Tag: measles

Public Health vs. Civil Liberty-the Eternal Dilemma

The post examines the ongoing challenges public health during disease outbreaks like COVID-19, measles, and cyclosporiasis. We need to manage the tension between individual liberties and public health measures, highlighting the need for balance to effectively manage health crises .We don’t seem to handle these tension well.

updated July 26, 2026

I wrote this post at the height of the first year of the pandemic. It occurs to me that we are seeing new examples of this dilemma.

Measles cases in the United States are at the highest levels in 30 years due to relaxed requirements for measles vaccination in children. We have a Secretary of Health who minimizes the value of vaccination and doubts the opinion of immunization scientists and physicians. Many people now distrust expert advice.

(Some links to government websites on this blog, such as whitehouse.gov, cdc.gov, nih.gov, and others, have been deleted or updated since January 2025.)

The original post

Since the start of the pandemic, and 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 and never rose to pandemic proportions. But certain aspects of its presence in the United States mimic 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.

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 presidential candidates initially gave different responses, 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

Thank you for reading this post. Please follow this blog and me on social media.

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Dr. Aletha
before you leave you may enjoy

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.

Pandemic: Tracking Contagions, from Cholera to Ebola and Beyond-a book review

Author Sonia Shah’s book “Pandemic” explores infection spread and urges awareness of infectious diseases, emphasizing the importance of vaccinations amidst rising global health threats. This post reviews this informative book.

Influenza has arrived in the United States with some areas already experiencing epidemics. We pretty much expect this to happen in the winter despite wide availability of influenza vaccine.

But other diseases that haven’t been seen much in the past 20 years are making a comeback all over the world. The number of measles cases continues to climb, with 5 countries accounting for half of the world’s victims- Congo, Liberia, Madagascar, Somalia and Ukraine.

In 2019 the United States almost lost its measles elimination status because of a nearly year-long measles outbreak in New York, with the greatest number of measles cases since 1992. The New York State Department of Health declared the outbreak over in October, and the Centers for Disease Control and Prevention announced it would maintain the country’s elimination status.

And in a part of the world that conjures up images of a tropical island with sunny skies and pristine beaches, Samoan children are dying of measles due to increasingly low vaccination levels, currently only 31%. Over 5,100 measles cases have been reported since the outbreak, with 74 recorded in a recent 24-hour period alone, according to Samoa’s government. 

The low vaccination rate this year was caused in part by distrust of vaccinations that spread last year after two infants died after a vaccine error- nurses incorrectly mixed vaccines with another medicine. The accident compounded the worldwide spread of misinformation about vaccines. 

The anti-vaccination movement made the list of the World Health Organization’s top threats to global health in 2019. 

CBS NEWS

I don’t know if anyone has suggested it , but it seems we may be entering a pandemic of measles. Here is a review of a book explaining what that means.

Pandemic by Sonia Shah

Sonia Shah , a science journalist, has built a career  writing about medical science. She explains the “what”  of her book in the subtitle-

Tracking contagions from cholera, to Ebola, and beyond

And she answers the “why” in the introduction-

“By telling the stories of new pathogens through the lens of a historical pandemic, I could show both how new pathogens emerge and spread, and how a pathogen that had used the same pathways had already caused a pandemic.”

Let me back up and define some terms.

Pathogen– any disease producing agent, but especially referring to a living  microscopic organism, such as a virus, bacteria, or  parasite; this includes the organisms that cause Lyme disease, Ebola, West Nile, HIV, bird flu, even the common cold

Epidemic– the rapid spread of infectious disease to a large number of people in a given population within a short period of time, usually two weeks or less.

Pandemic– a disease outbreak that spreads throughout a country, continent, or the world, as opposed to an epidemic, which is localized.

map of the world
In a pandemic, an infectious disease may spread all around the world.

Why infectious disease still matters

With healthcare focus on chronic diseases like heart disease, diabetes, cancer, and dementia, even physicians can get lulled into thinking that infectious disease has been conquered and no long a serious medical threat. This book reminded me that is not the case.

Ms. Shah recounts the history of cholera, which has caused epidemics on every continent except Antarctica, focussing on the epidemics which devastated London, New York City, and more recently Haiti.

Cholera is rare in the United States now, but in the past it has been deadly here and throughout the world. Cholera, an infection due to a bacteria Vibrio cholerae causes severe uncontrollable diarrhea which quickly renders its victims helpless, dehydrated and critically ill. The bacteria lives in and is spread by contaminated water, but for many years physicians did not know this; and even when some doctors recognized this, others refused to believe it. Thus the opportunity to control it and prevent thousands of deaths was delayed .

bacteria under the microscope
photo of the Vibrio cholera bacteria under a microscope; used courtesy of CDC/ Dr. William A. Clark

how disease spreads

The author explains how cholera and other infectious diseases cause so much human suffering by detailing “How disease spreads” in these  chapter titles.

Locomotion– Humans and pathogens travelling from place to place spreads disease.

Filth-Waste management and in some cases mis-management, leads to contamination of drinking water by human waste.

Crowds-People living in crowded slums creates perfect conditions to spread disease person to person.

Corruption– Public officials and business people who place profit and power above public health.

Blame No one willing to take responsibility for making hard choices, and too willing to blame someone else.

Ms. Shah uses examples from her personal life, like her annual family trips to India to visit relatives who lived in less than clean and sanitary neighborhoods. She also shares her and her sons’ battle with skin infections due to  MRSA, a form of staph (staphylococcal) that is resistant to many antibiotics and can be difficult to eradicate.

Pandemic includes extensive footnotes and a glossary of terms used in the book.

If you like history, current events, medical science, or just want to be more knowledgeable about why we should be concerned about infections , antibiotic resistance and vaccine phobia, you should read this book.

Here are other resources about how infections spread and how they can be stopped

For a visual lesson on how pandemics occur, watch this video.Warning: it is rather graphic. 

“How Pandemics Spread”

created by Mark Honigsbaum and animated by Patrick Blower 

 

When Germs Travel: Six major epidemics that have invaded America since 1900 and the fears they have unleashed

by Howard Markel

“Medical historian and pediatrician Howard Markel, author of Quarantine! tells the story of six epidemics that broke out during the two great waves of immigration to the United States—from 1880 through 1924, and from 1965 to the present—and shows how federal legislation closed the gates to newcomers for almost forty-one years out of fear that these new people would alter the social, political, economic, and even genetic face of the nation.”  (quote from Goodreads)

 At this link read how Dr. Gretchen LaSalle

blows the whistle on anti-vax false claims

an excerpt-

“Vaccines are recommended for personal health and required for the greater good. To protect those who can’t be vaccinated and to preserve the health of our communities, many vaccines are required for school entry. If you choose to participate in the community (ie, attend school), you have a duty not to harm those you come into contact with. And if you can’t make that decision for yourself, sometimes the states have to step in and make that decision for you. But still, you always have the choice to keep your kids out of school. The consequence for you is that you are now in charge of educating your own children. The consequence for your child is that their health is at risk and they are deprived of socialization and interaction with their peers. But, hey. You always have a choice! “

exploring the HEART of preventing disease

Thank you for reading this post. Please follow this blog and me on social media.

I share information and inspiration to help you transform challenges into opportunities for learning and growth.

Add your name to the subscribe box to be notified of new posts by email. Click the link to read the post and browse other content. It’s that simple. No spam.

I enjoy seeing who is new to Watercress Words. When you subscribe, I will visit your blog or website. Thanks and see you next time.

Dr. Aletha