Sunday, June 7, 2020

Illegal & Unscientific

Caduceus as a symbol of medicine - Wikipedia

- You've finished reading. What's your response?
- I'm embarrassed, astonished. I'm relieved. All this time I've been trying to understand how the experts in this country could be so stupid. And you say all you did was enter into the search engine the phrase "quarantine the healthy"?
- Yes. The articles were right at the top of the page.
- The Journal of the American Medical Association. The New England Journal of Medicine.
- About as respectable as you can get in the world of medicine.
- Listen to this:
Compulsory public health powers should be evaluated and justified under a common legal and ethical standard, including (1) individuals must pose a significant risk of spreading a dangerous, infectious disease; (2) interventions must be likely to ameliorate risks; (3) least-restrictive means necessary to achieve public health objectives are required; (4) use of coercion should be proportionate to the risk; and (5) assessments must be based on the best available scientific evidence. In emerging crises when the science is uncertain, adoption of the “precautionary principle” is reasonable to ensure public safety. Yet, health emergencies do not warrant coercion that is indiscriminate, overbroad, excessive, or without evidentiary support.*
Although we are likely to see greater use of robust social distancing measures, such as school closures or the cancellation of public meetings, broad sanitary cordons — in which geographic areas are quarantined — would raise serious constitutional questions. They also can present numerous logistical challenges and can increase the risk to those living in the restricted zone. Such measures may also have limited efficacy with a highly contagious disease such as Covid-19.**
Mandatory quarantine, regional lockdowns, and travel bans have been used to address the risk of COVID-19 in the US and abroad. But they are difficult to implement, can undermine public trust, have large societal costs and, importantly, disproportionately affect the most vulnerable segments in our communities. Such measures can be effective only under specific circumstances. All such measures must be guided by science, with appropriate protection of the rights of those impacted. Infringements on liberties need to be proportional to the risk presented by those affected, scientifically sound, transparent to the public, least restrictive means to protect public health, and regularly revisited to ensure that they are still needed as the epidemic evolves.  Voluntary self-isolation measures are more likely to induce cooperation and protect public trust than coercive measures, and are more likely to prevent attempts to avoid contact with the healthcare system. For mandatory quarantines to be effective and therefore scientifically and legally justified, three main criteria must be satisfied: 1) the disease has to be transmissible in its presymptomatic or early symptomatic stages; 2) those who may have been exposed to COVID-19 must be able to be efficiently and effectively identified; and 3) those people must comply with the conditions of quarantine. There is evidence that COVID-19 is transmitted in its pre-symptomatic or early symptomatic stages. However, the contribution of infected individuals in their pre-symptomatic or early symptomatic stages to overall transmission is unknown. Efficiently identifying those exposed will be increasingly difficult as community transmission of the virus becomes more widespread, making quarantine a less plausible measure as community spread proceeds. Whether individuals can comply will be determined by the degree of support provided, particularly for low-wage workers and other vulnerable communities. While quarantines are in effect in many places already, their continuing and new use by federal, state or local officials requires real-time assessment and evaluation to justify them as the science and the outbreak evolve, through a transparent, open decision making process including external scientific and legal experts.***
- You hadn't done your research. The American medical profession and experts in public health knew all the time the lockdown of the healthy was illegal and unscientific.
- Do you know what this situation reminds me of?
- What?
- The way neoliberalism, the political and economic theory that unregulated markets create wealth and encourage democracy, has been universally proven wrong in every one of dozens of countries its been tried in including our own, yet continues to be put into practice. The truth is known, obvious, and ignored. The untested theory that locking the sick in their homes with the healthy would turn out well has turned out very much unwell, yet it doesn't matter at all, it goes on.
- It is supposed to save lives. Maybe not too many, but who are you to say what is too high a cost to pay? And, you know, like ritual you see neoliberalism everywhere.
- Because it is everywhere.**** We could save 38,000 lives a year if we stopped driving and crashing our cars. If we were placed in a coma and spent our entire lives in bed we might be able to live a few months longer. Every year 70,000 Americans commit suicide, 15,000 are murdered. Estimates of yearly avoidable deaths in hospitals range from 22,000 to 250,000.***** Every year 3.3 million Americans are victims of violent crime. On any one night 550,000 with no place to live sleep on the street.
- If saving lives isn't the real reason people are throwing themselves head first into self-destruction, enlisting themselves in an obvious fraud, a medical neoliberalism, what is?
- For the politicians the epidemic is an opportunity to exercise power, for big business an opportunity to loot 5 trillion dollars from the treasury. They couldn't be happier. The people are happy too, locked down, isolated in their houses, enjoying a respite from having to be around their neoliberal competitors in the struggle for existence.****** It's a relief to discover the American medical profession isn't a group of complete morons. I would like to be able to say the same about the American people. They don't understand economics, they're not supposed to, but what's preventing them from understanding that remaining imprisoned in their homes they're losing their freedom?
- They're not supposed to understand that either. They're given little chance to exercise their freedom. They don't miss it when it's gone.

Further Reading:
Jump To Repression
The Epidemic: Accounting For Death
Science Based

Dr. Ashish Jha, director of the Harvard Global Health Institute
* US Emergency Legal Responses to Novel Coronavirus, Balancing Public Health and Civil Liberties, Journal of the American Medical Association, February 13, 2020
*Covid-19 - The Law and Limits of Quarantine New England Journal of Medicine, April 9, 2020
*** Achieving A Fair and Effective COVID-19 Response: An Open Letter to Vice-President Mike Pence, and Other Federal, State and Local Leaders from Public Health and Legal Experts in the United States, March 2, 2020
**** Convergence
***** Avoidable Hospital Deaths
****** Lockdown