine shot, but even at a 40% infection rate across the entire US population of 300 million people and a 2% death rate, if we did nothing we would be looking at 2.4 million deaths. But because Italy’s health care system is overwhelmed and they are rationing ventilators and other treatments, their death rate is closer to 5%. Our curve currently looks similar to theirs, which means if we do nothing more than they did at this same point in their trajectory, we are looking at 6 million deaths – a number similar to the Jews of the Holocaust. And half of that 6 million will have died unnecessarily simply because there wasn’t enough critical care (especially ventilators) to go around. Largely because some people don’t want to stay home for a few weeks to do their part to flatten the curve. Shelter in place is temporary – in the absence of widespread testing, we must assume everyone is contagious and make the sacrifice to stay home and practice social distancing as much as we possibly can until we flatten the critical care curve and develop more testing capacity.

There was recent news that the Justice Department was seeking to detain individuals indefinitely without trial during the crisis, but it is currently getting bipartisan pushback and is going nowhere in Congress. And when Italy’s example shows us what happens when people deny the severely infectious nature of this disease and the unusual lethality of it for certain categories of people, panicking about potential civil liberties violations stands in stark contrast to the correspondingly callous disregard for the welfare of the vulnerable. Any civil liberties lawsuits due to citations for willful violation of shelter in place orders will seem like small irritations when the families of people who die sue health care providers who denied their loved ones necessary critical care simply because there was not enough to go around.

Remember that shelter in place is a temporary measure necessary only because we lack a vaccine and adequate testing. Once we have rapid and widespread testing, we can shift back to less stringent social distancing practices, and once we have a vaccine it will become a non-issue. Until the next pandemic – for which we had better be more prepared. The silver lining of this crisis is that it could show us in stark detail the flaws in our current health care system and increase the political and economic will to finally fix it once and for all. But that is another post for another day. In the meantime – please voluntarily do the right thing and shelter in place as much as you possibly can. Be patient and kind, lend a hand when you can safely do so, thank our neighbors who work in essential front-line jobs, and stay safe.