Security vs. Liberty-the Eternal Dilemma

we Americans have trouble re-calibrating our traditional (and laudable) devotion to individual rights and civil liberties. That is the fundamental reason we’ve been so slow in getting serious about a virus. quote Charles Krauthammer

Since the start of the pandemic, and especially since it has become so politicized and polarized, I have wondered what the late Dr. Charles Krauthammer might have written in his Washington Post column. For many years he commented on all things political, social, and occasionally medical, having left his psychiatric medical practice for a journalism career. As I searched my previous posts about him, I found reference to a piece discussing a situation similar to COVID-19-the Ebola epidemic of 2014.

sign which says EBOLA, "wash hands with soap"
this image depicts an illustrative sticker that had been produced by the United Nations Children’s Fund, or UNICEF, which emphasized the importance of handwashing in the battle against this viral disease. credit to CDC/ Dr. Heidi Soeters, public domain

In 2014 when an Ebola epidemic broke out in Africa, a Liberian man entered the United States, became ill, and presented to a hospital emergency room; before he was isolated, healthcare workers were exposed. He was eventually diagnosed with Ebola and a nurse became infected. It caused a public health scandal which was widely criticized.

Fortunately, although deadly, Ebola is not as casually transmitted as coronavirus (not respiratory born) and never rose to pandemic proportions. But certain aspects of its presence in the United States mimics an aspect of COVID-19 which is hotly debated-personal freedom vs the common good.

Dr. Krauthammer wrote a piece commenting on this. I am quoting a few key paragraphs that particularly apply to the COVID-19 crisis. In italics I have inserted words referring to the specifics of the 2020 pandemic.

man sitting in front of computer monitor at the CDC.
Centers for Disease Control and Prevention (CDC) activated its Emergency Operations Center (EOC) to assist public health partners in responding to the coronavirus disease 2019 (COVID-19) outbreak first identified in Wuhan, China.Credit James Gathany, Public domain
Coronavirus vs civil liberties (quoting Dr. Krauthammer, unless noted)

Unnervingly, the U.S. public health services remain steps behind the Ebola virus (Coronavirus). Contact tracing is what we do, Centers for Disease Control Director Tom Frieden (Robert Redfield) assured the nation. It will stop the epidemic “in its tracks.”

These missteps raise questions of competence, candor and false confidence. But the problem is deeper. And it rests not in our doctors but in ourselves.

In the face of a uniquely dangerous threat, we Americans have trouble re-calibrating our traditional (and laudable) devotion to individual rights and civil liberties. That is the fundamental reason we’ve been so slow in getting serious about Ebola (COVID-19). Consider:

Privacy

In normal circumstances, privacy deserves absolute respect. But these are not normal circumstances. We’re talking about a possible epidemic by an unseen pathogen that kills 70 percent of its victims. Contact tracing is the key to stopping it, we’ve been told. 

Note: As of June 23, 2020, in the United States, COVID-19 has caused death in

  • 0/1000 cases in children
  • 1-8/1000 cases in people 18-49 years old
  • 29/1000 cases in ages 50-64 years
  • 100-300/1000 cases in ages 65 years and older.
Quarantine

Quarantine is the ultimate violation of civil liberties. Having committed no crime, having done no wrong, you are sentenced to house arrest or banishment. It’s unfair. It’s, well, un-American. But when an epidemic threatens, we do it because we must.

(Note: Americans have been asked to quarantine if they have come in close contact with someone confirmed with COVID-19. If they have the infection, they must self isolate for at least 10 days. )

Evacuation

Training and equipping every hospital in America to treat this rare disease would be ridiculously expensive and 99 percent wasted. Every Ebola (COVID-19) patient should be evacuated to a specialized regional isolation center, such as the ones in Atlanta, Omaha or Bethesda.

(Note: With the large number of COVID-19 hospitalizations, it is impractical to treat all patients at isolation centers. However, their care requires a high level of medical sophistication only available at large medical centers by physicians, nurses, and other professionals trained in critical and intensive care. Such care can potentially overwhelm the medical system, making care of COVID-19 patients more difficult and making care of other critically ill patients less available.)

Travel bans

The CDC argues that a travel ban would stop the flow of medical assistance to West Africa. This is silly. Simply make an exception for health-care workers. They apply to federal authorities, who charter their flights (or use military aircraft already headed there) and monitor their movements until 21 days (14 days) after their return home.

(Note: Non-essential travel to China from the United States was banned soon after the onset of the COVID-19 pandemic, and travel to other parts of the world followed. Ironically in July of 2020, some countries banned entry of arrivals from the United States due to a surge in cases. Some states instituted quarantine requirements for visitors from other states to limit spread during the summer surge of cases. )

President Obama, in his messianic period, declared that choosing between security and liberty was a false choice. On the contrary. It is the eternal dilemma of every free society. Politics is the very process of finding some equilibrium between these two competing values.

Regarding terrorism, we’ve developed a fairly reasonable balance. But it took time. With Ebola (COVID-19), we don’t have time. Viruses don’t wait. The sooner we reset the balance — the sooner we get serious — the safer we will be.

Here is a link to his original article which I hope you will read.

Charles Krauthammer: Ebola vs civil liberties

Resetting the balance with COVID-19

To contain and “flatten the curve” of COVID-19 cases, American citizens have been asked to limit or even avoid many common activities; these restrictions have been met with resistance and outright defiance. These include

  • closing “non-essential” businesses
  • closing schools
  • closing religious institutions
  • closing entertainment venues
  • deferring private social gatherings
  • avoiding non-essential travel
  • maintaining “social distance” when in public
  • wearing face coverings in public and at home if ill
cloth facial coverings to prevent transmission of COVID-19

This last one, wearing face coverings to prevent the spread of coronavirus containing droplets, has at times been the most contentious among people, with some enthusiastically embracing their use and some rejecting.

Even the two candidates for President had different responses initially, with Mr. Trump refusing to wear one, while Mr. Biden did. (By mid July, Mr. Trump began wearing a mask and urged citizens to do so.)

We’re instead asking Americans to use masks, socially distance, and employ vigorous hygiene — wash your hands every chance you get — while sheltering high-risk populations.  We are imploring young Americans to avoid packed bars and other crowded indoor gatherings.  Be safe and be smart.

President Donald Trump, July 21, 2020

Some cities passed ordinances making masks mandatory, although some didn’t. By late July 2020 many major retailers including Walmart , Target, Costco, and CVS required customers to wear a face cover to enter their stores.

from the CDC website

Life vs Liberty

In 1776 when the American colonies threw off unjust English rule, the leaders declared independence based on the rights of

Life, Liberty, and the Pursuit of Happiness

The Declaration of Independence

But when Life is threatened by disease, Liberty may also be threatened- and it remains to be seen if the democratic government they established can save both .

exploring the HEART of health and freedom

Thanks for following this blog. If you’re visiting, I would love for you to start following Watercress Words : use the form to get an email notification of new posts. Don’t worry, you won’t get anything else from me. I also want you to find and follow me on Facebook, Pinterest , Instagram, and LinkedIn .

                              Dr. Aletha 

before you leave you may enjoy
at a baseball game, a player at bat

Dr. Charles Krauthammer- eternal Washington Nationals fan

When I read Charles Krauthammer book, Things That Matter, one of the most important things I learned wasn’t about politics, medicine, or ethics, subjects he knew well and wrote about often. I learned that he was a die hard Washington Nationals baseball fan.

Joe Biden’s Plan to Combat Coronavirus (COVID-19)

For this and a previous post I reviewed statements about the United States’ coronavirus pandemic response from the President candidates’ official campaign websites.

The year 2020 looked to be historic even prior to the coronavirus pandemic, police involved shootings, riots, and Black Lives Matter protests. The USA will choose the next president, impacting the economy, security, defense, education, and healthcare.

In two previous posts I reviewed the healthcare plans of each candidate-Republican incumbent President Donald Trump and Democratic challenger former Vice President Joe Biden.

In this and a previous post I review statements about the United States’ coronavirus pandemic response from the candidates’ official campaign websites. I encourage you to read the entire documents yourself by follow the links provided.

This post will review Mr. Biden’s page. You may want to review the previous post now, or after reading this one.

Joe Biden’s Plan for Healthcare

The sitting President heads the Executive Branch of the U.S. Government.

The Department of Health and Human Services through the President’s cabinet member head manages the response to COVID-19. Other Cabinet members and their Departments are involved as well.

The agencies most involved in the COVID-19 response include

  • Health and Human Services-HHS
  • Federal Emergency Management Agency-FEMA
  • Centers for Disease Control-CDC
  • National Institutes of Health-NIH
  • Federal Drug Administration-FDA
  • Small Business Administration-SBA
  • Veterans Administration-VA
  • Department of Defense -DOD
  • Treasury Department
  • State Department

The President leads the Executive Branch of the government, including all of the departments and agencies headed by the Cabinet members, including the Department of Health and Human Services.
THE BIDEN PLAN TO COMBAT CORONAVIRUS (COVID-19) AND PREPARE FOR FUTURE GLOBAL HEALTH THREATS

The American people deserve an urgent, robust, and professional response to the growing public health and economic crisis caused by the coronavirus (COVID-19) outbreak. That is why Joe Biden is outlining a plan to mount: 

  • A decisive public health response that ensures the wide availability of free testing; the elimination of all cost barriers to preventive care and treatment for COVID-19; the development of a vaccine; and the full deployment and operation of necessary supplies, personnel, and facilities.
  • A decisive economic response that starts with emergency paid leave for all those affected by the outbreak and gives all necessary help to workers, families, and small businesses that are hit hard by this crisis. 

Biden will be ready on Day One of his Administration to protect this country’s health and well-being. But he is not waiting until then to communicate his views on what must be done now to properly serve the American people. Biden believes the following steps must immediately be taken. If Trump does not take them, Biden will on Day One.

an electron microscope image of the coronavirus
the Coronavirus SARS-CoV-2, responsible for causing COVID-19- photo used with permission, CDC.GOV

December 31, 2019-China reports the coronavirus to WHO-the World Health Organization.

RESTORING TRUST, CREDIBILITY, AND COMMON PURPOSE 

We must immediately put scientists and public health leaders front and center in communication with the American people in order to provide regular guidance and deliver timely public health updates, including by immediately establishing daily, expert-led press briefings.

Ensure that public health decisions are made by public health professionals and not politicians

Immediately restore the White House National Security Council Directorate for Global Health Security and Biodefense, which was established by the Obama-Biden Administration 

MOUNTING AN EFFECTIVE NATIONAL EMERGENCY RESPONSE THAT SAVES LIVES, PROTECTS FRONTLINE WORKERS, AND MINIMIZES THE SPREAD OF COVID-19

Ensure that every person who needs a test can get one – and that testing for those who need it is free. 

Task all relevant federal agencies to take immediate action to ensure that America’s hospital capacity can meet the growing need

Prepare to stand up multi-hundred-bed temporary hospitals in any city on short notice

Expand CDC surveillance programs

Instruct the CDC to establish real-time dashboards tracking

  • (1) hospital admissions related to COVID-19, especially for ICUs and emergency departments, and
  • (2)supply chain information for essential equipment and personal protective equipment (PPE). 

Give all frontline workers high-quality and appropriate personal protective equipment . Issue guidance to states to prioritize first responders to receive PPE, and educate the public on reserving equipment for professionals. 

Ensure the National Institutes of Health (NIH) and the Biomedical Advanced Research and Development Authority are swiftly accelerating the development of rapid diagnostic tests, therapeutics and medicines, and vaccines. NIH must be responsible for the clinical trial networks and work closely with the U.S. Food and Drug Administration (FDA) on trial approvals.

Instruct the CDC to provide guidance and resources about containment and mitigation to schools, health care facilities, higher education, and school administrators, and the general public. 

Work with businesses to expand production of personal protective equipment, including masks and gloves, and additional products such as bleach and alcohol-based hand sanitizer.

Establish and fund a U.S. Public Health Service (PHS) Reserve Corps to expand medical and public health capacity. 

Expand staffing for the Adequate Fire and Emergency Response (SAFER) grant program for fire departments can increase staffing. As Vice President he secured an expansion of the SAFER Act. 

Increase federal resources to cover all necessary federal costs, and create a State and Local Emergency Fund to meet critical health and economic needs to combat this crisis 

ELIMINATING COST BARRIERS FOR PREVENTION OF AND CARE FOR COVID-19.

Amend the PHS Act to cover all testing, treatment, and preventive services necessary to address a public health emergency for an infectious disease. All commercial plans and public plans-Medicare, Medicaid, VA, etc- would be required to cover services. 

Fund and expand authority for the National Disaster Medical System (NDMS) to reimburse health care providers for COVID-19-related costs not covered by insurance.

Secure maximum Medicaid enrollment for currently eligible populations 

Provide explicit authority for the HHS Secretary to approve the commercial price of vaccines developed in conjunction with federally funded research

PURSUING DECISIVE ECONOMIC MEASURES TO HELP HARD-HIT WORKERS,FAMILIES, AND SMALL BUSINESSES AND TO STABILIZE THE AMERICAN ECONOMY 

The immediate economic measures in Biden’s plan include 

Comprehensive 12 weeks of paid family and medical leave envisioned in the FAMILY Act and 7 days of paid sick leave in the Healthy Families Act. The paid leave plan will cover 100% of weekly salaries or average weekly earnings up to $1400.00 weekly. 

Reimbursements to employers up to 14 days of paid sick leave, in addition to existing employer paid leave

Ensure unemployment benefits are available to those who would be denied due to rules that should not apply in a crisis 

Employment relief for reduced hours, work-sharing arrangements, domestic workers, caregivers, gig workers or independent contractors with reduced pay and hours 

Expanded food relief for hard-pressed families and children, creating a federal-state partnership to expand SNAP (Supplemental Nutrition Assistance Program) relief

Increase Federal Medical Assistance Percentage (FMAP) for the state administered Medicaid program 

Establish a temporary small and medium size loan program to address unanticipated shortfalls in revenue 

Support for child care and remote student learning by expanding assistance to federal child care enters and Title 1 schools 

Relief or forbearance of federal student loans and federally backed mortgages 

Protect union health funds

A state and local emergency fund for governors and mayors to respond to their communities’ needs including  

  • Mortgage and rental relief for impacted workers
  • Employer assistance for job maintenance
  • Interest free loans for small businesses 
  • Cash assistance or refundable tax relief

RALLYING THE WORLD TO CONFRONT THIS CRISIS WHILE LAYING THE FOUNDATION FOR THE FUTURE 

Direct the U.S. Agency for International Development (USAID) in coordination with the State Department, DOD, HHS, and the CDC, to mobilize an international response to assist vulnerable nations to address COVID-19

Empower the State Department to ensure the U.S. plays a major role in all global decisions about the outbreak

Create a Global Health Emergency Board to harmonize crisis response for vulnerable communities, ensuring a coordinated health and economic response globally

Bolster CDC and DOD’s disease detection and protections programs to protect America’s troops and deployed citizens, providing testing and treatment, and evacuation when necessary 

Expand the Global Health Security Agenda to mobilize the world against the threat of infectious diseases (established under the Obama-Biden administration)

Fully staff all federal agencies, task forces, and scientific and economic advisory groups focused on health security.

Build a global health security workforce by investing in the education of public health professionals, including the CDC’s training programs Fight climate change as a driver of health threats;  fully integrate climate change into our foreign policy and global health security

Exploring the HEART of health

Thanks for following this blog. If you’re visiting, I would love for you to start following Watercress Words : use the form to get an email notification of new posts. Don’t worry, you won’t get anything else from me. I also want you to find and follow me on Facebook, Pinterest , Instagram, and LinkedIn .

By following this blog, you’ll know when I post the additional pieces reviewing the COVID-19 pandemic as well as other topics that explore the HEART of health.

                              Dr. Aletha 

And please, register if you need to, and don’t neglect to vote in your upcoming primaries and on November 3.

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Please vote; it is our right and a privilege.