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Thursday, June 20, 2024

Social distancing

From Wikipedia, the free encyclopedia

https://en.wikipedia.org/wiki/Social_distancing

In public health, social distancing, also called physical distancing,is a set of non-pharmaceutical interventions or measures intended to prevent the spread of a contagious disease by maintaining a physical distance between people and reducing the number of times people come into close contact with each other. It usually involves keeping a certain distance from others (the distance specified differs from country to country and can change with time) and avoiding gathering together in large groups.

By minimising the probability that a given uninfected person will come into physical contact with an infected person, the disease transmission can be suppressed, resulting in fewer deaths. The measures may be used in combination with others, such as good respiratory hygiene, face masks and hand washing. To slow down the spread of infectious diseases and avoid overburdening healthcare systems, particularly during a pandemic, several social-distancing measures are used, including the closing of schools and workplaces, isolation, quarantine, restricting the movement of people and the cancellation of mass gatherings. Drawbacks of social distancing can include loneliness, reduced productivity and the loss of other benefits associated with human interaction.

Social distancing measures are most effective when the infectious disease spreads via one or more of the following methods, droplet contact (coughing or sneezing), direct physical contact (including sexual contact), indirect physical contact (such as by touching a contaminated surface), and airborne transmission (if the microorganism can survive in the air for long periods). The measures are less effective when an infection is transmitted primarily via contaminated water or food or by vectors such as mosquitoes or other insects. Authorities have encouraged or mandated social distancing during the COVID-19 pandemic as it is an important method of preventing transmission of COVID-19. COVID-19 is much more likely to spread over short distances than long ones. However, it can spread over distances longer than 2 m (6 ft) in enclosed, poorly ventilated places and with prolonged exposure.

The term "social distancing" was not introduced until the 21st century. Social distancing measures have been successfully implemented in several epidemics. In St. Louis, shortly after the first cases of influenza were detected in the city during the 1918 flu pandemic, authorities implemented school closures, bans on public gatherings and other social-distancing interventions. The influenza fatality rates in St. Louis were much less than in Philadelphia, which had fewer cases of influenza but allowed a mass parade to continue and did not introduce social distancing until more than two weeks after its first cases.

The World Health Organization (WHO) has suggested using the term "physical distancing" instead of "social distancing" because it is physical separation which prevents transmission; people can remain socially connected by meeting outdoors at a safe distance (when there is no stay-at-home order) and by meeting via technology.

Definition

The American Centers for Disease Control and Prevention (CDC) have described social distancing as a set of "methods for reducing frequency and closeness of contact between people in order to decrease the risk of transmission of disease". During the 2009 swine flu pandemic the WHO described social distancing as "keeping at least an arm's length distance from others, [and] minimizing gatherings". During the COVID-19 pandemic, the CDC defined social distancing as "remaining out of congregate settings, avoiding mass gatherings, and maintaining distance (approximately six feet or two meters) from others when possible".

Social distancing, combined with the use of face masks, good respiratory hygiene and hand washing, is considered the most feasible way to reduce or delay a pandemic.

Measures

Several social distancing measures are used to control the spread of contagious illnesses. Research indicates that measures must be applied rigorously and immediately in order to be effective.

Avoiding physical contact

Social distancing includes eliminating the physical contact that occurs with the typical handshake, hug, or hongi; this New Zealand illustration offers eight alternatives.

Keeping a set physical distance from each other and avoiding hugs and gestures that involve direct physical contact, reduce the risk of becoming infected during outbreaks of infectious respiratory diseases (for example, flu pandemics and the COVID-19 pandemic of 2020.) These distances of separation, in addition to personal hygiene measures, are also recommended at places of work. Where possible, remote work may be encouraged.

The distance advised by authorities varies. During the COVID-19 pandemic, for example, the World Health Organization recommends that a distance of 1 m (3.3 ft) or more is safe. Subsequently, China, Denmark, France, Hong Kong, Lithuania and Singapore adopted a 1 m social distancing policy. South Korea adopted 1.4 m (4.6 ft). Australia, Belgium, Germany, Greece, Italy, Netherlands, Portugal and Spain adopted 1.5 m (4.9 ft). The United States adopted 6 ft (1.8 m), and Canada adopted 2 m (6.6 ft). The United Kingdom first advised 2 m, then on July 4, 2020 reduced this to "one metre plus" where other methods of mitigation such as face masks were in use.

The WHO's one-metre recommendation stems from research into droplet-based transmission of tuberculosis by William F. Wells, which had found that droplets produced by exhalation, coughs, or sneezes landed an average of 3 ft (0.9 m) from where they were expelled.Quartz speculated that the U.S. CDC's adoption of 6 ft (1.8 m) may have stemmed from a study of SARS transmission on an airplane, published in The New England Journal of Medicine. When contacted, however, the CDC did not provide any specific information.

Some have suggested that distances greater than 1–2 m (3.3–6.6 ft) should be observed. One minute of loud speaking can produce oral droplets with a load of 7 million SARS-CoV-2 virus per milliliter that can remain for more than eight minutes, a time-period during which many people could enter or remain in the area. A sneeze can distribute such droplets as far as 7 m (23 ft) or 8 m (26 ft). Social distancing is less effective than face masks at reducing the spread of COVID-19.

Various alternatives have been proposed for the tradition of handshaking. The gesture of namaste, placing one's palms together, fingers pointing upwards, drawing the hands to the heart, is one non-touch alternative. During the COVID-19 pandemic in the United Kingdom, this gesture was used by Prince Charles upon greeting reception guests, and has been recommended by the Director-General of the WHO, Dr. Tedros Adhanom Ghebreyesus, and Israeli Prime Minister Benjamin Netanyahu. Other alternatives include the popular thumbs up gesture, the wave, the shaka (or "hang loose") sign, and placing a palm on one's heart, as practiced in parts of Iran.

In this computer lab, every other workstation has been closed off to increase the distance between people working, and screens between workstations are also in place.
Floor markings can help people maintain distance in public places, especially when queueing.
Urinals adjusted in a way close contacts are less likely

School closures

Mathematical modeling has shown that transmission of an outbreak may be delayed by closing schools. However, effectiveness depends on the contacts children maintain outside of school. Often, one parent has to take time off work, and prolonged closures may be required. These factors could result in social and economic disruption.

Workplace closures

Modeling and simulation studies based on U.S. data suggest that if 10% of affected workplaces are closed, the overall infection transmission rate is around 11.9% and the epidemic peak time is slightly delayed. In contrast, if 33% of affected workplaces are closed, the attack rate decreases to 4.9%, and the peak time is delayed by one week. Workplace closures include closure of "non-essential" businesses and social services ("non-essential" means those facilities that do not maintain primary functions in the community, as opposed to essential services).

Canceling mass gatherings

Cancellation of mass gatherings includes sports events, films or musical shows. Evidence suggesting that mass gatherings increase the potential for infectious disease transmission is inconclusive. Anecdotal evidence suggests certain types of mass gatherings may be associated with increased risk of influenza transmission, and may also "seed" new strains into an area, instigating community transmission in a pandemic. During the 1918 influenza pandemic, military parades in Philadelphia and Boston may have been responsible for spreading the disease by mixing infected sailors with crowds of civilians. Restricting mass gatherings, in combination with other social distancing interventions, may help reduce transmission. A recent peer-reviewed study in the British Medical Journal (The BMJ) also suggested it as one of the key components of an effective strategy in reducing the burden of COVID-19.

Travel restrictions

Border restrictions or internal travel restrictions are unlikely to delay an epidemic by more than two to three weeks unless implemented with over 99% coverage. Airport screening was found to be ineffective in preventing viral transmission during the 2003 SARS outbreak in Canada and the U.S. Strict border controls between Austria and the Ottoman Empire, imposed from 1770 until 1871 to prevent persons infected with the bubonic plague from entering Austria, were reportedly effective, as there were no major outbreaks of plague in Austrian territory after they were established, whereas the Ottoman Empire continued to suffer frequent epidemics of plague until the mid-nineteenth century.

A Northeastern University study published in March 2020 found that "travel restrictions to and from China only slow down the international spread of COVID-19 [when] combined with efforts to reduce transmission on a community and an individual level. ... Travel restrictions aren't enough unless we couple it with social distancing." The study found that the travel ban in Wuhan delayed the spread of the disease to other parts of mainland China only by three to five days, although it did reduce the spread of international cases by as much as 80 percent.

Shielding

Shielding measures for individuals include limiting face-to-face contacts, conducting business by phone or online, avoiding public places and reducing unnecessary travel.

During the COVID-19 pandemic in the United Kingdom, shielding referred to special advisory measures put in place by the UK Government to protect those at the highest risk of serious illness from the disease. This included those with weakened immune systems (such as organ transplant recipients), as well as those with certain medical conditions such as cystic fibrosis or severe asthma. Until June 1, 2020, those shielding were strongly advised not to leave home for any reason at all, including essential travel, and to maintain a 2 m (6.6 ft) distance from anyone else in their household. Supermarkets quickly made priority grocery delivery slots available to those shielding, and the Government arranged for food boxes to be sent to those shielding who needed additional assistance, for example elderly people shielding on their own. This was gradually relaxed from June to allow shielders to spend more time outside, before being suspended indefinitely from August 1.

Quarantine

During the 2003 SARS outbreak in Singapore, approximately 8000 people were subjected to mandatory home quarantine and an additional 4300 were required to self-monitor for symptoms and make daily telephone contact with health authorities as a means of controlling the epidemic. Although only 58 of these individuals were eventually diagnosed with SARS, public health officials were satisfied that this measure assisted in preventing further spread of the infection. Voluntary self-isolation may have helped reduce transmission of influenza in Texas in 2009. Short and long-term negative psychological effects have been reported.

Stay-at-home orders

The objective of stay-at-home orders is to reduce day-to-day contact between people and thereby reduce the spread of infection During the COVID-19 pandemic, early and aggressive implementation of stay-at-home orders was effective in "flattening the curve" and provided the much needed time for healthcare systems to increase their capacity while reducing the number of peak cases during the initial wave of illness. It is important for public health authorities to follow disease trends closely to re-implement appropriate social distancing policies, including stay-at-home orders, if secondary COVID-19 waves appear.

Cordon sanitaire

In 1995, a cordon sanitaire was used to control an outbreak of Ebola virus disease in Kikwit, Zaire.President Mobutu Sese Seko surrounded the town with troops and suspended all flights into the community. Inside Kikwit, the World Health Organization and Zaire's medical teams erected further cordons sanitaires, isolating burial and treatment zones from the general population and successfully containing the infection.

Protective sequestration

During the 1918 influenza epidemic, the town of Gunnison, Colorado, isolated itself for two months to prevent an introduction of the infection. Highways were barricaded and arriving train passengers were quarantined for five days. As a result of the isolation, no one died of influenza in Gunnison during the epidemic. Several other communities adopted similar measures.

Other measures

Other measures include shutting down or limiting mass transit and closure of sport facilities (community swimming pools, youth clubs, gymnasiums). Due to the highly interconnected nature of modern transportation hubs, a highly contagious illness can achieve rapid geographic spread if appropriate mitigation measures are not taken early. Consequently, highly coordinated efforts must be put into place early during an outbreak to proactively monitor, detect, and isolate any potentially infectious individuals. If community spread is present, more aggressive measures may be required, up to and including complete cessation of travel in/out of a specific geographic area.

Communicating social distancing public health guidelines

Public health messaging, gaining the public's trust (countering misinformation), ensuring community involvement and two-way exchange of ideas can affect the uptake, adherence, and effectiveness of best-evidence social distancing approach to preventing disease spread. The communication approaches, messaging, and delivery mechanisms need to be flexible so that they can be changed as both the best-evidence social distancing measures change and as the community needs change.

History

Leper colonies and lazarettos were established as a means of preventing the spread of leprosy and other contagious diseases through social distancing, until transmission was understood and effective treatments invented.

The Lazzaretto of Ancona was constructed in the 18th century on an artificial island to serve as a quarantine station and leprosarium for the port town of Ancona, Italy.
Two lepers denied entrance to town. Woodcut by Vincent of Beauvais, 14th century
New York City parks and playgrounds were closed during a 1916 polio epidemic.
Passenger without mask being refused boarding of a streetcar amid 1918 flu pandemic. (Seattle, Washington, 1918)

1916 New York City polio epidemic

During the 1916 New York City polio epidemic, when there were more than 27,000 cases and more than 6,000 deaths due to polio in the United States, with more than 2,000 deaths in New York City alone, movie theaters were closed, meetings were cancelled, public gatherings were almost non-existent, and children were warned not to drink from water fountains, and told to avoid amusement parks, swimming pools and beaches.

Influenza, 1918 to present

During the influenza pandemic of 1918, Philadelphia saw its first cases of influenza on 17 September. The city continued with its planned parade and gathering of more than 200000 people on 28 September and over the subsequent three days, the city's 31 hospitals became fully occupied. During the week ending 16 October, over 4500 people died. Social distancing measures were introduced on 3 October, on the orders of St. Louis physician Max C. Starkloff, more than two weeks after the first case. Unlike Philadelphia, St. Louis experienced its first cases of influenza on 5 October and the city took two days to implement several social distancing measures, including closing schools, theatres, and other places where people get together. It banned public gatherings, including funerals. The actions slowed the spread of influenza in St. Louis and a spike in cases and deaths, as had happened in Philadelphia, did not occur. The final death rate in St. Louis increased following a second wave of cases, but remained overall less than in other cities. Bootsma and Ferguson analyzed social distancing interventions in sixteen U.S. cities during the 1918 epidemic and found that time-limited interventions reduced total mortality only moderately (perhaps 10–30%), and that the impact was often very limited because the interventions were introduced too late and lifted too early. It was observed that several cities experienced a second epidemic peak after social distancing controls were lifted, because susceptible individuals who had been protected were now exposed.

School closures were shown to reduce morbidity from the Asian flu by 90% during the 1957–1958 pandemic, and up to 50% in controlling influenza in the U.S., 2004–2008. Similarly, mandatory school closures and other social distancing measures were associated with a 29% to 37% reduction in influenza transmission rates during the 2009 flu epidemic in Mexico.

The 2009 swine flu pandemic caused social distancing to rise in popularity, most notably in Mexico, with the country's Ministry of Health advising people to avoid handshakes and kissing as ways of greeting people. A mandatory nationwide school closure enacted in Mexico, which lasted for 18 days from late April 2009 to early May 2009, was a form of social distancing aimed at reducing the transmission of Swine flu. A study from 2011 found the mandatory nationwide school closure and other forms of social distancing in Mexico were effective at reducing influenza transmission rates.

During the swine flu outbreak in 2009 in the UK, in an article titled "Closure of schools during an influenza pandemic" published in The Lancet Infectious Diseases, a group of epidemiologists endorsed the closure of schools to interrupt the course of the infection, slow the further spread and buy time to research and produce a vaccine. Having studied previous influenza pandemics including the 1918 flu pandemic, the influenza pandemic of 1957 and the 1968 flu pandemic, they reported on the economic and workforce effect school closure would have, particularly with a large percentage of doctors and nurses being women, of whom half had children under the age of 16. They also looked at the dynamics of the spread of influenza in France during French school holidays and noted that cases of flu dropped when schools closed and re-emerged when they re-opened. They noted that when teachers in Israel went on strike during the flu season of 1999–2000, visits to doctors and the number of respiratory infections dropped by more than a fifth and more than two fifths respectively.

SARS 2003

During the SARS outbreak of 2003, social distancing measures were implemented, such as banning large gatherings, closing schools and theaters, and other public places, supplemented public health measures such as finding and isolating affected people, quarantining their close contacts, and infection control procedures. This was combined with the wearing of masks for certain people. During this time in Canada, "community quarantine" was used to reduce transmission of the disease with moderate success.

COVID-19 pandemic

During the COVID-19 pandemic, social distancing and related measures are emphasized by several governments as alternatives to an enforced quarantine of heavily affected areas. According to UNESCO monitoring, more than a hundred countries have implemented nationwide school closures in response to COVID-19, impacting over half the world's student population. In the United Kingdom, the government advised the public to avoid public spaces, and cinemas and theaters voluntarily closed to encourage the government's message.

With many people disbelieving that COVID-19 is any worse than the seasonal flu, it has been difficult to convince the public—particularly youth, and the anti vaxx community to voluntarily adopt social distancing practices. In Belgium, media reported a rave was attended by at least 300 before it was broken up by local authorities. In France, teens making nonessential trips are fined up to US$150. Beaches were closed in Florida and Alabama to disperse partygoers during spring break. Weddings were broken up in New Jersey and an 8 p.m. curfew was imposed in Newark. New York, New Jersey, Connecticut and Pennsylvania were the first states to adopt coordinated social distancing policies which closed down non-essential businesses and restricted large gatherings. Shelter in place orders in California were extended to the entire state on 19 March. On the same day Texas declared a public disaster and imposed statewide restrictions.

These preventive measures such as social-distancing and self-isolation prompted the widespread closure of primary, secondary, and post-secondary schools in more than 120 countries. As of 23 March 2020, more than 1.2 billion learners were out of school due to school closures in response to COVID-19. Given low rates of COVID-19 symptoms among children, the effectiveness of school closures has been called into question. Even when school closures are temporary, it carries high social and economic costs. However, the significance of children in spreading COVID-19 is unclear. While the full impact of school closures during the coronavirus pandemic are not yet known, UNESCO advises that school closures have negative impacts on local economies and on learning outcomes for students.

In early March 2020, the sentiment "Stay Home" was coined by Florian Reifschneider, a German engineer and was quickly echoed by notable celebrities such as Taylor Swift, Ariana Grande and Busy Philipps in hopes of reducing and delaying the peak of the outbreak. Facebook, Twitter and Instagram also joined the campaign with similar hashtags, stickers and filters under #staythefhome, #stayhome, #staythefuckhome and began trending across social media. The website claims to have reached about two million people online and says the text has been translated into 17 languages.

Impact on mental health

There are concerns that social distancing can have adverse affects on participants' mental health. It may lead to stress, anxiety, depression or panic, especially for individuals with preexisting conditions such as anxiety disorders, obsessive compulsive disorders, and paranoia. Widespread media coverage about a pandemic, its impact on economy, and resulting hardships may create anxiety. Change in daily circumstances and uncertainty about the future may add onto the mental stress of being away from other people.

Psychologist Lennis Echterling noted that, in such social distancing situations, using technology for "connection with loved ones...is imperative" to combat isolation, for the sake of one's well-being. Social worker Mindy Altschul noted that the concept of "social distancing" ought to be reframed as "physical distancing", so as to emphasize the fact that being physically isolated need not, and should not, result in being socially isolated.

People with autism also suffer impact from social distancing. Adjusting to a new routine can be stressful for everyone within the spectrum but especially for children who have trouble with change. Children with autism may not know what is going on or might not be able to express their fears and frustrations. They also may need extra support to understand what's expected of them in some situations.The adjustment to a new situation can lead to challenging behavior uncharacteristic of the autistic individual's true character. In some countries and demographics, teenagers and young adults within the autistic spectrum disorder (ASD) receive support services including special education, behavioral therapy, occupational therapy, speech services, and individual aides through school, but this can be a major challenge, particularly since many teenagers with ASD already have social and communication difficulties. Aggressive and self-injurious behaviors may increase during this time of fear and uncertainty.

Portrayal in literature

In his 1957 science fiction novel The Naked Sun, Isaac Asimov portrays a planet where people live with social distancing. They are spread out, miles from each other, across a sparsely-populated world. Communication is primarily through technology. A male and a female still need to engage in sex to make a baby, but it is seen as a dangerous, nasty chore. In contrast, when communication is through technology the situation is the reverse: there is no modesty, and casual nudity is frequent. The novel's point of departure is a murder: this seemingly idyllic world, in fact, has serious social problems.

Theoretical basis

From the perspective of epidemiology, the basic goal behind social distancing is to decrease the effective reproduction number, $R_{e}$ or $R$ , which in the absence of social distancing would equate to the basic reproduction number, i.e. the average number of secondary infected individuals generated from one primary infected individual in a population where all individuals are equally susceptible to a disease. In a basic model of social distancing, where a proportion $f$ of the population engages in social distancing to decrease their interpersonal contacts to a fraction $a$ of their normal contacts, the new effective reproduction number $R$ is given by:

R = [1 - (1 - a^{2}) f] R_{0}

Where the value of $R$ can be brought below 1 for sufficiently long, containment is achieved, and the number infected should decrease.

For any given period of time, the growth in the number of infections can be modeled as:

y_{n} = \sum_{i = 0}^{n} R^{i}

where:

$y_{n}$ is the number of infected individuals after $n$ incubation periods (5 days, in the case of COVID-19)

Using COVID-19 as an example, the following table shows the infection spread given:

A: No social distance mitigation
B: 50% reduction in social interaction
C: 75% reduction in social interaction

Number of infections after $n$ days for various values of $R$
Time	A	B	C
	$R = R_{0} = 2.5$	$R = 1.25$	$R = 0.625$
5 days (1 incubation period)	2.5	1.25	0.625
30 days (6 incubation periods)	406	15	2.5

Effectiveness

An empirical study published in July 2020 in The BMJ (British Medical Journal) analyzed data from 149 countries, and reported an average of 13% reduction in COVID-19 incidence after the implementation of social distancing policies. Another study found that four social distancing interventions combined resulted in a reduction of the infection rate from 66% to less than 1%.

Leper colony

From Wikipedia, the free encyclopedia

Spinalonga on Crete, Greece, one of the last leprosy colonies in Europe, closed in 1957

A leper colony, also known by many other names, is an isolated community for the quarantining and treatment of lepers, people suffering from leprosy.

M. leprae, the bacterium responsible for leprosy, is believed to have spread from East Africa through the Middle East, Europe, and Asia by the 5th century before reaching the rest of the world more recently. Historically, leprosy was believed to be extremely contagious and divinely ordained, leading to enormous stigma against its sufferers. Other severe skin diseases were frequently conflated with leprosy and all such sufferers were kept away from the general public, although some religious orders provided medical care and treatment. Recent research has shown M. leprae has maintained a similarly virulent genome over at least the last thousand years, leaving it unclear which precise factors led to leprosy's near elimination in Europe by 1700. A growing number of cases following the first wave of European colonization, however, led to increased attention towards leprosy during the New Imperialism of the late 19th century. Following G.A. Hansen's discovery of the role of M. leprae in the disease, the First International Leprosy Conference held in Berlin in 1897 renewed interest and investment in the isolation of lepers throughout the European colonial empires. Although Western countries now generally treat cases of leprosy individually on an outpatient basis, traditional isolated colonies continue to exist in India, China, and some other countries.

Names

In medieval Latin, a place for the isolation and care of lepers was known as a leprosaria, leprosarium, or leprosorium, names which are sometimes used in English as well. The Latin domus leprosaria was calqued in English as leper house, with leper colony becoming by far the most common English term in the 1880s as the growing number of leprosy cases were discussed within the context of European colonialism. Less common synonyms include leper asylum, leper lodge, and leper hospital. Other names derive from the figure of Lazarus in one of Jesus's parables, treated by the Catholic Church during the Middle Ages as a historical figure and as the patron saint of both lepers and the Crusader Order of Saint Lazarus, who administered the leper colony in Jerusalem before spreading to other locations. This caused leper colonies to also be known as lazar houses and, after the leper colony and quarantine center on Venice's Sta. Maria di Nazareth, as lazarets, lazarettes, lazarettos, and lazarettas. The name leper or leprosy villageis sometimes used for colonies in China, a calque of the Mandarin name máfēngcūn (t 麻風村, s 麻风村).

History

Abandoned nun's quarters at the leper colony on Chacachacare Island in Trinidad and Tobago

Although not all of the skin diseases (kushtha) discussed in the Indian Vedas and the Laws of Manu were leprosy, some of them seem to have been, with the disease appearing in the subcontinent by at least 2000 BC. The Indian religious texts and laws did not organize formal leper colonies but treated those afflicted with the disease as untouchable outcastes, forbidding and punishing any marriage with them while they suffered from the disease, which was considered both contagious and a divine punishment for sins of the sufferer's current or former life. In legend, even kings were removed from power and left to wander in the forests while suffering from leprosy, although their position could be restored in the event of their recovery, whether through divine intervention or Ayurvedic herbal remedies such as chaulmoogra oil. Similarly, the ancient Persians and Hebrews considered certain skin diseases to render people unclean and unfit for society, without organizing any special locations for their care; it seems likely, however, that the references to "leprosy" in the Old and New Testaments of the Bible are the result of a misunderstanding produced by the Septuagint's Greek translation and subsequent Latin translations like the Vulgate and originally referred to a variety of conditions such as psoriasis before becoming associated with leprosy centuries later. This confusion of terms—and the related divine opprobrium—was then translated into Islamic medicine in the 9th century. The introduction of leprosy to southern Europe was blamed on the armies of Alexander and Pompey; ancient Greek and Roman doctors did not blame divine punishment and advocated various treatments but still usually advised that lepers be kept out of cities. Some early Christians sought to emulate Jesus's example by personally ministering to lepers or communities of lepers, activity recorded in hagiographies like St Gregory's life of St Basil.

Leprosy seems to have reached the rest of Europe during late Antiquity and the early Middle Ages, with the imperial Church reducing formal restrictions on lepers while setting aside funds for leprosaria where clerics would treat the afflicted. Such leper houses are documented at St-Oyen in 460, Chalon-sur-Saône in 570, and Verdun in 634; their management was often provided by monastic orders. The area of modern Belgium alone may have had as many as 700 or 800 prior to the Crusades. Christian folklore misunderstood the parable of Lazarus and Dives as a historical account and took the sore-covered beggar in the story as St Lazarus, patron of lepers; the military order St Lazarus was established to care for lepers in Crusader Jerusalem and subsequently operated other leprosaria around Europe. Some colonies were located on mountains or in remote locations to ensure isolation, some on main roads, where donations would be made for their upkeep. Others were essentially hospitals within major cities. In 1623 the Congregation of the Mission, a Catholic society of apostolic life founded by Vincent de Paul, was given possession of the Priory of St. Lazarus, a former leper house in Paris, due to which the entire Congregation gained the name of "Lazarites" or "Lazarists" although most of its members had nothing to do with caring for lepers.

Debate exists over the conditions found within historical colonies; while they are currently thought to have been grim and neglected places, there are some indications that life within a leper colony or house was no worse than the life of other, non-isolated individuals. There is even doubt that the current definition of leprosy can be retrospectively applied to the medieval condition. What was classified as leprosy then covers a wide range of skin conditions that would be classified as distinct afflictions today. Some leper colonies issued their own money or tokens, in the belief that allowing people affected by leprosy to handle regular money could spread the disease. Today leper hospitals exist throughout the world to treat those afflicted with leprosy, especially in Africa, Brazil, China and India.

Political aspects

In 2001, government-run leper colonies in Japan came under judicial scrutiny, leading to the determination that the Japanese government had mistreated the patients, and the district court ordered Japan to pay compensation to former patients. In 2002, a formal inquiry into these colonies was set up, and in March 2005, the policy was strongly denounced. "Japan's policy of absolute quarantine... did not have any scientific grounds." The inquiry denounced not only the government and the doctors who were involved with the policy, but also the court that repeatedly ruled in favor of the government when the policy was challenged, as well as the media, which failed to report the plight of the victims.

Wednesday, June 19, 2024

Trillion-dollar coin

From Wikipedia, the free encyclopedia
https://en.wikipedia.org/wiki/Trillion-dollar_coin

The trillion-dollar coin is a concept that emerged during the United States debt-ceiling crisis of 2011 as a proposed way to bypass any necessity for the United States Congress to raise the country's borrowing limit, through the minting of very high-value platinum coins. The concept gained more mainstream attention by late 2012 during the debates over the United States fiscal cliff negotiations and renewed debt-ceiling discussions. After reaching the headlines during the week of January 7, 2013, use of the trillion-dollar coin concept was ultimately rejected by the Federal Reserve and the Treasury.

The concept of the trillion-dollar coin was reintroduced in March 2020 in the form of a congressional proposal by congresswoman Rashida Tlaib during the shutdown caused by the COVID-19 pandemic in the United States. Tlaib sought to fund monthly $2,000 recurring stimulus payments until the end of the pandemic.

The idea gained further traction in late 2021 with propositions by Bloomberg journalist Joe Weisenthal amongst others, amidst the United States debt-ceiling crisis of 2021.

Legal basis

The issuance of paper currency is subject to various accounting and quantity restrictions that platinum coinage is not. According to the United States Mint, coinage is accounted for as follows:

Since Fiscal Year (FY) 1996, the Mint has operated under the United States Mint Public Enterprise Fund (PEF). As authorized by Public Law 104-52 (codified at 31 U.S.C. § 5136), the PEF eliminates the need for appropriations. Proceeds from the sales of circulating coins to the Federal Reserve Banks (FRB), bullion coins to authorized purchasers, and numismatic items to the public and other customers are paid into the PEF and provide the funding for Mint operations. All circulating, bullion and numismatic operating expenses and capital investments incurred for the Mint's operations and programs are paid out of the PEF. By law, all funds in the PEF are available without fiscal year limitation. Revenues determined to be in excess of the amount required by the PEF are transferred to the United States Treasury General Fund as off-budget and on-budget receipts. Off-budget receipts consist of seigniorage, the difference between the receipts from the Federal Reserve System from the sale of circulating coins at face value and the full costs of minting and distributing circulating coins. Seigniorage is deposited periodically to the General Fund where it reduces the government's need to borrow.

The concept of striking a trillion-dollar coin that would generate one trillion dollars in seigniorage, which would be off-budget, or numismatic profit, which would be on-budget, and be transferred to the Treasury, is based on the authority granted by Section 31 U.S.C. § 5112 of the United States Code for the Treasury Department to "mint and issue platinum bullion coins" in any denominations the Secretary of the Treasury may choose. Thus, if the Treasury were to mint one-trillion dollar coins, it could deposit such coins at the Federal Reserve's Treasury account instead of issuing new debt.

31 U.S.C. 5112(k) as originally enacted by Public Law 104-208 in 1996:

The Secretary may mint and issue bullion and proof platinum coins in accordance with such specifications, designs, varieties, quantities, denominations, and inscriptions as the Secretary, in the Secretary's discretion, may prescribe from time to time.

In 2000, the word "bullion" was replaced with "platinum bullion coins". According to the United States Mint: “A bullion coin is an investment-grade coin that is valued by its weight and fineness of a specific precious metal.”

Platinum bullion coins can, by this statute, be minted in any denomination, whereas coins in any other specified metal are restricted to amounts of $50, $25, $10, $5 and $1. The concept of minting a very high denomination coin relies on the platinum clause as a loophole for the executive branch to raise revenues without congressional oversight.

Philip N. Diehl, former director of the United States Mint and with Republican Congressman Michael Castle co-author of the platinum coin law, has said the procedure would be permitted by the statute. Castle says he never intended such a use. The platinum coinage provision was eventually passed by a Republican Congress over the objections of a Democratic Treasury in 1996.

Laurence Tribe, a constitutional law professor at Harvard Law School, said the legal basis of the trillion-dollar coin is sound and that the coin could not be challenged in court as no one would have standing to do so.

Emergence of the concept

The idea for the Treasury Department to mint a coin and send it to the Federal Reserve to pay off the debt was first popularized by Populist Party presidential candidate Bo Gritz in 1992. As a standard part of his stump speeches, he would hold up a five-inch example coin. The specific concept was first introduced by Carlos Mucha, a lawyer who commented under the name "beowulf" on various blogs. "Beowulf" outlined the idea in a series of comments on Warren Mosler's blog in May 2010, noting that "Congress has already delegated to Tsy [Treasury] all the seigniorage power authority it needs to mint a $1 trillion coin". Beowulf also drew attention to the concept on the blog of economist Brad Delong in July 2010 and in a legal analysis blogpost of his own in January 2011, but it was not until July 2011 that the use of the concept as an unorthodox method of resolving the debt-ceiling crisis came to the attention of the financial press and mainstream media blogs. At that time, the idea found some support from legal academics such as Yale Law School's Jack Balkin. Once the debt ceiling crisis of the summer of 2011 was resolved, attention to the concept faded.

The concept gained renewed and more mainstreamattention by late 2012, as the debt-ceiling limit was being approached again. In early January, the economist Paul Krugman endorsed the idea and asserted that opposition to the idea was coming from people unwilling to admit the truth that "money is a social contrivance". His endorsement attracted considerable media attention. Former Mint director Diehl was widely cited in the media debunking criticisms of the coin and its basis in law.Congressman Jerry Nadler endorsed the idea, and it was featured in the international press by January 4, 2013.

"Beowulf" would later tell Wired magazine that the coin idea came from a December 2009 Wall Street Journal article that talked about how several people were able to generate frequent-flyer miles at no cost by ordering coins from the U.S. Mint with a credit card offering mileage rewards, then depositing the coins at a bank to pay off the credit card debt. He also said that he was inspired by the 2008 book Web of Debt by Ellen Brown, which cited a former Washington official who said the government could order the minting of large coins to pay off the national debt. "Beowulf" said the trillion-dollar coin idea is more rightly attributed to a small discussion group than to an individual, adding that the group was "just in it for the lulz" (i.e., for personal amusement).

Analysis and reaction

Some commentators have argued that although the concept may be strictly legal, it would weaken the checks and balances system of U.S. government, even if the spending that the coin would allow was already authorized by Congress. Opinion columnist Megan McArdle wrote that "minting a $1 trillion coin neatly end-runs GOP obstructionists, but only by proving that the president himself has little respect for the institutional restraints on his office." Felix Salmon, another journalist, wrote that the concept "would effectively mark the demise of the three-branch system of government, by allowing the executive branch to simply steamroller the rights and privileges of the legislative branch." Salmon said that he does not agree with what Congressional Republicans are doing, but that they have a right to do that, and that the president should not use the trillion-dollar coin option to circumvent them. He said, "Yes, the legislature is behaving like a bunch of utter morons if they think that driving the US government into default is a good idea. But it's their right to behave like a bunch of utter morons."

On the other hand, many economists and business analysts endorsed the coin as a way to counter threats by congressional Republicans to force the country into default by refusing to raise the debt limit. Paul Krugman said (in 2013), "So minting the coin would be undignified, but so what? At the same time, it would be economically harmless – and would both avoid catastrophic economic developments and help head off government by blackmail." He also declared the trillion-dollar coin debate to be "the most important fiscal policy debate of our lifetimes".

Michael Steel, spokesperson of House Speaker John Boehner, dismissed the concept by comparing it to a Simpsons episode called "The Trouble with Trillions", which aired 13 years before the United States debt-ceiling crisis, in which Homer Simpson is on a mission in search of a missing trillion-dollar bill.

On January 7, 2013, Republican congressman Greg Walden announced he would introduce a bill to close the platinum coin loophole. Rep. Walden said that the intention is to "take the proposal off the table." New York representative Jerry Nadler opposed the bill and said that the idea remains a valid option.

On January 12, 2013, the Treasury and Federal Reserve announced they would not mint a platinum coin, and five days later, Senate Minority Whip John Cornyn (R-Texas) announced that Senate Republicans would end their threat to block an increase in the debt ceiling.

In January 2023, Treasury Secretary Janet Yellen said that minting a trillion dollar coin was not on the table as a solution to the 2023 United States debt-ceiling crisis and possible U.S. default on its debt, because the Federal Reserve would be unlikely to accept it, calling it "a gimmick". In May 2023, Paul Krugman commented: "As for claims that [Fed Chair Jerome] Powell would refuse to accept the coin, or the Supremes would block premium bonds — well, nobody knows. But my guess is that nobody wants to be the guy who destroys the world economy." Premium bonds have been touted as a possible alternative to the trillion dollar coin, and an alternative to congressional action raising the debt limit.

In April 2023, Bloomberg News reported that a poll of 1,212 people was conducted in March 2023 to gauge the support for the U.S. Treasury minting the $1 trillion platinum coin to pay off the country's debt obligations. The poll results showed that 14% supported the coin's minting, 37% opposed it, while 49% have no opinion or were undecided.

Inflation risks

The Federal Reserve's purchase of the trillion-dollar coin would be analogous to the securities purchases that are part of quantitative easing (QE), in both cases adding to the monetary base, which is the sum of currency in circulation and bank reserves, i.e. the liabilities of the Federal Reserve. Commercial bank reserves would increase as the Treasury spent the proceeds from the coin's purchase by the Federal Reserve. This would generate the accounting change at the Federal Reserve of moving funds from the Treasury's deposits at the Federal Reserve to commercial banks' deposits at the Federal Reserve ("bank reserves"), a transfer from one Federal Reserve liability category to another. This is no different than the normal process by which checks from the Treasury clear in the banking system. There is a common misconception that banks can loan out these reserves to customers, thereby increasing the money supply, potentially too rapidly, causing the economy to overheat, and adding to inflation and increasing expectations of future inflation. For example, Jaret Seiberg of the Washington Research Group stated, “the $1 trillion coin would expand the money supply by a considerable amount, which could spark serious inflation...this economic chaos could worsen the economic downturn, which would further weaken credit conditions and impose higher losses on banks.”

In April 2011, a paper published by the St Louis Federal Reserve Bank said, "some believe QE will sharply increase inflation rates; however, these fears are not consistent with economic theory and empirical evidence – assuming the Federal Reserve is both willing and able to reverse QE as the recovery gains momentum." The paper added that "if the public trusts that the increase in the monetary base QE creates is only temporary, then they will not expect rapid inflation in the near future. These expectations collectively influence actual pricing behavior and, in turn, actual inflation." The Federal Reserve could ensure that commercial banks do not lend out excess reserves by paying interest on their reserves at the Fed, so that the return commercial banks receive on them is greater than they could receive from alternative uses. Finally, in the case of the coin, the Federal Reserve could also sterilize the government's spending of the coin by selling other assets from its balance sheet on a dollar-for-dollar basis, in which case the effect on the monetary base should net to zero. If the debt ceiling were lifted, the Treasury could use borrowing to buy the coin back from the Federal Reserve and return it to the Mint to be melted.

Independence of the Federal Reserve

Although the Federal Reserve had already indicated on December 12, 2012, that it wished to expand its balance sheet by another $1.02 trillion throughout 2013 via its ongoing purchases of U.S. Treasuries and government-sponsored mortgage-backed securities, Greg Ip has argued that if the Fed's balance sheet were expanded for ostensibly fiscal policy reasons instead of monetary policy reasons, that could constitute an imposition on the independence of the central bank. Ip suggested that any such imposition could be avoided if the additional trillion in coinage were issued directly to the public (in more useful smaller denominations) instead of deposited with the Fed. In May 2010, there was $40.4 billion in coin in circulation and about another $900 billion in banknotes.

Former U.S. Mint Director Edmund C. Moy voiced doubts to TheStreet.com about whether the Federal Reserve could buy the coin, noting also that under the current system for initiating orders for coinage, the order might have to be placed by the current Fed Chair, or by one of the 12 Presidents of the regional Federal Reserve Banks. Former Director Diehl disagreed with Moy concerning a platinum bullion coin but agreed with Moy that a platinum coin would be a problem for the Fed. Diehl reiterated his view that "I certainly think [minting a trillion-dollar coin] is inferior to raising or eliminating the [debt] limit, but it's far better than defaulting and suffering the consequences of doing so."

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