01 May 2009
The Q-Word
(Texas Public Health Card)
I am civil libertarian, no surprise, and that is at the heart of the debate on the matter of the Q-Word: forced Quarantine.
I don’t like being told what to do, and bristle at the signs of imposed authority. I respect the President for telling us to wash our hands and cover our mouths, though hairs start to stand up on the back of my neck. Helpful suggestions are good, but like a lot of people, I get wary when Uncle Sam, in the form of the Doctor-in-Chief, starts telling me what is good or bad for us.
Under Commissioner David Kessler, there was always the possibility that a paternal Food and Drug Administration would start acting like Mayor Blumberg in New York by fiat. Kessler wanted to start with second-hand smoke and move on to manage the nation’s cholesterol with the force of law.
In fairness, Kessler was appointed by the first Bush, but he really got rolling with swell ideas and the kindred spirits in the Clinton administration that re-appointed him to a second full term.
The Commissioner has the legal authority to take actions to protect the public health and has considerable power to make administrative changes without congressional action. That is one of the reasons I watch the second and third tier appointments in the departments with such interest. There is where the Nanny State lives.
The New Flu today, what next tomorrow? Whiskey and smokes? What other new Prohibition might be good for us?
I feel so strongly about the matter of liberty that I volunt arily surrendered many of my constitutional rights to the Uniform Code of Military Justice for more than a quarter century.
I think it was worthwhile, though like any decent Ponzi scheme, the maintenance of our basic civil rights requires new generations to make the same contribution. We’ll see how that goes.
The whole defense of the Constitution and Liberty is a paradox. In order to protect them, a whole class of people have to give them up.
I was still subject to the Uniform Code when I was working at Health and Human Services, and the Severe Acute Respiratory Syndrome virus was radiating out across the globe from Room 911 at the Metropole Hotel in Hong Kong.
It was in Toronto already, by the time the real nexus of the infection was traced back to Guandong Province in south-east China. The predilection to secrecy of the local Party officials contributed to cloak the spread, and without the full picture, early reports made SARS appear to have a mortality rate that was truly frightening.
A man was locked up, detained, in the transit area at JFK. People at the policy level began to breath the Q-word, like the local authorities did at the Amoy Garden apartment complex in Hong Kong where masked constables .
I told you this was all a paradox. In my military mind, the issue was quite straightforward: Quarantine works. Cut off contact, cut transmission.
In the great Spanish Flu pandemic of 1918-1919, Austr alia implemented a maritime quarantine that delayed the arrival of the disease for nearly three months after it had ravaged New Zealand, which did not.
The island of Tasmania off Australia’s southeastern shore managed to hold off the virus until August 1919, and when it did finally arrive, it was a milder, attenuated version of the pandemic that may have killed more than fifty million people worldwide. The death rate for Tasmania was one of the lowest recorded for any jurisdiction.
I was insensitive, of course, and not exactly for the first time. The Public Health community knew exactly the same thing, but reacted with alarm at the m ention of the Q-word.
What I did not understand was that something big had happened in between the Spanish Flu and SARS, another pandemic that was loaded with civil rights and public health baggage: AIDS.
I understood the issue, and I understand paradox. The logical step in stopping the transmission of a deadly virus is a rigorous process of sequester, public health reporting, and full transparency.
None of those things could happen in the context of an emergency that could not be described in a common language. AIDS was either a public health matter or a problematic issue in a fundamental struggle for liberation and personal rights.
Of course it was both, and in our inability to address both sides of a public health crisis, many people died who did not need to. The matter could have been addressed with the truth about transmission, coupled respect for individual liberty. But it was not.
I didn’t have any answers for the HIV crisis then, and don’t now. I did discover that doing the logical thing was not possible, any more than sealing the border with Mexico is now.
I know that the Administration has moved beyond all that. Vice President Biden honestly addressed the matter in an interview yesterday morning on the Today Show. Smokin’ Joe is at his best when he is relaxed and expansive.
He said it this way: "I would tell members of my family, and I have, I wouldn't go anywhere in confined places now ... If you're out in the middle of the field and someone sneezes, that's one thing. If you're in a closed aircraft, a closed container, a closed car, a closed classroom, that's another thing."
I definitely agree with him, from a public health perspective.
The Administration apparently did, too, since they heard immediately from the travel industry. The first person to be affected with the Q-word was the Vice President himself.
C2
I don’t think we will be seeing him out in public until the Administration thinks quarantine is no longer required to protect the public, and the New Flu has attenuated itself.
Maybe in August, in Tasmania.
Copyright 2009 Vic Socotra
www.vicsocotra.com