Lenny Marcus and his wife have already walked through the scenarios together: What happens if one of them is possibly exposed to the new coronavirus and told to self-quarantine?
Marcus figures he'd bike home from Harvard Square, where he works as the founding co-director of the National Preparedness Leadership Initiative at Harvard, and "in the case of my wife, she's going to walk home."
No public transport when you need to avoid possible contagion. No hugging co-workers goodbye, of course. It's a "don't pass go" moment.
"You want to get into a place where you're confined," Marcus says, "and be ready to be there by yourself without social contact for up to two weeks. It's useful, therefore, to plan what you would do, where you would go, and then how you would maintain yourself for those two weeks."
According to the latest state numbers in Massachusetts, 719 people have self-quarantined — 470 have completed the two-week stint while 249 are still in the midst of it.
In his house, Marcus says, there's a family room with a bathroom, so it makes sense to stock up on essentials like medications and plan to hole up in there, watch TV and have food delivered to the door.
Making such plans can help emotionally as well as practically, he says: "Whenever we are faced with any kind of a crisis, it's very natural for us to go to what we call your 'emotional basement.' That's the reptilian part of your brain that is designed to get our attention in the middle of any kind of crisis or any kind of danger."
It's natural to go there, but we don't do our best thinking there, he adds: "What we tell people is that when you're in the basement, it's important in an emergency to get out of the basement."
And the best way to get out of the basement, he says, is to make a what-if plan and a to-do list, "because once your mind knows that there's something to do and you start doing it, you actually calm down."
Self-quarantine could result from warnings issued by an institution or health officials, Marcus says, or it could be a common-sense reaction to news about nearby coronavirus cases, decided upon in consultation with medical staff.
Quarantine tends to be imposed from above, so Dr. Rochelle Walensky, the chief of infectious diseases at Massachusetts General Hospital, prefers the term "self-isolation" for coronavirus precautions.
She offers the example of a passenger recently returned from Italy who's feeling fine, doesn't know anyone they were exposed to who has been sick, "but given the amount of community spread in that country, really feels duty-bound to self-isolate, to protect themselves and their loved ones, and others in the community from potential community spread."
She says self-isolation is especially important these days because there's very little testing available to determine who has the virus.
"Right now, the biggest resource constraint that we have is the inability to do widespread diagnostics," she says. And without good testing, she considers precautionary self-isolation by people potentially exposed to the virus — via foreign travel or contact with domestic cases — a good idea.
It's not fun, Walensky readily admits, but it is doable.
"What we're really asking you to do is stay in your bedroom, stay in a small area that won't infect other people, use your own towels, clean your surfaces, use your own bathroom, really just be careful."
Tight living arrangements present extra challenges: "This would get difficult in a dormitory. Then we might want to have a different conversation."
The person who's self-isolating should wear a mask if they're in contact with anyone — not the visitor, she says. And pizza is still possible: "If you want to have the pizza delivered, have the pizza delivered, and leave the 20 under the door and then pick up your pizza. Those things, I think, are really reasonably OK." [Editor's note: of course, you could also just order and pay online with no cash involved.]
People in self-isolation should also monitor themselves for symptoms, Walensky says, including taking their temperature. Novel coronavirus symptoms include dry cough, fever and shortness of breath. And they should be aware that the coronavirus can live on surfaces for hours to days. So "you want to wipe your surfaces. You want to wipe your phone. You want to not use somebody else's phone," she says.
Some people might see self-quarantine as stigmatizing, as in "You could be Typhoid Mary here," Walensky says. "But one could also say 'Thank you! This is a total pain in the neck. It's really hard. It's really isolating — literally. And thank you, because what you're doing is trying to protect me.' And I think that's really, really important to understand."
It could become even more important to understand if the number of people in self-quarantine grows in the coming weeks. Tolerance may well be required from employers who must do without face-to-face workers for two weeks. Lenny Marcus from Harvard notes that if you know someone who has self-quarantined, it could be a kindness to call them and deliver food to them.
"Stopping this disease is going to depend on a lot of really good behavior on the part of every individual," he says. And that means avoiding social contact if you could have the virus — work, school, the T. "You don't want to be the spreader. If you've been instructed to self-quarantine, we all depend on your good behavior, too."