A group of over 450 public health experts signed a public letter last week warning that widespread transmission of the Covid-19 coronavirus within the United States is “inevitable.” Their letter urges government decisionmakers to enact policies that will have the best chance of minimizing the effects of the virus: those based strictly on the best available scientific information, and those that are imposed in a fair and equitable fashion.
It is essential that all government officials follow these experts’ recommendations to help ensure a response plan that protects the health, safety, and civil liberties of all.
At the American Civil Liberties Union (ACLU), we have always recognized that, during a disease outbreak, individual rights must sometimes give way to the greater good. After all, when it comes to disease, we are not just individuals but also one big bio-mass. That is why people can sometimes be deprived of their liberty through quarantine, for example. And this is as it should be, provided — and this is a crucial and sometimes violated condition — that the science supports the effectiveness and proportionality of measures such as quarantine. And even if a quarantine is imposed, people do not lose their due process rights, which at a minimum require that they be able to challenge their quarantine.
While an office worker who is starting to feel ill may be able to self-isolate, someone in a more precarious situation may calculate the different risks they face in their life and conclude their only option is to hide their condition and head to work. A disease does not care whose employers offer good sick leave.
The public health experts remind us in their letter that there is a flip side to the limits on liberty, however. Just as a disease cares little for our notions of individualism — as crucial as they are to our happiness in other contexts — neither does it care about other artifacts of our individualistic society, such as differences in wealth, status, ethnicity, or immigration status. If the authorities want to be effective in limiting the transmission of this virus, they will need to pay particular attention to the most vulnerable people in our society.
A disease does not care who has health insurance, for example. You may have the best insurance in the world, but if 30 million others who are part of your bio-mass are not getting tested or treated because they lack insurance, that will increase your risk. Similarly, if members of immigrant communities fear they’re going to fall into the hands of an ICE officer if they seek treatment, that is a public health problem for all of us. A disease does not care who is undocumented.
In their letter, the public health experts call for officials to work with insurance companies to make sure that lack of insurance and high costs do not become a barrier to testing and treatment. They call for health care facilities to be declared as “immigration enforcement-free zones” — a step that has been taken before during hurricanes and other emergencies. And they call for extra help to be provided to under-resourced front-line hospitals and community health centers, which need more help than wealthy institutions in acquiring materials and equipment.
The experts draw attention to the need to support minimum-wage workers and others who live on the economic margins, cannot telecommute, and cannot afford to lose their job. While an office worker who is starting to feel ill may be able to self-isolate, someone in a more precarious situation may calculate the different risks they face in their life and conclude their only option is to hide their condition and head to work. A disease does not care whose employers offer good sick leave.
The experts also stress the importance of the free flow of information, stressing that “honest, transparent and timely reporting of developments will be crucial to maintaining public trust and cooperation.” Political leaders need to scrupulously ensure that their public messages are accurate and guided by science. There is a sad history of responses to emergencies that are hindered by politics, including China’s response to the SARS outbreak, China’s attempts to repress information about this outbreak, and, as millions of viewers have seen in the recent HBO series, the Soviet government’s response to the Chernobyl disaster. Open government is effective government.
Finally, the experts echo some of the longstanding lessons of their field: Voluntary self-isolation measures are more likely to induce cooperation — and therefore be effective — than coercive measures. Mandatory restrictions such as quarantines and travel bans “can be effective only under specific circumstances” and “must be guided by science, with appropriate protection of the rights of those impacted.” Those rights include due process rights to appeal confinement and the right to legal counsel. While leaders in outbreaks can be tempted to impose draconian measures as a show of strength, the letter’s signers also remind us that a disease also does not care how tough a leader looks.
The ACLU will be watching closely to make sure the government heeds these experts’ recommendations, and that its response is scientifically justified and no more intrusive on civil liberties than absolutely necessary.
Jay Stanley is a Senior Policy Analyst with the American Civil Liberties Union.
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