2d:null 2e:["$","title",null,{"children":"The Case for Funding Self-Isolation Facilities | Blake Elias | Observable"}] 33:T519,md` May 4, 2020 In the following letter (https://apps.npr.org/documents/document.html?id=6877567-Bipartisan-Public-Health-Leaders-Letter-on), several (former) health officials and politicians have asked the US Congress to provide funding for tracing and isolating individuals infected with COVID-19. In particular, they call for using vacant hotels as self-isolation facilities: > **2. Voluntary self-isolation facilities utilizing vacant hotels.** In order to prevent infection spread, we will need to offer individuals the opportunity to self-isolate for up to two weeks if they are unable to do so in their homes. There is substantial evidence that providing a voluntary option to safely isolate will help to dramatically reduce spread of infection to one’s family and therefore the spread of infection overall. [...] In this document, we seek to answer: * How many people would need to be isolated? * How much would this cost? While the letter above only recommend isolating *infected patients*, we also propose isolating family members and roommates of those infected. Additionally, we propose preventive isolation of healthcare workers who are regularly exposed to COVID-19 cases through their daily work.⁵ Let us analyze the costs involved in such a plan. ------ ------ `34:T43c,md` The number of new cases per day is estimated based on past daily case counts⁴, which have been above 20,000 every day for the past month (as of May 4, 2020). We consider the number of cases that will occur over the next 18 months (~540 days). These simplified estimates would yield anywhere from **${(cases_per_day[0] * pandemic_duration[0]).toLocaleString('en-US')}** to **${(cases_per_day[1] * pandemic_duration[1]).toLocaleString('en-US')}** new confirmed cases in the US over the next 18 months. By comparison, the US has experienced **1,152,372** confirmed cases to-date (as of May 4, 2020). More-sophisticated estimation is possible; we are just aiming for an order-of-magnitude estimate. We also know that *confirmed* case counts under-count *true cases* -- perhaps by a factor of 10 or more -- see [here](https://reason.com/2020/04/12/official-covid-19-numbers-represent-just-6-of-total-infections-a-new-analysis-suggests/) and [here](https://www.businessinsider.com/real-number-of-coronavirus-cases-underreported-us-china-italy-2020-4).⁶ ------`35:Tc1a,{ function num_needing_isolation(calculate_min) { } function total_cost(calculate_min) { const index = calculate_min ? 0 : 1; return total_nights(calculate_min) * nightly_price[index]; } function total_cases(calculate_min) { const index = calculate_min ? 0 : 1; return cases_per_day[index] * pandemic_duration[index]; } function total_nights(calculate_min) { const index = calculate_min ? 0 : 1; return total_cases(calculate_min) * ( days_to_isolate_infected[index] + contacts_per_case[index] * days_to_isolate_contact[index] ) + healthcare_workers * proportion_hcw_isolate[index] * pandemic_duration[index]; } function hotel_rooms_per_night(calculate_min) { const index = calculate_min ? 0 : 1; return total_nights(calculate_min) / pandemic_duration[index]; } function weekly_spend(calculate_min) { const index = calculate_min ? 0 : 1; return hotel_rooms_per_night(calculate_min) * nightly_price[index] * 7; } function convert_to_suffix(number, is_currency) { var new_number = number; var suffix = ""; if (number > 1e6) { new_number = number / 1e6; suffix = "M"; } if (number > 1e9) { new_number = number / 1e9; suffix = "B"; } if (number > 1e12) { new_number = number / 1e12; suffix = "T"; } var formatted_number; if (is_currency) { const format = new Intl.NumberFormat('en-US', { style: 'currency', currency: 'USD', }); formatted_number = format.format(new_number); } else { formatted_number = new_number.toLocaleString('en-US'); } return formatted_number + " " + suffix; } const min_cost = convert_to_suffix(total_cost(true), true); const max_cost = convert_to_suffix(total_cost(false), true); const min_weekly_spend = convert_to_suffix(weekly_spend(true), true); const max_weekly_spend = convert_to_suffix(weekly_spend(false), true); const min_nights = convert_to_suffix(total_nights(true), false); const max_nights = convert_to_suffix(total_nights(false), false); const min_hotel_rooms = convert_to_suffix(hotel_rooms_per_night(true), false); const max_hotel_rooms = convert_to_suffix(hotel_rooms_per_night(false), false); return md` | | Minimum | Maximum | |--------- |---------|---------| | **Total Cost** | **${min_cost}** | **${max_cost}** | | Weekly Spend | ${min_weekly_spend} | ${max_weekly_spend} | | Hotel Rooms Occupied Nightly | ${min_hotel_rooms} | ${max_hotel_rooms} | | Total Hotel Room Nights | ${min_nights} | ${max_nights} | `; // | Hotel Rooms | ${min_hotel_rooms} | ${max_hotel_rooms} | /*return html`

Min cost	Max cost
${convert_to_suffix(min_cost)}	${convert_to_suffix(max_cost)}

Min cost: ${convert_to_suffix(min_cost)}
Max cost: ${convert_to_suffix(max_cost)}
`;*/ } 36:T4f9,md`For comparison, the cost estimate for voluntary self-isolation facilities in the [cited letter](https://apps.npr.org/documents/document.html?id=6877567-Bipartisan-Public-Health-Leaders-Letter-on) was ** $4.5 B ** over 18 months. Thus, our estimates are of a similar scale at the low end (**$5.43 B** over 18 months), while allowing the possibility of an additional order of magnitude on the high end. ## Recommendations Compared with current federal stimulus packages, which are in the trillions of dollars, we believe that spending the amounts in this range is quite reasonable. Additionally, using the funds this way **may be more effective than existing stimulus plans**, as this plan uses the funds to directly reduce the spread of the disease by funding isolating of critical individuals. Such a plan could contribute to eventually **driving COVID-19 to elimination** --- which should be our true goal. Existing economic stimulus, on the other hand, has primarily been aimed at combating economic difficulties, while the source of these difficulties -- the pandemic itself -- drags on. This is the classic case of treating the symptom rather than the cause, and will result in more economic loss as compared with simply ending the disease outbreak entirely.`37:T911,html`

Sources

¹Bureau of Labor Statistics, State Occupational Employment Statistics Survey, May 2019. Available at http://www.bls.gov/oes/tables.htm
²CDC - Health Care Workers - Workplace Safety and Health Topic, May 2020. Available at https://www.cdc.gov/niosh/topics/healthcare/default.html
³Total Health Care Employment | The Kaiser Family Foudnation, May 2018. Available at https://www.kff.org/other/state-indicator/total-health-care-employment/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D
⁴Cases in the U.S. | CDC, May 2020. Available at https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/cases-in-us.html

Additional Commentary

⁵This could be extended to other "frontline" workers, including law-enforcement, food service, transportation, etc. These were not included, both for ease of calculation, and because these individuals are at lower risk than healthcare workers and family members / roommates of infected individuals.

⁶Due to the under-counting of confirmed cases, it may be worthwhile to offer isolation options to those who have a suspected case, rather than only a confirmed one. One way would be to offer such isolation facilities to those who are concerned that they, or a close contact (e.g. family member) may be infected, simply by reporting symptoms, without requiring a positive test result. Given the present scarcity of tests, this may indeed be necessary for effectively representing all of those infected. This may also yield a large number of individuals who are not infected, but who avail themselves of the isolation facilities anyway. It is challenging to quantify the number of individuals who would make use of this service -- and to identify what form of self-diagnosis would be acceptable. `38:[] 31:{"id":"5ffe19d886a531f8","slug":"estimating-number-of-hotel-rooms","title":"The Case for Funding Self-Isolation Facilities","thumbnail":"310734f39805990c142137817928c1e6fbd78014b720efa3cfcc4a3c258f1e95","access_level":"public","create_time":"$D2020-05-04T19:02:53.642Z","update_time":"$D2020-10-10T03:38:57.890Z","view_time":null,"first_public_time":"$D2020-05-04T22:39:43.405Z","has_unpublished_edits":null,"fork":false,"stars":0,"starred":false,"owner":{"type":"team","id":"614157e65006a2d4","login":"blakeelias","name":"Blake Elias","avatar_url":"https://avatars-next.observableusercontent.com/bcb2d8974dfe29de8246d628c79d40f80dd37cb59dc6d869a9030f5158e1b5ca","tier":"starter_2024"},"version":474,"publish_version":474,"role":null,"authored":false,"authors":[{"type":"individual","id":"01ac8a6a43bd3e70","login":"blakeelias","name":"Blake Elias","avatar_url":"https://avatars-next.observableusercontent.com/bcb2d8974dfe29de8246d628c79d40f80dd37cb59dc6d869a9030f5158e1b5ca","tier":null}],"members":[{"type":"individual","id":"01ac8a6a43bd3e70","login":"blakeelias","name":"Blake Elias","avatar_url":"https://avatars-next.observableusercontent.com/bcb2d8974dfe29de8246d628c79d40f80dd37cb59dc6d869a9030f5158e1b5ca","tier":null,"role":"editor"}],"comments":[],"custom_thumbnail":false,"trashed":false,"lapsed":null,"subscribed":null,"forks":2,"collection":null,"type":"notebook","body":{"title":"The Case for Funding Self-Isolation Facilities","cells":[{"id":0,"value":"md`# The Case for Funding Self-Isolation Facilities`","pinned":false,"hidden":false,"mode":"ojs","author":"$undefined","summary":"$undefined","output":"$undefined","database":"$undefined"},{"id":291,"value":"$33","pinned":false,"hidden":false,"mode":"ojs","author":"$undefined","summary":"$undefined","output":"$undefined","database":"$undefined"},{"id":463,"value":"md`\n## Update: See [HERE](https://observablehq.com/@blakeelias/funding-self-isolation-facilities) for an updated set of calculations.\n----\n____`","pinned":false,"hidden":false,"mode":"ojs","author":"$undefined","summary":"$undefined","output":"$undefined","database":"$undefined"},{"id":306,"value":"md`\n\n\n### How many healthcare workers would need isolation?`","pinned":false,"hidden":false,"mode":"ojs","author":"$undefined","summary":"$undefined","output":"$undefined","database":"$undefined"},{"id":215,"value":"viewof healthcare_workers = slider({\n min: 10000000,\n max: 30000000,\n step: 1000,\n value: 18000000,\n format: \",\",\n //title: 'The optional title',\n description: \"Number of healthcare workers in the US ^{1, 2, 3}\",\n})","pinned":false,"hidden":false,"mode":"ojs","author":"$undefined","summary":"$undefined","output":"$undefined","database":"$undefined"},{"id":250,"value":"viewof proportion_hcw_isolate = rangeSlider({\n min: 0,\n max: 1,\n step: .01,\n value: this ? this.value : [.01, .10],\n format: \"%\",\n //title: 'The optional title',\n description: \"Portion of healthcare workers to isolate for the duration of the pandemic (perpetually at-risk of COVID-19 exposure; unable to self-isolate at home)\",\n \n color: style[\"color\"],\n theme: style[\"theme\"]\n})","pinned":false,"hidden":false,"mode":"ojs","author":"$undefined","summary":"$undefined","output":"$undefined","database":"$undefined"},{"id":309,"value":"md`This would involve isolating between ** ${(healthcare_workers * proportion_hcw_isolate[0]).toLocaleString('en-US')} ** and ** ${(healthcare_workers * proportion_hcw_isolate[1]).toLocaleString('en-US')} ** healthcare workers, for the duration of the pandemic.\n\n------\n`","pinned":false,"hidden":false,"mode":"ojs","author":"$undefined","summary":"$undefined","output":"$undefined","database":"$undefined"},{"id":319,"value":"md`### How many infected individuals do we isolate?`","pinned":false,"hidden":false,"mode":"ojs","author":"$undefined","summary":"$undefined","output":"$undefined","database":"$undefined"},{"id":8,"value":"viewof cases_per_day = rangeSlider({\n min: 0,\n max: 20000,\n step: 1,\n value: this ? this.value : [1000, 5000],\n format: \",\",\n //title: 'The optional title',\n description: \"New confirmed cases per day\",\n \n color: style[\"color\"],\n theme: style[\"theme\"]\n})","pinned":false,"hidden":false,"mode":"ojs","author":"$undefined","summary":"$undefined","output":"$undefined","database":"$undefined"},{"id":30,"value":"viewof pandemic_duration = rangeSlider({\n min: 0,\n max: 30*24,\n step: 1,\n value: this ? this.value : [30*18, 30*18],\n format: \",\",\n //title: 'The optional title',\n description: \"Days left in pandemic\",\n \n color: style[\"color\"],\n theme: style[\"theme\"]\n})","pinned":false,"hidden":false,"mode":"ojs","author":"$undefined","summary":"$undefined","output":"$undefined","database":"$undefined"},{"id":324,"value":"$34","pinned":false,"hidden":false,"mode":"ojs","author":"$undefined","summary":"$undefined","output":"$undefined","database":"$undefined"},{"id":342,"value":"md`### How many close contacts?`","pinned":false,"hidden":false,"mode":"ojs","author":"$undefined","summary":"$undefined","output":"$undefined","database":"$undefined"},{"id":19,"value":"viewof contacts_per_case = rangeSlider({\n min: 0,\n max: 10,\n step: .1,\n value: this ? this.value : [.5, 3],\n format: \",\",\n //title: 'The optional title',\n description: \"Number of close contacts per case (immediate family, house-mates)\",\n \n color: style[\"color\"],\n theme: style[\"theme\"]\n})","pinned":false,"hidden":false,"mode":"ojs","author":"$undefined","summary":"$undefined","output":"$undefined","database":"$undefined"},{"id":346,"value":"md`With the number of infected individuals above, we're now looking at **${(cases_per_day[0] * pandemic_duration[0] * contacts_per_case[0]).toLocaleString('en-US')}** to **${(cases_per_day[1] * pandemic_duration[1] * contacts_per_case[1]).toLocaleString('en-US')}** close contacts to isolate.`","pinned":false,"hidden":false,"mode":"ojs","author":"$undefined","summary":"$undefined","output":"$undefined","database":"$undefined"},{"id":427,"value":"md`### How long to isolate?`","pinned":false,"hidden":false,"mode":"ojs","author":"$undefined","summary":"$undefined","output":"$undefined","database":"$undefined"},{"id":23,"value":"viewof days_to_isolate_infected = rangeSlider({\n min: 1,\n max: 60,\n step: 1,\n value: this ? this.value : [14, 30],\n format: \",\",\n //title: 'The optional title',\n description: \"Days to isolate infected patient\",\n \n color: style[\"color\"],\n theme: style[\"theme\"]\n})","pinned":false,"hidden":false,"mode":"ojs","author":"$undefined","summary":"$undefined","output":"$undefined","database":"$undefined"},{"id":190,"value":"viewof days_to_isolate_contact = rangeSlider({\n min: 10,\n max: 60,\n step: 1,\n value: this ? this.value : [14, 14],\n format: \",\",\n //title: 'The optional title',\n description: \"Days to isolate close contacts\",\n \n color: style[\"color\"],\n theme: style[\"theme\"]\n})","pinned":false,"hidden":false,"mode":"ojs","author":"$undefined","summary":"$undefined","output":"$undefined","database":"$undefined"},{"id":430,"value":"md`A close contact, who is not presently infected, needs to remain in isolation for 14 days to confirm they are not infected, as it takes approximately this long for symptoms to develop. An infected patient needs to stay in isolation longer, until the disease runs its course -- either until they recover, or until they need hospitalization.`","pinned":false,"hidden":false,"mode":"ojs","author":"$undefined","summary":"$undefined","output":"$undefined","database":"$undefined"},{"id":434,"value":"md`### How much does it cost?`","pinned":false,"hidden":false,"mode":"ojs","author":"$undefined","summary":"$undefined","output":"$undefined","database":"$undefined"},{"id":34,"value":"viewof nightly_price = rangeSlider({\n min: 10,\n max: 300,\n step: 1,\n value: this ? this.value : [50, 100],\n format: \"$,\",\n //title: 'The optional title',\n description: \"Nightly price of hotel room.\",\n \n color: style[\"color\"],\n theme: style[\"theme\"]\n})","pinned":false,"hidden":false,"mode":"ojs","author":"$undefined","summary":"$undefined","output":"$undefined","database":"$undefined"},{"id":437,"value":"md`We assume that each person being isolated needs to stay in their own hotel or dormitory room. While we cannot state what different accomodations may cost, we can estimate the order of magnitude for the nightly rate at a hotel. We consider a low range for such a rate, due to the current lack of demand, as well as bulk pricing that would be expected for this volume of occupancy.`","pinned":false,"hidden":false,"mode":"ojs","author":"$undefined","summary":"$undefined","output":"$undefined","database":"$undefined"},{"id":369,"value":"md`------`","pinned":false,"hidden":false,"mode":"ojs","author":"$undefined","summary":"$undefined","output":"$undefined","database":"$undefined"},{"id":372,"value":"md`## Cost Tallies\nWith the above estimates, we can now compute the total cost of isolating all the relevant individuals:\n`","pinned":false,"hidden":false,"mode":"ojs","author":"$undefined","summary":"$undefined","output":"$undefined","database":"$undefined"},{"id":113,"value":"$35","pinned":false,"hidden":false,"mode":"ojs","author":"$undefined","summary":"$undefined","output":"$undefined","database":"$undefined"},{"id":388,"value":"$36","pinned":false,"hidden":false,"mode":"ojs","author":"$undefined","summary":"$undefined","output":"$undefined","database":"$undefined"},{"id":220,"value":"$37","pinned":false,"hidden":false,"mode":"ojs","author":"$undefined","summary":"$undefined","output":"$undefined","database":"$undefined"},{"id":178,"value":"md`-----\n\n----\n\n----\n\n----\n\n----\n\n----\n`","pinned":false,"hidden":false,"mode":"ojs","author":"$undefined","summary":"$undefined","output":"$undefined","database":"$undefined"},{"id":286,"value":"md`### (Technical Stuff...)`","pinned":false,"hidden":false,"mode":"ojs","author":"$undefined","summary":"$undefined","output":"$undefined","database":"$undefined"},{"id":81,"value":"style = {\n var style = {\n \"color\": \"#3b99fc\",\n \"theme\": themes[\"Chrome macOS\"]\n }\n return style;\n}","pinned":false,"hidden":false,"mode":"ojs","author":"$undefined","summary":"$undefined","output":"$undefined","database":"$undefined"},{"id":3,"value":"import {slider} from '@jashkenas/inputs'","pinned":false,"hidden":false,"mode":"ojs","author":"$undefined","summary":"$undefined","output":"$undefined","database":"$undefined"},{"id":40,"value":"import {rangeSlider, themes} from \"@mootari/range-slider\"","pinned":false,"hidden":false,"mode":"ojs","author":"$undefined","summary":"$undefined","output":"$undefined","database":"$undefined"}],"files":"$W38","stdlib":"1","titling":"auto"}} 32:"$31:body"