LOCK 'EM UP
03 May 2003
Source: New York Times, May 2, 2003
Lock 'Em Up
By NICHOLAS D. KRISTOF
Right after returning from covering the war in Congo five years ago, around the time of an Ebola outbreak there, I abruptly broke into the shakes and a high fever one night. I was living in Tokyo, so a Japanese friend helpfully called the health authorities and asked what to do with a foreigner who had just emerged from the central African jungle with a high fever.
Ten minutes later, I heard the sirens approaching my apartment. Then there was a pounding at the door, and a team of men looking like space invaders in bioprotection suits came to take the Ebola patient away.
Good for them!
In my case it was just malaria. But a lesson of the SARS outbreak is that we in the United States need to compromise on civil liberties to confront health risks more effectively.
After 9/11, the Bush administration wisely pushed a Model Emergency Health Powers Act as a template for legislation by the states. Such legislation would permit governors to respond to health crises with a state of emergency in which they could impose quarantines, order vaccinations and the destruction of dangerous property, limit people's movements and ration medicine, and seize anything from dead bodies to private hospitals. The steps are tough and sobering, but would apply only in desperate circumstances and within safeguards. So far only 22 states have passed this kind of law, and California, New York and Texas have all spurned it.
One main obstacle has been shrieks of protest by civil libertarians, whom I'm usually sympathetic to — but not this time.
"In a smallpox attack, you're talking about a weapon of mass destruction," notes Keith Richman, a Republican doctor in the California Assembly and sponsor of the law there. "The ability of the public health system to respond in an emergency will determine how many hundreds of thousands of lives you save."
A smallpox attack is, I hope, very unlikely. But who knows? The spooks thought Iraq might have the smallpox virus, in which case it could now turn up anywhere, and North Korea may also possess it. A U.S. simulation called Dark Winter suggested that a smallpox attack could quickly leave one million Americans dead and the nation in complete chaos.
Aside from terrorism, 30 new diseases have popped up in the last quarter-century, from avian flu to AIDS. This is an age of global disease, when viruses flit across continents.
In the SARS outbreak, New York forcibly quarantined a man suspected of having the disease after he refused to isolate himself. That's a real breach of liberty, but suppose he had been an irresponsible superspreader like Typhoid Mary and caused the disease to spin out of control?
Consider Hong Kong and Singapore in the SARS outbreak. Hong Kong reacted to the disease much as America would have. Meanwhile, Singapore required visitors from any country with SARS to pass through a thermal scanner that flagged anyone with a temperature over 100 degrees; such people were forcibly quarantined for 10 days. Singapore's SARS patients were allowed no visitors, and schools were closed. And when a vegetable seller came down with the disease, all 2,400 people working in that market were forced into quarantine. While Hong Kong had five deaths yesterday, Singapore had none, and it appears to be over the hump.
I first encountered the dictatorial approach to public health in rural China, which combated leprosy much more effectively than democratic countries like India. Leprosy is so humiliating a disease that sufferers sometimes do not seek treatment, risking infecting others. So China instituted rewards — turn in a leper (even your spouse) for cash. This policy wiped out leprosy in China, and the Chinese are better off for it.
The American Civil Liberties Union argues that the model U.S. law "could have serious consequences for individuals' freedom, privacy and equality." That's right. But the alternative is to risk many, many deaths.
"I have very close ties to civil liberties," said Lawrence Gostin, a Georgetown University law professor who drafted the model legislation (and who used to serve on the national board of the A.C.L.U.). "But I think we've got the balance wrong, and we've forgotten the other important issue of public health."
If you disagree, how about if I visit your neighborhood the next time I'm back from an Ebola outbreak in Congo and feeling feverish?