As coronavirus sweeps across the US, American officials have warned that mandatory prevention measures may be needed to stop its spread. But is the US willing to go as far as Italy – another democracy – or even authoritarian China?
Italy has banned mass gatherings and barred from citizens travelling outside their home region.
China has forced more than 50 million citizens to self-isolate and even threatened severe penalties, including death, for quarantine breakers.
So what measures is the US prepared to take, and could coronavirus besiege an American city?
Experts say the US could eventually follow Italy’s plan to quarantine a large segment of its population, but it would be very hard and would face strong opposition.
“The likelihood of that happening in the United States is extremely, extremely small,” says Dr Irwin Redlener, Director of Columbia University’s National Centre for Disaster Preparedness.
“Essentially that amounts to martial law,” he tells BBC News. “Government ordered shutdowns” of public spaces and ability to travel would be “a very far step for Americans to manage,” he says.
“It’s just part of our culture. It’s just the antithesis of the freedoms that we theoretically have.”
Dr Anthony Fauci of the US National Institutes of Health has said that “anything is possible” given the scale of the outbreak, but large scale quarantines do not appear to be on the horizon.
On Tuesday, New York’s governor mandated a one-mile “containment zone” for the city of New Rochelle, about 20 miles (32km) from downtown Manhattan. Governor Andrew Cuomo sought to soften the order, saying: “You’re not containing people, you’re containing facilities.”
Emergency managers are focused on individual precautions, but they are also talking about the possibility of travel restrictions similar to Italy’s, says Kyle McPhee, the Director of Preparedness Programmes for disaster management firm Hagerty Consulting.
According to Mr McPhee, the emphasis now is on “self-imposed quarantine or voluntary quarantine”. It puts the burden “on the individual and the public to keep themselves and their neighbours and their community safe,” he says.
Emergency planners make contingency plans based on worst and best case scenarios, so plans for forced quarantines are certainly being discussed. But Mr McPhee warned that mass closures could have knock-on effects and it could be short-sighted to implement them in a hurry.
For example, closing schools could have unintentional consequences in the US, says Dr Redlener.
“By closing schools in poorer neighbourhoods, working parents have to take off, they won’t get compensation, and there’s a tremendous economic impact on them.”
Poor families often depend on US schools to provide breakfast and lunch to pupils, making it likely that children would go hungry.
“These are not steps to be taken lightly” he says, adding that any quarantine measure will face “strenuous legal challenges, at every level of government” from civil rights groups.
The American Civil Liberties Union (ACLU) has written a letter signed by 450 public health experts acknowledging that “individual rights must sometimes give way to the greater good” during an outbreak.
People can sometimes be quarantined, for example. “This is as it should be” – as long as the measures are in line with scientific research proving effectiveness, says the group.
However, citizens must not lose their right to challenge the government’s ability to hold them in captivity even if there is a quarantine, the group warns.
It also cautioned that containment zones could become “politicised”, for example if the US government tries to use them to find undocumented immigrants and deport them.
If migrants are afraid to come forward to seek medical treatment, the larger community will be at greater risk, the letter warns.
Finally, there are far more gun-owners in the US than anywhere else in the world, as well as anti-government factions that would certainly oppose government intrusion in their lives.
Law and order
During public health emergencies local governments form “emergency operation centres” to manage the response, says Mr McPhee.
They are typically lead by the local health agency, which would take advice from experts before issuing quarantine orders.
The legal situation at US borders is different and managed federally.
Under President Donald Trump, the federal government has banned non-citizens from coronavirus-hit regions entry, but US citizens are allowed back into the country after a two-week quarantine.
Local officials need more help from Washington, said Scott Gottlieb, the former Food and Drug Administration (FDA) commissioner.
“There’s no systematic plan of when a city should close school, when they should tell businesses that they have to telework, when they should close movie theatres and cancel large gatherings,” he told CBS news.
“We leave these decisions to local officials, but we really should have a comprehensive plan in terms of recommendations to cities.”
What about supplies?
The governor of Washington state, where the majority of US deaths from Covid-19 have occurred, has said that officials are weighing “whether mandatory measures are required”.
But closing events and public spaces “could be hard for the public because they may not have seen the full wave yet,” Gov Jay Inslee said.
Washington has been receiving face masks and hospital gowns from the Strategic National Stockpile, the country’s emergency medical stash, but more has to be done by the federal government to make emergency medical supplies available, Mr Inslee said.
The US health secretary has warned that the Strategic stockpile has only a fraction of the face masks that medical workers need to stay safe while treating US patients.
Prison reform activists say that those in jail are more likely to contract the virus due overcrowding and low levels of sanitisation. The US jails more of its citizens per capita than any other country.
Inmates are quarantined from the rest of society, but not from each other. Activists warn that prisoners often lack hand-washing facilities or hand sanitiser, which is sometimes deemed contraband due to its alcohol content.
Handcuffed people also cannot cover their mouths when they cough or sneeze.
Incarcerated inmates across Italy rioted when new restrictions were announced on prison visits due to the virus, and Iran has temporarily released 70,000 prisoners to keep Covid-19 from spreading behind bars.
New York state has hired prisoners to produce approximately 100,000 gallons of hand sanitizer per week, but activists questioned whether they would be permitted to actually use the stuff.