The corona hotels: Learning the right lessons
For one week, Israel had the dubious distinction of being virtually the only country in the free world to mandate quarantine in government-run facilities for its own citizens returning from travel abroad. Wisely, the cabinet has now cancelled this order. But it did so for the wrong reasons.
Officials pointed to its poor execution: only some 40 percent of returning Israelis were actually sent to these so-called “Corona hotels,” as most returnees fabricated alibis to the airport authorities to obtain permission to self-isolate at home. Cold and sometimes spoiled food was delivered to quarantine rooms at irregular hours, leading to breakout protests at several sites.
But not even one official noted the plan’s primary flaw: it contravened the norms of public health policy practiced in the free world.
Writing in the Canadian Journal of Public Health, Ross Upsher notes that the ethics of quarantine are based on the principle of least restrictive or coercive means. A variety of means exist to achieve public health ends, but the full force of state authority and power should be employed only when less coercive methods have failed.
Indeed, some returning citizens do bring the virus home with them. And many Israelis these past months have not adhered to the rules of home quarantine. Yet, before lowering the sledgehammer of quarantine facilities, authorities had a range of tools at their disposal to bolster home isolation: on-site visits; stiff fines for violation. Returning travelers could have been given the option of location tracking bracelets or consent to phone tracking app in lieu of quarantine in a government facility. The government has spent a half-billion shekels on these facilities since the beginning of the outbreak. All of these less-coercive options together would have run a fraction of the costs of operating some two-dozen hotels for the thousands of travelers returning each day. Officials told Prime Minister Netanyahu that world-wide, home quarantine rules are enforced through stiff fines, but were rebuffed because his coalition partners rejected the idea.
But there is more. Writing in the Yale Journal of Biology and Medicine, Martin Cetron and Julius Landworth note that voluntary cooperation and public trust are key ingredients of a successful response to a public health crisis. Governments should ensure that the public is fully aware of the rationale for restrictive measures. Education must precede incarceration. Just what was the morbidity rate of individuals returning from abroad? What less coercive measures were considered before this drastic curtailing of basic civil liberties? These were never even so much as publicized to the shareholders in these decisions—the public itself, thus denying the government the trust necessary to carry out such a decree.
But as Cetron and Landworth note, forced quarantine works best when there is a fair distribution of burdens and benefits among various segments of society. Quarantine measures must be proportional, necessary, relevant, and equitably applied. A good example of this is Australia. Down under, the government has exercised a firm and decisive hand in combating the spread of COVID-19 and today there is virtually zero community spread of the disease. As part of its strategy, the government mandates returning citizens to quarantine in state-run facilities. But because the government has executed its plan in an evenhanded and transparent way, Aussies have embraced the plan as the best way to ensure that the virus does not reach their shores.
Compare that with the situation here, where the government administers its strategy through the so-called “traffic light” plan of differentiated response. Israelis have well-noted how this works: when mass weddings, funerals, and prayer services are held in the areas with the highest morbidity, the light flashes “green.” But somehow, when passengers arrived at baggage claim, the light suddenly blinks red. The drastic step of forcibly restricting freedom of movement could only have succeeded had those paying the price seen that across the board measures were being equitably and transparently applied.
Balaam the prophet said of Israel, hen am levadad yishkon, “behold, a nation that dwells alone!” (Num 23:9). That slogan would have made a wonderful mantra for the closing of Israel’s skies, the policy adopted during the first lockdown last spring. Instead, Israel found itself alone in the free world in enforcing a policy of quarantine incarceration without any of the proper societal preparation necessary to justify such a step. Moving forward, cognizance of the norms practiced elsewhere and a heightened consciousness of the care needed before denying citizens their basic liberties will give our democracy a well-needed shot in the arm.