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 this 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 where I also explore the HEART of health.

                              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.

National Doctors’ Day 2020- battling the COVID-19 pandemic

Doctors’ Day 2020 will be somber for not only U.S. doctors, but for physicians all over the world. This year we are all working together against the biggest medical foe any of us have ever faced- the novel coronavirus pandemic

National Doctors’ Day

Did you know there is a national day to honor physicians? In 1990, the U.S. Congress established a National Doctors’ Day, first celebrated on March 30, 1991.

The first Doctors’ Day observance was March 30, 1933, in Winder, Georgia. The idea came from a doctor’s wife, Eudora Brown Almond,  and the date was the anniversary of the first use of general anesthetic in surgery.

an electron microscope image of the coronavirus
used with permission, CDC.GOV

Doctors’ Day 2020

But Doctors’ Day 2020 will be somber for not only U.S. doctors, but for physicians all over the world. This year we are all working together against the toughest medical foe any of us have ever faced- the novel coronavirus pandemic.

March 30 is Doctors' Day

You may not have a chance to honor your doctor in person, but you can commit to doing your part to establish a trusting, respectful relationship with your doctors. It will be good for both of you.

a medical person holding a stethoscope

how to improve communication with your doctors-

Be open and honest about your medical history,lifestyle, and concerns. 

Sometimes patients leave out important information due to forgetting, thinking it’s not important, embarrassment, or fear. But that may be the very piece of data I need to pinpoint what’s wrong.

So tell the doctor

  1. If you can’t do something you’re asked to do
  2. If you can’t afford medication, tests, or treatment
  3. If you are afraid of a test or treatment
  4. If other doctors are caring for you
  5. Your social habits-alcohol use, smoking, sexual behavior

Learn more tips on talking with your doctor here-

How to talk to your doctor to improve your medical care a male doctor holding a tablet

Give details about your problem, explain what you feel

I find that patients often have difficulty describing how they feel. They may say they hurt, cough, itch or get short of breath, but give few details. Maybe because we use  text messaging with its brevity, abbreviations and emoticons. We have forgotten how to use descriptive words.

I don’t think we doctors expect our patients to always recite a rehearsed narrative  about “why I came to the doctor today.” But it does help if you come prepared to answer questions as specifically as possible.

You might try thinking about your problem using the PQRST mnemonic. It will help your doctor identify possible causes for your symptoms, and may also help you understand your problem and even suggest ways you can help yourself.

Find out what PQRST means at this post-

How to tell your doctor what’s wrong with you.

Female doctor looking at an xray
Recognize your doctors are people first

As physicians, our patients’ “social histories” help us understand factors in your life that impact your health -where you live, your job, your family, your hobbies . Besides that, we enjoy getting to know you, especially the things that make you and your life unique and interesting. That feeling can go both ways.

a woman in white coat with mask over mouth

Exchanging a few social words can make the encounter more satisfying for you and your doctor. Some of us will be more open about sharing our personal lives, and some subjects may be off limits. But I don’t think any of us will object to polite,  caring interest in our lives outside of medicine.  

You may cry when you read about a unique doctor-patient relationship in this post-

A simple way to help your doctor beat burnout

Finally, in honor of Doctors’ Day, meet some physicians with unique experiences to share, just a few of the many doctors who work tirelessly to share the HEART of health.

INTERNATIONAL HEALTHCARE

Dr. Kent Brantly awoke feeling ill- muscle aches, fever, sore throat, headache and nausea. As his condition progressively worsened to include difficulty breathing, he learned the cause of his illness- the Ebola virus. Having spent the past few weeks caring for patients caught up in the Ebola epidemic that swept Liberia in the spring of 2014, Dr. Brantly had contracted the disease himself, and would likely die, as almost all victims do.

Continue this story at-

Surviving Ebola, “Called for Life”- Dr. Kent Brantly

affiliate link

 DISASTER HEALTHCARE

When she applied for a position in New York City at the NYC Office of the Chief Medical Examiner (OCME), Dr. Judy Melinek never imagined that decision would plunge her into the nightmare of September 11, 2001. She was at the ME office that day when the Twin Towers were attacked and fell, killing thousands of people.

She and the other staff collaborated with the team of investigators who worked night and day identifying remains of the victims, a task she vividly describes in the book. This was basically their only job, since the cause of death was for the most part irrelevant, and impossible to determine. Sometimes they had only a small body part, as little as a finger, to extract DNA to identity a victim. Such identification was critical to bring closure to the families who lost loved ones, people who left for work that day, and never came home.

Read more about Dr. Melinek at this review of her book-

Working Stiff: Two Years, 262 Bodies, and The Making of a Medical Examiner- a review of words worth sharing

Meet the 91 year old still practicing physician, whose grandfather was a slave- Melissa Freeman, M.D.

Photos in this post are from the LIGHTSTOCK.COM collection, an affiliate link. Consider Lightstock for your photo and graphic needs. You will get quality media and help support the mission of this blog-to inform and inspire us all to discover the HEART of health.

exploring the HEART of dedicated physicians

Join me on Facebook March 30 through April 3 where I share stories about physicians past and present who share the HEART of health every day.

Thanks for following this blog. If you’re visiting, I would love for you to start following Watercress Words : use this 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 where I also explore the HEART of health.

                              Dr. Aletha