During this ‘anniversary’ of the coronavirus pandemic in the United States, I offer three vignettes. Draw as loose, or tight, connection as you like.
A Pandemic! Who’s in Charge?
Among my favorite webinars this year are the podcasts offered by the National Constitution Center, a non-partisan, non-profit organization dedicated to appreciating our constitution. Last March, Polly Price and Ed Richards, two experts in the history of quarantine addressed: Can state and federal governments require people to stay at home during the coronavirus pandemic?
The US Constitution is quiet on issues of pandemic and public health. Before air travel, disease spread slowly across land or sea. The term for our fundamental response to plague—quarantine—refers to port cities that mandated ships suspected of carrying plague to rest at harbor for forty days before unloading their cargo. Can you imagine that level of delay in our just-in-time system of global production and distribution? Plague raged through the world for hundreds of years, yet its severity varied over time and place. As a consequence, responding to pandemics has historically been a local matter. Accordingly, James Madison deferred public health issues to cities and states in our constitution.
Like many aspects of our hybrid Republic, there are quirks. The Federal government maintains jurisdiction of waterways that provide interstate transit; a role later extended to rail and truck traffic. Cities and states that impose quarantines at their borders must demonstrate real danger to impede interstate transit. However, once documented, federal rights bow to local quarantines.
A guiding precedent of the relationship among governmental entities during pandemic comes from my own city of Cambridge, MA. Back in 1902, Henning Jacobson, a Swedish immigrant who suffered a negative reaction to a childhood vaccine in his native country, refused to get the mandatory smallpox vaccine. (Massachusetts was one of 11 states at the time that allowed cities to impose mandatory vaccinations.) Pastor Jacobson appealed his fine and argued to the Supreme Court an invasion of his liberty. “No person should be required to receive a vaccination to which he objects.” The Supreme Court decided 7-2 (Massachusetts vs. Jacobson, 1905) in favor of the state: the rights of individual liberty could be curtailed for a demonstrated public good. As a result, cities and states maintained broad police powers during pandemics; Pastor Jacobson was out five bucks; and the anti-vax movement was born. Since 1908, the Anti-Vaccination League of America has been championing individual rights over scientifically proven collective benefit.
Public Health / Private Health
My favorite statistic of the 1900’s is this: Over the 20th century, the average life expectancy of an American increased by 25 years. An additional three months every year! I doubt the 21st century will deliver a proportionate increase, as American’s average life expectancy has actually been falling.
As an architect who spent much of the 1980’s and 90’s designing intensive care units, imaging centers, and operating suites, I know well the accolades bestowed on our technologically driven health care system. But the truth behind increased longevity lies elsewhere. MRI’s, stents, and laser surgery all enhance the prognosis for an individual patient’s life. But the tremendous growth in 20th century life expectancy is due to simpler, more broadly applied health measures: tenement laws that required access to light and air, clean water, social security, and mass vaccination.
In the 1970’s, healthcare spending began to grow much faster than inflation. It’s spiraled up ever since. Spending also shifted—in parallel with societal trends—towards individual benefit. Today, we spend over $11,000 per person on healthcare, 17.7% of our GNP. Yet less than 1% is directed towards public health. This may explain why the drug rep pushing metformin to the thirty million Americans with Type-2 diabetes makes top money; while folks working to change the food system that fosters the disease go begging. But it doesn’t explain why we continue to make such lop-sided, expensive choices. An obstinate streak of individualism over evidence accounts for that. Those who can afford it, get hip replacements and erectile dysfunction pills; while collective crises like contaminated water in Flint, MI; exposed sewerage in Lowndes County, AL; virulent gun violence; and rampant opioid addiction rage on.
Just as public health measures increased longevity during the twentieth century, our lack thereof chips away at our collective lifespan today. And leaves us unprepared, in stockpiles as well as in empathy, to address a collective challenge like coronavirus.
The Voice of Truth
Like many, I’ve spent hours listening and reading stories of pandemic. “Ugh, another tale of pain and death,” I think as a Reveal program about a doctor in Fresno, CA comes on the radio. But following Dr. Paloma Marin-Nevarez during her COVID-drenched first-year residency is a powerful tale. Her insights are the most relevant I’ve heard.
Early on, the ‘Hero’ signs that greet this fresh doctor coming to work make her uneasy. “I don’t feel like a hero. That’s not me. I’m not doing the impossible.”
Eight months later, the interviewer asks a more confident and seasoned Dr. Marin-Nevarez to reflect on being called a hero:
“This pandemic was a catastrophic failure. There almost 400,000 people who are dead in this country because we expect that the job of taking care of others lies only in those who get paid to do so. And by calling other people heroes, we are separating ourselves from that job.
“What if every single person had seen themselves as a hero, and had said ‘no’ to traveling during the holidays. Or had said, ’no’ to throwing a wedding during a pandemic, or had said ‘no’ to having a party or to have get together. Or to give something up.
“What if everyone had thought…‘it is also my job to take care of others’…By calling healthcare workers heroes we let ourselves off the hook. We absolve ourselves of what we could have done to protect each other.”
James Madison, a drug rep, and a Hispanic resident walk into a bar. One brings a delicately balanced governmental structure that allows for collective collaboration—or can easily be contorted to confuse and mislead. One is flush from giving individuals the exact relief they seek—he’s buying this round. The third bears the burden of folks so rich and so powerful for so long they simply outsource any responsibility for their fellow human—and deduct it from their taxes.
The punchline of the joke? Over half-a-million dead…and counting.
The Awkward Pose 
I never knew about Pastor Jacobson and the ruling in his case. Thanks for educating me.
I was surprised to listen to the podcast and find the origins of anti-vaxing lies in my own home town! As always, thanks for reading and I appreciate your comments.