Part 3 of our COVID-19 Transition series coming at you! Next up is a deeper dive on social distancing policies and individual liberties.
As many Americans enter their 3rd month of lockdown and restrictions on social behavior, the energy to push back on these guidelines has swelled to protests, outrage, and outright defiance of expert recommendations. For some, it’s been about getting back to work to make money to support their families. For some, it’s been about getting haircuts and tattoos. But for many people, the argument has shifted to become about infringing on individual liberties - “It’s a free country. The government can’t tell me what to do.” What many of these people don’t realize is…it can, and this has been upheld at the highest levels of federal law. There’s a difficult balance to be struck between the rights of individuals and public safety, and we rely on the government to appropriately exercise this infringement when it’s in our best interests as a society.
The strongest evidence for this is in an ethical/legal discussion. Let’s take it back to 1905 when the Supreme Court ruled in support of compulsory vaccination for smallpox. The majority opinion’s justification was to defend the rights of the community to protect itself from infectious disease over the individual’s right to decline vaccination. In this circumstance, the court rejected the claim to individual liberties when at the expense of public safety. Crucially, however, this rejection was further specified to be appropriate only if there was “real or substantial relation” to protecting public health (read more here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1449224/).
I think most people would agree that if social distancing was demonstrably ineffective in providing substantial relation to protecting public health, it would be appropriate to go about business as usual with an expectation of loss of life. The point of contention now is that the best evidence that we have suggests that social distancing - including quarantining, school closings, avoiding crowds and restricting movement - has been effective. In countries like South Korea, it is thought to be largely credited for the superior control of viral spread. If you have a known societal tool to save lives, and you don’t use it, some may consider it negligent. Although limited, the data currently available has moved the Centre for Evidence-Based Medicine from the University of Oxford to put their support behind social distancing measures. You can read their detailed analysis of the current body of evidence here: (https://www.cebm.net/wp-content/uploads/2020/03/What-is-the-evidence-for-social-distancing-during-global-pandemics-final-1.pdf)
Many details related to the optimal breadth and magnitude of the extent of social distancing measures are, admittedly, currently unknown. Unfortunately, there is just not enough high-quality evidence available to address this level of depth. Efforts are currently underway from the City University of New York Institute for Implementation Science in Population Health in a 6-month study to figure out if what we’re doing is working, and if so, which components are the most effective. But until then, we can’t let “perfect” be the enemy of “good”. Social distancing has been shown to be effective at limiting the propagation of the virus. Overall, in ideal conditions, the consideration comes down to: Nobody wants to deny liberties. Everybody wants to save lives. For now, we need to support the rights of communities to protect themselves through employing social distancing measures when appropriate. Remaining thoughtful about the skillful timing of our efforts moving forward, it is likely that a middle ground will more safely emerge as a viable option to limit violations of individual liberties if we invest in our public health systems, support our scientists, and follow the data.