In pandemic, individual rights secondary to those of public
Amid scarce resources, treat everyone as if they have Covid-19. No one is immune
A nurse holds a nasal swab and vial as she prepares to administer a coronavirus test: disease has spread rapidly. Photograph: Lindsey Wasson
Covid 19 is going to change many things. The main moral shift will have to be from thinking about health as an individual right to understanding that in times of a pandemic, public health is the most important goal.
I am not a pandemic virgin. At the height of the Aids pandemic in South Africa, I worked as an ethicist at two hospitals at the epicentre of the emergency at KwaZulu/Natal in the 1990s and 2000s. I served on the hospitals’ ethics committees, which made life and death resource allocation decisions, and that experience carries lessons for us in treating Covid-19.
In normal situations, we have the luxury of thinking of ourselves first, of keeping ourselves healthy and deciding what treatments we could receive. We struggle to understand any frustrations we face in getting the care we perceive that we need, such as not getting an antibiotic we asked for from our GP, or having to wait in the emergency department as cases that arrived after us are attended to.
The elderly patient being resuscitated is, to be blunt, using up an intensive care unit bed that might be urgently required by another
Our societies are built around that individualism; we try to save every life. Elderly people with frail bones are aggressively given CPR to keep them living for maybe a few weeks longer, and we allow parents to make a choice as to whether or not to vaccinate their child.
In public health emergencies like this one though, it is the public, not individuals, who are of prime concern. To put it starkly, an individual’s rights and liberties are trumped by the public’s right to stay safe.
Spread of ‘superbugs’
This is already part of some aspect of public health policy. Patients demanding antibiotics are refused them because, when not clinically advised, their use contributes to the public spread of “superbugs”.
Emergency departments must prioritise patients according to the urgency of their care requirements. The elderly patient being resuscitated is, to be blunt, using up an intensive care unit (ICU) bed that might be urgently required by another patient. Those who do not vaccinate their children unfairly endanger others.
This small dose is going to get larger.
You might be frustrated at not being offered a test for the virus that causes Covid-19, but as Dr Anthony Fauci of the White House Coronavirus Task Force said in a media briefing on Friday, there are not enough tests and those the Centres for Disease Control and Prevention initially created were faulty .
The Covid-19 virus is new and there is no stock of tests to be deployed. They have to be manufactured, and the demand for them is outstripping manufacturing capacity. As tests do become available, they should be rationed to those who most urgently need them, like healthcare workers.
While it is true that the best way of combating the pandemic would have been testing and isolating every single case, and doing contact tracing and isolating contacts, the disease has spread too rapidly.
Infection and stigma
I remember the first test I had for HIV took several days to return. The medical advice while I waited those agonising days? Act as if you have the disease. It is sound advice for everyone now. Know that you may have no symptoms, and that you’re highly infectious before you even suspect you may be sick.
None of us is immune. None of us should be ashamed
However, acting like you have the disease can lead to stigma. I watched with horror as the first few Covid-19 “patient zeros” in countries around the world were lambasted on social media for bringing the virus into “their” country. In South Africa, the Treatment Action Campaign did a marvellous job of destigmatising a HIV-positive diagnosis.
One campaign involved suggesting everyone (HIV-positive or not) wear a T-shirt saying: “HIV +”. It’s a wake-up call. Treat everyone as though they have the virus. None of us is immune. None of us should be ashamed. The more we do this, the fewer cases there will actually be. So follow the official advice. And self-isolate if you can at this critical time.
You may think I am being too cautious, and I understand why governments are reluctant to seem authoritarian or to be overreacting. Swift action and guidance are, however, necessary. The problem is, with the features of this virus, it will likely have spread exponentially before the first cases were reported. The result is an epidemiological modeller’s fantasy.
Mellisa Stobie lives in Kilare and lectured in ethics at the University of KwaZulu-Natal between 1999 and 2008. She served on the hospital ethics committees of two large government teaching hospitals during the height of the Aids pandemic in KwaZulu/Natal in the 1990s and 2000s