Americans Aren’t Actually Quarantining

If you flew into Honolulu International Airport anytime after the start of the pandemic, you would have had a different experience from most Americans who have traveled elsewhere this year. In the days following your arrival, you would not be wading into the azure waters of Waikiki Beach. You would not be climbing the soaring crest of Diamond Head to gaze upon the Pacific Ocean. A noble sea turtle might be floating in the bay, ready to swim alongside you, but you would not be able to join him. You would be in your hotel room, where you would be ordered to stay for the next 14 days for the state’s mandatory coronavirus quarantine.

And Hawaii does mean stay. At one point, hotels issued visitors single-entry key cards.

In mid-October, the state announced that it would allow tourists to bypass its mandatory two-week quarantine by showing a recent, negative Covid-19 test upon arrival. But before then, people who emerged from six-hour flights from LAX would find themselves imprisoned in paradise. Some of them broke quarantine, and more than 200 were arrested. In April, the Hawaii attorney general’s special agents arrested a man while he was loading groceries from Costco into his car. They busted honeymooners in May after the pair went out to buy pizza. On the Big Island, police swept up 21 members of a “family with a leader” in June. In August, authorities charged a 69-year-old man who refused to sign the quarantine paperwork at the airport. In October, special agents arrested a couple for breaking their quarantine for the second time in two days, after their hotel snitched on them. All of the arrested tourists faced the prospect of a one-year jail sentence—which no one has served yet—or a $5,000 fine.

Americans who drive to, say, Cincinnati, and do not isolate in the days that follow do not risk arrest. Ohio, like Hawaii, has introduced a quarantine for people who have visited high-risk areas. But complying with Ohio’s restrictions is voluntary. In other states, you are “urged” or “asked” to quarantine, but no one will check that you did.

Even now, Hawaii has one of the strictest quarantine laws in the country. (Indeed, police arrested a couple in late November for knowingly boarding a flight to Hawaii while infected. And state senators are now recommending a two-test requirement for tourists—one before departure, a second upon arrival—plus a seven-day quarantine in Hawaii, even if both tests come back negative.) The state’s geographic isolation has helped and hurt its efforts to control the virus. On one hand, the state would be completely unequipped to deal with a coronavirus surge. There are no states nearby from which to borrow doctors or ICU capacity. The island of Kauai has just 15 ventilators. On the other hand, everyone enters Hawaii through its airports, which makes enforcing a quarantine easier there than in almost every other state.

This policy may seem a little harsh coming from a place associated with a relaxed “aloha” spirit. But when I called Hawaii Attorney General Clare Connors, she put it this way: “We need to take care of the health and safety of our people so that we can keep Hawaii safe for people who want to come when it is time to come again.” Or as Honolulu Mayor Kirk Caldwell sternly told CNN, “Aloha works both ways.”

There’s no national database of quarantine noncompliance, but in U.S. states other than Hawaii, quarantine violations rarely result in fines or jail time—or, really, any consequences at all, multiple experts told me. “Clearly, we wouldn’t have this type of community transmission if everybody was actually doing what they were supposed to be doing,” says Amesh Adalja, a senior scholar at the Center for Health Security at Johns Hopkins University.

Yet quarantine compliance is essential for the combination of testing, contact tracing, and isolation of sick people to work. Simply telling people they’ve been exposed and letting them loose on the nation’s Outback Steakhouses is not sufficient. But persuading close contacts—people who spent significant amounts of time within six feet of someone who tests positive for Covid-19—to quarantine has been especially difficult, local health officials say, because these individuals might not be stuck in bed with Covid-19 symptoms.

[Read: Who should get the vaccine first—and last]

Though the CDC’s recent shortening of the quarantine period is likely to encourage more people to comply, it won’t solve all the country’s problems with getting people who might have been exposed to the virus to stay home. And until spring comes and Americans have broad access to the vaccine, quarantining is the main thing keeping us healthy. So why aren’t more Americans doing it?

Early in the pandemic, some states other than Hawaii did try to enforce their quarantine rules, arresting a handful of people after they were spotted by a neighbor or a police officer. But these crackdowns dropped off as case numbers swelled and public-health authorities struggled to keep up.

Public-health departments are reluctant to seem like bad cops—or cops at all. After the pandemic, they will have to persuade teens to wear condoms and hippies to get flu shots. Theirs is a soft power, and they’ve been hesitant to throw the book at quarantine breakers. Actual police officers, meanwhile, have bigger priorities than watching people sneak off to Target.

Hawaii created its quarantine law as a travel quarantine, stopping everyone at the airport. These types of quarantines are logistically easier to implement—they don’t require contact tracers—than medical quarantines, in which the state orders a certain individual to stay in isolation. They’re also subject to different legal rules: To medically quarantine a given person in many states, authorities have to issue a court order, not simply call and encourage them to isolate. “We’ve had a lot more nudges than real, enforceable orders,” says Wendy Parmet, a law professor at Northeastern University.

Hawaii is also unique in that it has no land borders with other states. In most states, stopping people at the border is impossible because people regularly cross state lines for work and other essential activities. “Imagine trying to actually enforce an interstate quarantine in the New York metro area. You can’t do it,” Parmet told me. Supposed state travel restrictions, she said, “are somewhat sad acts of desperation based on the lack of federal policy.”

Some other countries have imposed much tougher travel restrictions and quarantine policies. At one point, Greeks were required to text authorities to explain why they needed to go out. Norway quarantined its own citizens under threat of a fine or imprisonment. Most foreigners still can’t fly to Vietnam. All these countries have lower death rates from Covid-19 than the U.S.

Hawaii’s effort has been boosted by a unique citizen activist group called Kapu Breakers. Made up of 6,700 Hawaii residents and led by a former newscaster named Angela Keen, the group tracks down tourists who might be breaking quarantine, then forwards their information to law enforcement. In addition to scouring social media, they rely on tips from hotel concierges, taxi drivers, and others who could have contact with tourists who might be breaking kapu, or “sacred laws.”

Keen believes that Hawaii residents are on such high alert because of long-ago pandemics that came to the islands and killed large percentages of the population. “Generations of stories you hear, from great-grandparents, grandparents, parents, that the pandemics nearly killed off Native Hawaiians,” she told me. “So there is a great fear here of outsiders coming in and bringing it with them.” In the past century and a half, thousands of people, mostly Hawaiians, died of Hansen’s disease—known informally as leprosy—at Kalaupapa, Hawaii’s most infamous quarantine.

On the mainland, states cite a combination of Covid-19 denial, logistical hurdles, and funding and personnel shortages to explain why they haven’t been willing or able to enforce quarantines. One problem is the scofflaws: Some people stay inside for three or four days, then decide, “I’m bored with staying home,” Brenton Nesemeier, the field-services director for the North Dakota Health Department, told me. The health department sends people who are supposed to quarantine daily email surveys, but beyond that, it doesn’t do much to ensure that either infected people or their close contacts stay home for the entire quarantine period. About 40 to 50 percent of North Dakotans who come in close contact with infected people do not complete their quarantine, Nesemeier estimated.

Some states can’t quarantine people, because they have too many cases to trace. New Hampshire said in mid-November that it would stop conducting contact tracing for all new Covid-19 cases. In North Dakota, Nesemeier said the health department doesn’t have the manpower to reach out to close contacts of people who test positive. Instead, it relies on North Dakotans who have Covid-19 to call their own contacts. This system creates a new set of problems: The call might never happen, or the person on the other end of the line might not take a “stay home” suggestion from Uncle Roy very seriously.

Even if a North Dakotan wants to do the right thing, she might not be able to without going hungry or losing her job. Grocery delivery isn’t available in parts of the large and rural state. And because so many residents are considered essential workers, many employers ask close contacts to come into work even if they’ve been exposed to the virus.

[Read: The most American COVID-19 failure yet]

In fact, many Covid-exposed Americans who want to stay home and quarantine have an intractable problem: Their bosses won’t let them. Unlike the tourists traveling to Hawaii, most Americans aren’t attempting some sort of pandemic vacation right now—they have to work. (Hawaii’s essential workers, too, might have to go out in public when they prefer to stay home.) Public-health officials in several states have said that some people are neglecting to quarantine because they won’t get paid if they don’t go to work. “We hear people say, ‘I have to work; I have to have my income,’” says Ray Przybelski, the director of the Portage County Health and Human Services Department in Wisconsin.

The Families First Coronavirus Response Act granted paid leave to recover from Covid-19 to many Americans. But the law doesn’t cover everyone: Large companies aren’t included, and small companies can claim an exemption. Because of these exemptions, only 47 percent of private-sector workers have guaranteed access to coronavirus-related sick leave, according to an analysis by the liberal Center for American Progress. The U.S. is the only country out of 193 nations to exclude workers from sick-leave benefits based on the size of the company they work for, according to a recent UCLA study.

Conflicts over remote work and leave are the most common type of Covid-19 employment litigation in the U.S., according to a database compiled by the law firm Fisher Phillips. “We don’t really pay people to stay at home to quarantine,” Polly Price, a global-health professor at Emory University, says. But that’s exactly the problem: In a study in Israel, people were more likely to quarantine after exposure to Covid-19 if they were paid during their isolation.

Months into the pandemic, half of Americans didn’t know they might have the right to stay home with pay if they contracted the coronavirus. And even if they did, employers might have pressured them to come to work if they were no longer showing symptoms, says Vicki Shabo, a senior fellow on paid-leave policy at the New America Foundation. These protections expire at the end of December, setting up what Shabo calls a “public-health crisis.”

Employees are complaining about being forced back to work, but to no apparent avail. Through November 22, more than 600 people have filed complaints with the Occupational Safety and Health Administration mentioning issues at their workplace involving coronavirus quarantine, according to data from the Department of Labor. “After testing positive, employees are being scheduled and expected to work as long as they don’t show symptoms and [are] not placed in quarantine,” a worker at a Georgia taco restaurant complained in July. OSHA has formally inspected just 11 of the employers in these incidents. “Under the Trump administration, OSHA decided to do almost no enforcement,” says Debbie Berkowitz, the worker-health-and-safety program director at the National Employment Law Project. (In an email, a Department of Labor spokesperson said, “The claim that OSHA is not taking enforcement actions is patently false. OSHA is committed to protecting America’s workers during the pandemic, and has been working around the clock to that end.”)

America’s laissez-faire federal pandemic response has, in effect, treated each state like its own country. States have been responsible for their own restrictions and their own personal protective equipment and their own nursing-home protection plans. When it comes time to isolate sick people, though, it becomes painfully clear that states aren’t countries. Wisconsin can’t stop Iowans from driving into it. North Dakota doesn’t have enough health workers to trace all of its infected citizens. The governor can’t help you when your employer is—legally—dragging you back into the office.

Hawaii was an independent country before the U.S. annexed it and turned it into a state. And the reason Hawaii has been so ruthlessly effective at quarantine is that it in some ways still acts as its own country with its own border controls. The strategy has paid off: The state consistently has some of the lowest case numbers in the nation. As with so many other pandemic rules, Americans might not like quarantine, but it works.