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.

from 1776 to 2020-a vision for a “more perfect Union”

The United States’ healthcare system combines public health efforts with mostly private delivery of health care. Usually they coexist side by side with some but infrequent interaction. The public health emergency created by the pandemic forced them into a “union” that quickly became politicized, and unfortunately diminished the effectiveness of the response.

In ophthalmology, visual acuity is measured by the distance one can see compared to “normal”. 20/80 vision means at 20 feet you only see what a normal vision person can see from 80 feet. Perfect vision is labeled 20/20.

Maybe you expected 2020 to be a perfect year. I didn’t expect perfection, but I hoped it would be better than last year, when my husband and I spent 8 months mostly homebound while he recovered from a devastating ankle fracture.

But instead this year has brought

  • a contentious presidential election and an unexpected serious pandemic
  • peaceful protests and raucous riots
  • racism confrontations and reconciliation pursuits
  • health inequities battles and healthy community pursuits
Statue of Liberty
Lady Liberty lifting her torch in New York harbor
Independence Day 2020

Every year on July 4th the United States celebrates Independence Day- the day in 1776 the original 13 American colonies established an independent country.

A few years later they established a government as specified in the Constitution of the United States, to “form a more perfect Union”.

The United States Constitution

The Constitution does not specifically mention, establish, create, or endorse a healthcare system. Some phrases in the Preamble hint at it though-

  • establish Justice
  • insure domestic Tranquility
  • provide for the common defense
  • promote the general Welfare

Government sponsored health care programs

The Affordable Care Act, aka Obamacare

The  United States Congress passed the Patient Protection and Affordable Care Act (ACA) in 2010 to guarantee basic health insurance to all citizens.  During the last presidential campaign, President Trump vowed to “repeal and replace” this law but although it has been modified, it is still in place.

Healthcare for military service members, veterans ,and their families

During the American Revolution the fledgling government extended health care benefits to the soldiers and veterans of that war; that system evolved into the current Department of Defense military health care system which covers service members and the Veterans’ Administration system for veterans.

a Veterans Administration clinic
a Veterans Administration clinic (photo by Dr. Aletha)
American soldiers serving in Afghanistan
American soldiers serving in Afghanistan
Medicare and Medicaid

Two other government healthcare programs- Medicare and Medicaid are over 50 years old. 

Medicaid provides insurance coverage for adults and children who are unemployed or low income.  

Medicare covers disabled children and adults  and persons 65 years and older.

ELDERLY COUPLE -189282_1280
Senior adults age 65 and older use Medicare.

Department of Health and Human Services

Most of the health care activities of the federal government fall under the agencies of the Department of Health and Human Services or HHS. The Secretary of HHS serves in the President’s Cabinet.

Due to the COVID-19 pandemic, we’ve heard more about the HHS in the news than usual; maybe you’ve never heard of these agencies. Generally, management of a pandemic or other public health emergency falls within the work of the CDC.

Centers for Disease Control and Prevention

The CDC’s mission is simple but encompasses many facets of health

“to work 24/7 to protect America from health, safety and security threats, both foreign and in the U.S.”

The CDC website devotes an entire section now to information, guidelines, and news about the SARS-CoV-2 virus and COVID-19.

illustration showing the coronavirus which causes COVID-19

The goal of public health is to avoid or prevent health threats from becoming public health emergencies, like the COVID-19 pandemic. If they accomplish the mission, we hardly notice. But when an outbreak occurs, their work suddenly becomes visible, scrutinized, and debated.

The CDC director, Dr. Robert Redfield, spoke to Congress soon after the pandemic started, and his assessment of the response and funding for it were not positive. Lack of funding hampered the federal government’s response to the coronavirus outbreak, he told lawmakers on March 10, 2020.

“The truth is we’ve underinvested in the public health labs,There’s not enough equipment, there’s not enough people, there’s not enough internal capacity, there’s no search capacity”

Dr. Robert Redfield, Director, CDC

The Trump administration subsequently enlisted private companies to help cut the difference. The CDC partnered with Integrated DNA Technologies to manufacture the tests under a CDC contract. IDT partnered with commercial labs, including LabCorp and Quest, for the testing.

This was reported at CNBC. at the following link.

Coronavirus testing delays caused by lack of funding for public health labs

National Institutes of HealthNIH

The National Institutes of Health, part of the Public Health Service,

  • supports biomedical and behavioral research with the United States and abroad,
  • conducts research in its own laboratories and clinics,
  • trains promising young researchers, and
  • promotes collecting and sharing medical knowledge.

And within the NIH is the NIAID– the National Institutes of Allergy and Infectious Diseases, which has been an invaluable source of guidance as the United States and the world works to understand and manage this new infectious disease.

Strategic Plan for COVID-19 RESEARCH

  1. Improve fundamental knowledge of SARS-CoV-2 and COVID-19
  2. Support the development of diagnostics and assays
  3. Characterize and test therapeutics
  4. Develop safe and effective vaccines against SARS-Cov-2

Read the full report at the link.

President Donald Trump Visits NIH
President Donald Trump visited NIH on March 3, 2020 and toured the National Institute of Allergy and Infectious Diseases’ Vaccine Research Center (VRC) to learn about research on a vaccine for the novel coronavirus SARS-CoV-2. From left: VRC Deputy Director Dr. Barney Graham, NIH Director Dr. Francis Collins, VRC Director John Mascola, Department of Health and Human Services Secretary Alex Azar, President Trump, and VRC Research Fellow Dr. Kizzmekia Corbett.
credit NIH, public domain
Novel Coronavirus SARS-CoV-2
This scanning electron microscope image shows SARS-CoV-2 (orange)—also known as 2019-nCoV, the virus that causes COVID-19—isolated from a patient in the U.S., emerging from the surface of cells (green) cultured in the lab.
 
Credit: National Institute of Allergy and Infectious Diseases-Rocky Mountain Laboratories, NIH

Food and Drug Administration– FDA

The FDA joins the pandemic response by

  • reviewing and approving diagnostic tests for the coronavirus
  • protecting consumers from fraudulent products for COVID-19.
  • issuing Emergency Use Authorizations (EUAs) for ventilators
  • sampling and testing of respirators for importation

As of June 26 there are 153 currently authorized tests under EUAs; these include 129 molecular tests, 23 antibody tests, and 1 antigen test.

There are currently no FDA-approved products to prevent or treat COVID-19. Consumers concerned about COVID-19 should consult with their health care provider.

COVID-19 Diagnostic Test Attire
FDA Commissioned Corps officer RADM Estella Jones, DVM, OCET Deputy Director and Co-Chair of the FDA Animal Welfare Council, oversees Commissioned Corps officers as they practice proper fitting of protective items. Healthcare workers testing patients for COVID-19 novel coronavirus infection must wear specific protective gowns, gloves, ventilation masks, and full facial shields as shown, and must replace these items after each patient is tested. credit FDA, public domain

Occupational Safety and Health administration-OSHA

OSHA is part of the United States Department of Labor. OSHA’s administrator answers to the Secretary of Labor, who is a member of the cabinet of the President of the United States.

Congress created the Occupational Safety and Health Administration (OSHA) in 1970 to

ensure safe and healthful working conditions for working men and women by setting and enforcing standards and by providing training, outreach, education and assistance.

For the pandemic response, OSHA offers guidance on

  • returning to work
  • preparing workplaces for COVID-19
  • worker exposure risk to COVID-19
  • for specific industries including airlines, farms, retail, corrections
  • use of respiratory protection equipment

This page on the OSHA website explains the

key differences between cloth face coverings, surgical masks, and respirators.

important laws that administer and regulate both private and public healthcare.

The Affordable Care Act- ACA
Health Insurance Portability and Accountability Act-HIPPA
Emergency Medical Treatment and Labor Act- EMTALA
Americans with Disabilities Act-ADA
Family Medical Leave Act-FMLA
replica of the Liberty Bell at Disney World, Florida

Let Freedom Ring

In the Declaration of Independence, the founders of the United States created a nation based on the “self-evident truths”  of  “Life ,Liberty, and the pursuit of Happiness” and to promote “Safety and Happiness” . 

They didn’t mention “healthcare” either, maybe because in the late 1700s medical practice was more superstition than science.

Surgery was rudimentary due to no anesthesia and infections frequently proved deadly due to no antibiotics.

No one had even imagined, much less identified the human genome, and viral DNA-what was that??

I wonder if they intended their new government to spend so much time and money providing and regulating health care –most of which was not available or even imagined at that time? 

Public vs Private-not a perfect Union

The United States’ healthcare system combines public health efforts with mostly private delivery of health care. Usually they coexist side by side with some but infrequent interaction.

The public health emergency created by the pandemic forced them into a “union” that quickly became politicized, and unfortunately diminished the effectiveness of the response.

But despite the lack of coordination and cooperation between all levels of government and private citizens, our health care professionals, in both public health and private medical practice stayed true to their calling. Many risked their own lives to care for COVID-19 victims. Others sacrificed time and finances to lead the pandemic response in their communities and on social media- maybe not perfectly, but definitely UNITED in resolve to lead, help, and heal their fellow citizens through this unprecedented health emergency.

Let’s celebrate!

woman holding a sprakler
Let’s celebrate ! This photo and featured image from stock photo site- Lightstock.com (affiliate)

Sharing and celebrating the HEART of health

I appreciate all of you who follow this blog; there are numerous other blogs to choose from so I am honored you chose to spend some time here. A special welcome to all my new followers from this past month.

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 

a woman in a red, white, and blue shirt
Me, a few years ago, showing my patriotic spirit by posing in red, white, and blue

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