This is a working draft.
COVID-19 has proven difficult to contain with standard measures in today’s hyper-connected world. The virus often becomes infectious before symptoms are observed and there are high rates of asymptomatic carriers who spread the virus unwittingly. In addition, infectious viral particles exist airborne and in feces and the high transmission rates between individuals, lead to the recipe for the pandemic we have today.
Blanket travel restrictions and stay at home policies have made an impact in reducing the spread of the disease and “flattening the curve,” However, this has come at great expense to economic and social activity, since we have to treat everybody as being potentially infectious. Moreover, the measures implemented so far are not enough to “crush the curve.”
We are far from herd immunity, as soon as blanket restrictions are lifted the virus will begin to spread exponentially again. In the absence of a vaccine or therapeutics, pursuing herd immunity is not an ethical option as many millions of people may die and the long-term risks of the disease are still uncertain.
We must take action now to allow communities to safely get back to economic activity. We cannot simply wait for a vaccine or an antiviral drug to be developed as the timeline and efficacy are still uncertain.
The virus is a tough opponent, but it is not invincible, nor is it everywhere. The virus is only spread through contact with infectious individuals and the surfaces they have infected. Proper protocols can be put into place to keep uninfected communities safe. Proper protocols can also be put in place to make sure that infected communities can handle and contain the virus until the infectious period is over and they are no longer a threat to safe communities.
There is precedence in history for communities effectively dealing with viral epidemics for which no vaccines or antivirals exist. Quarantine, isolation and travel restrictions date back to the biblical times and have long been a method of preventing the spread of epidemics. The term quarantine originated in Venice during the Black Death where ships would need to wait for a period of 40 days before entering the city and was an effective method for preventing the spread of disease. More recently, during the Spanish flu of 1918, travelers entering new townships would either need to submit to quarantine or be escorted through the township to make sure they did not leave their vehicle. Cities that implemented early and prolonged social isolation in the United States during the Spanish flu faired markedly better than their counterparts who did not.
While our population centers have become more dense and transport has become more widespread than the past, isolation and travel restrictions are still possible – and effective.
We propose a federated model for growing Safe Zones to mitigate community risk of infection. A Safe Zone is defined as a community with a well-defined border in which everyone follows Safe Zone policies. Safe Zone communities can connect and interact with one another through Safe Protocols. If a member community of the federated Safe Zone becomes infected, they can be isolated until the infections stops. Once they demonstrate that they are again a Safe Zone they can rejoin the federation.
Safe Zones is a bottom up approach and requires support at the regional, state and national levels to coordinate and enforce quality testing, tracing and supply chain methodologies. Blanket travel restrictions, isolation, testing and mask wearing should remain in place for all zones which are not Safe Zones.
Strategic resources include protective masks, thermometers, universal symptom questionnaire, cleaning agents and disinfectant, viral test kits, PCR machines, antibody test kits
In order to be designated a safe zone the community must:
- Demonstrate that there is no active infection in the safe zone through viral testing.
- Conduct ongoing surveillance testing (wastewater, random viral testing, daily thermal readings, universal symptom reporting)
- Designate and establish of isolation area/s to place infected individuals in the event of an outbreak.
- Designate and establish area/s to quarantine quarantine inbound visitors and people planning to establish residence in the Safe Zone.
- Provide ongoing reminders and education about safe zone policies.
- If the safe zone becomes infected: quarantine infected individuals and monitor closely. In order to be deemed a safe zone again, they must demonstrate no community transmitted infection for an amount of time equal to two times the virus incubation period (~14 consecutive days).
- When interacting with other safe zones verify that they are complying with safe zone policies prior to easing border restrictions. While safe zones can connect to grow the original safe zone structures should continue to exist in order to mitigate the scale-risk of an outbreak.
- When interacting with other Safe Zones that become infected close borders to the zone and provide support as necessary until they become a Safe Zone again.
- When dealing with people who are following no Safe Zones protocol or unknown protocols treat as though they are infected.
- Essential goods entering the Safe Zone from a non-verified zone should be quarantined and sanitized. Certificate of origin as well as travel itinerary should be inspected.
Administrative level responsibilities
Local level: Lead community-level safe zone initiatives following Safe Protocols. Enforce checkpoints at borders. Coordinate purchasing and distribution of state and county-sourced strategic resources needed to implement safe zones policies as necessary.
Metropolitan level: Support township-level safe zone initiatives. Enforce travel restrictions between townships as necessary. Coordinate purchasing and distribution of state-sourced strategic resources needed to implement safe zones policies as necessary.
Region level: Support township-level safe zone initiatives. Enforce travel restrictions between townships as necessary. Coordinate purchasing and distribution of state-sourced strategic resources needed to implement safe zones policies as necessary.
State/Provincial level: Support county-level safe zone initiatives. Enforce travel restrictions between counties as necessary. Coordinate purchasing of national-sourced strategic resources needed to implement safe zones policies as necessary.
National/Federal level: Support state- and provincial-level safe zone initiatives. Enforce travel restrictions between states and provinces as necessary. Coordinate purchasing of strategic resources needed to implement safe zones policies as necessary. Coordinate testing and ensure interlocking goals at different levels are met through pandemic testing board.
International level: Support nation-level safe zone initiatives. Enforce travel restrictions for infected nations.
Cross-functional and inter-level fusion cells with daily calls may aid in communication and remove some of the communication inefficiencies of chain of command.
- safe circles has bad connotations when the group size is small. Zone is a term that seems more scale independent w/r to connotation.
- The size of the safe zone needs to be thought about. Ideally the safe zone would contain essential services as well but in catchment areas of things like hospitals and sanitation systems can be quite large.
- Toll between regions to pay for testing?
- Incentivize people to stay in unit until next to another safe unit. Recognize that we benefit from having more people in the federation.
- Cost of growing federation must be lower than cost of staying independent
- Do not incentivize people to get sick so that they have the incentive to get antibodies. What is to stop bad actor from crossing the safe zone to say “f* you.”
- Sometimes you need to do stuff that you dont really want to to come up with solutions.
- What about areas that are not economically independent like hawaii that can do safe zones but currently rely heavily on tourism?
Handbook of COVID19 prevention and treatment
Roadmat to Resilience. Harvard University. https://ethics.harvard.edu/files/center-for-ethics/files/roadmaptopandemicresilience_updated_4.20.20_0.pdf
Roadmap to responsibly reopen America. Paul Romer. New York University.
What models cannot tell us
Community based analysis
Essential Coronal Virus Guidelines https://assets-global.website-files.com/5e62f57a6f9734c5e7879c84/5e6ee4bda4e7ff2b9816afac_Essential%20Coronavirus%20Guidelines.pdf
Alert color codes
Superspreader events – types of superspreaders
Transition to extinction – pandemics are serious and global travel connectedness is exacerbating the issue
Linked shared space model- forming closed social Zones
While the smallest of these is not normally a stand-alone grouping, the others appear as natural community sizes in hunter-gatherer societies: Lehmann, Lee, and Dunbar (2014) give values of 42.8 ± 18.0SD (bands), 127.3 ± 43.8 (clans), 566.6 ± 166.2 (mega-bands) and 1727.9 ± 620.6 (tribes)… sympathy groups are 11.3 (+/-6.19)
Why a 5-week lockdown can stop covid-19 – need to get past the 2X incubation period (this line not in paper) with negative testing to call your zone safe
What can be done to stop the wuhan coronavirus pandemic – multiscale approach. Some communities for self-contained cells limiting transportation within and between them. No in no out policy. Deffinition of community: street office in urban area, or town government. Three types of community A, no cases; B, one case in past 14 days; C two or more cases and potential spreading.Uninfected (Community A) strategy: “Prevent outside in-put:” mobilize the community, provide health education andspecific information, improve the environment, stockpile sup-plies, and manage the case of people who live in the commu-nity returning from affected areas (with detailed description).Potentially Exposed (Community B) strategy: “Prevent in-side spread, prevent outside output” include all above (A) andmanage close contacts and sanitation.Infected (Community C) strategy: “Prevent inside rampage,prevent outside output” include all above (A and B) andblockade the area and limit gatherings within the community
How community response stopped ebola. – Contact tracing wasn’t working because people were becoming infectious and infecting their community before anything could be done about it. Each member of a community screened daily for fever and isolated if they show early symptoms. Exponential decline40-50 percent compliance results in declining cases. As those communities realized, just like isolation of individuals does not mean abandoning them, neither does community quarantine mean abandoning them. It is an opportunity to focus care, preventr people from getting infected and stop the disease. If this had been the earliest response to the outbreak, many more lives would have been saved and unimaginable suffering, as well as the economic and social disruption, would have been prevented.
The same principles of community-based intervention can be applied to a wide variety of potential diseases. Understanding the lessons of Ebola’s containment will allow for these policies to be implemented more effectively in the future, reducing the death toll of future epidemics and limiting the possibility of a larger pandemics.https://medium.com/complex-systems-channel/how-community-response-stopped-ebola-a13a28a674d0
Beyond contact tracing – 40% compliance with community level policy leads to negative case growth. 60% rapidly ends it https://aarongreendotblog.files.wordpress.com/2020/04/77531-beyondcontacttracing.pdf