Public Health and the Libertarian Urge

Covid may have ruined everything

A sidewalk reminder to distance.

A Covid warning in Paterson - at a National Park Site

This piece was triggered by RFK Jr. as he assembled a panel of crackpots to unravel decades of consensus on vaccines. Thus we went from the triumph of Western medicine with the quick development of a successful Covid vaccine to the beginning of what promises to be the great unraveling.

How did this happen?

Vaccines, clean water and sewage treatment are all part what we can label as public health. The maintenance of public health includes constraints on personal freedom. We see this with seatbelt laws, or rules against using a cell phone while driving. Most of us will chafe at some of the rules, but we are better off as a society when we all cooperate. So we are better off when restaurant workers wash their hands after using the rest room. Or when they wear a hair net and use plastic gloves.

We are also better off when most of us are vaccinated.

Chafing is ok, and for most adults, we recover our composure and move on, but for some the very notion of being personally compelled to do anything is repellant. This reflects a libertarian streak that is as old as the Republic. The Gadsden flag with a rattle snake and the slogan Don’t Treat on Me sums it up pretty well.

The Gladsden Flag

Working in opposition to libertarianism is the desire to form a community and so to work together for the common good. This trend is also ancient and so goes back to the Puritans in New England. Think of New England town meetings - often conducted in meeting houses (churches). It has its own symbol - Ben Franklin’s image of a snake cut into piece with its slogan, unite or die. His adopted home of Philadelphia was a model of civic cooperation with many house of worship, a college (now the University of Pennsylvania) a hospital and fire companies.

Ben Franklin’s motto

The independent spirit may have been useful on the frontier but when the US began its period of rapid industrial development after the Civil War, towns realized they needed common institutions from public schools, libraries, hospitals as well as city water and sewers. Public high schools were built as grand structures and represented civic pride.

In recent decades the communitarian spirit has begun to lose out to a reinvigorated libertarian streak.

Covid may have tipped to balance.

When Covid emerged we knew little about it - there was no set treatment, nor did we know how it spread. Sadly it turned out asymptomatic persons could spread disease and the disease could be spread by airborne particles. In the US, the CDC was obliged to issue guidance based on best guesses. With the spread rapid and patients dying, It was a time for panic.

At first there was much focus on sanitizing surfaces. Less on face masks, though that soon changed. Public gatherings were cancelled. Churches closed. One of the first groups to be infected and have many die were in a choir in the West Coast. I am a member of a choir in NJ and we stopped meeting in mid March 2020.

Schools, restaurants and much commerce was put on hold. For those like me who could work from home, we did. But for others, if their work was essential they continued to work. For others - it was a lousy year.

Vaccines emerged at the end of 2020 (a triumph) and by the middle of 2021, the epidemic began to come under control.

If this was the whole story, the Covid year might be seen as a public health success. But politics made a mess of things.

Savvy politicians took the libertarian point of view and did their best to discourage citizens from using masks or from having businesses shut down. Some even encouraged attendance at crowded events. When the vaccines became available, they discouraged that too.

And who can forget the Governor of Florida who attacked cruise lines that demanded that customers be vaccinated. Bizarre stuff.

It easy to question medical recommendations. An example is with vaccines itself - they are not 100% effective nor is it always clear how long immunity will last. And in truth, we don’t need everyone to be vaccinated - but we need most. So for vaccines to work we need over 90% compliance. There was a time when vaccines were not questioned at all (like when the polio vaccine was released) but now there are questions galore - from religious communities, from worried mothers, and from onerous libertarians who wanted to be left alone. So measles are back. Two cheers?

While medicine is based on science, treatment is often set by a template. Let’s use the example of cholesterol. My total cholesterol has never been above 170, and for most patients, that is all one needs to know, but at my age and with high blood pressure (well controlled) my doctor worried about an LDL level above 70. So I take a statin. Whether I take the statin only impacts me. But when the issue is public health - sorry we all need to pull together.

What is especially sad is to see the press publishing stories about the disease that reinterpret the past with knowledge that we would eventually get a vaccine and so the pandemic would end. With hind sight, the initial decisions are presented as folly.

But were they? I remember the fear - so folks in my local Shop Rite scared to death to move closer than 6 feet from the next customer at the checkout. And I remember parents afraid to let their kids play with anyone.

Was it ok to close schools. Of course it was. And the next time we have a pandemic - well who knows. We can learn from what we did - but useful lessons are relatively few, except that some politicians will take advantage of the chaos. And we knew that they did that already.

The real bottom line is that if we have a pandemic again, we will go through much of what we did with Covid until we gradually learn what we are dealing with. We may even close the schools.

And the same stupidity will likely repeat itself.