We need a better approach for pandemic self-isolation in modern America, given our baseline individualism, nuclear families, and nearly nonexistent social safety nets. Neighborhood resilience is an important step, but I think we can build on that to support people who need other people to come in their houses—such as those with other illnesses, those who need childcare, and other situations.
This is inspired by the needs of those with children. Children need other children to play with, the children need to be supervised, and the adults cannot work (from home or elsewhere) if the children are in the throes of cabin fever. And most challenging of all, children are terrible at hygiene, so any families that have children playing together should assume they are all in the same "transmission pool".
Here I propose a model for ad-hoc cell-based resilience. If you have research papers or studies that have bearing on this. please send them my way. If you know any experts on epidemiology or community resilience in epidemics, I would love to get their thoughts on all this.
This is not a guide, it is a discussion prompt. If feedback looks positive, perhaps someone could turn this from a specification into a public-friendly protocol, but this has not yet received review of any sort, so please do not share it as if it is an expert's recommendation.
I have no public health training, but here's my instinct on the matter:
- Households self-organize into small cells of three which will be in mutual contact. I pick three because it is the smallest cell size that can tolerate a crisis affecting one member of the cell.
- The purpose of a cell is for reduced social distance, not to replace wider mutual aid.
- A "household" should be the entirety of any group that is sharing living space. This might be a nuclear family, or a group of four unrelated housemates, or a person living by themselves. I consider all people sharing a living space to be a single risk pool, no matter how hard they try to reduce transmission (which they should still do!)
- The households agree on a mutual understanding and covenant on how they will manage risk. For example, they may practice radical self-isolation in general and treat all public spaces and external materials as contaminated, but not worry as much about contact between the households in the group.
- Ideally, the members of the cell should have very similar vulnerability profiles and general lifestyles, to reduce friction between the members. For example, if one member household wants to let their child go to playgrounds, the others should be OK with this as well, otherwise there will be arguments. And if any member households have medically vulnerable members, perhaps other member households should as well, so that their incentives are lined up.
- Each household should continue complete self-isolation for an agreed upon period (perhaps 10 days) so that any incubation periods, infectious periods, and surface contamination periods can run out. Households with infected members should still rely on community support.
This all requires a great deal of trust between the households, both to stick to the covenant, and to truthfully report any new symptoms. I suspect that the perceived danger of losing access to the group can be ameliorated by having a strong community support network as a background.
These cells would be able to dispense with some social distancing protocols when interacting with each other, in exchange for further distancing from outside parties. This would allow for rotating responsibility for small-group childcare, easier sharing of resources (food, medication, other materials) including those not easily sanitized, and allow the groups to prolong their distancing from the larger "physical contact network". Self-isolation can be deeply unpleasant, which limits how long it can be prolonged. Segregation of the wider network into isolated cells may provide a sufficiently similar barrier to transmission as total isolation, while improving staying power.
Challenges with this proposal:
- Transmission into the cell would be more difficult, if the cell is more self-sufficient, but once inside the cell, it would be easier. Depending on the relative dynamics of those two, this might have no effect at all, or even make things worse. This also likely depends on the stage of the epidemic, and/or the percentage of the general population that is contagious.
- It is easier said than done to arrange for groups with matching risk profiles and lifestyles, and I do not have any particular recommendations on the social and psychological factors to consider.
- Some people cannot reasonably self-isolate: Healthcare workers, those with on-site service industry jobs (retail, etc.), and others. Contrary to my recommendation of risk-matching, I do not think it would be helpful to have a cell where all of the households include such a person, since the cell would then not be a cell at all. Perhaps they could instead form a "cul-de-sac", where only one household has increased exposure, and the other two would act as a dead-end for any transmission. This would create a psychological imbalance, but some might be willing to do it.
- In general, I'm not sure "risk-matching" is even a good idea at all! Perhaps this would only be advisable for low risk households (young healthy people). Perhaps vulnerable households would be able to match with less vulnerable households who are willing to sacrifice their freedom somewhat in order to match and uphold the heightened risk mitigation strategies of the vulnerable household.