Balancing rights and responsibilities

(10/1) The search for social grace in the age of social distancing.

Once upon a time, there was a young woman named Mary. She was a cook in private homes in New York and New Jersey in the early twentieth century. She had quite the reputation as a cook, her employers were particularly fond of her ice cream recipe. When she left one place of employment, her next employer would be the beneficiary of her art in the kitchen, their dinner parties having a special new sparkle. Around 1907, after there had been severe typhoid outbreaks, the health authorities of the region traced the chronological path of sick and sometimes dying patients to the employment history of Mary Mallon, coveted cook, incubator of typhus, aka Typhoid Mary.

Mary was confined to a sanitarium for a few years, later released with the agreement that she would not seek employment as a cook. She broke that agreement. Shortly after taking on a new position as a household cook, another outbreak of typhoid fever was traced to her. Mary was permanently housed in a state facility until her death.

We remember Typhoid Mary to this day because who doesn’t love a good catchphrase or a scapegoat? Maybe your family lost loved ones to cholera, typhus, or the influenza of 1918. Is there a favorite aunt, or uncle your parents remembered, who is still missed?

To live in a society of humans, agreements and compromises are made, rights and responsibilities are balanced. The old adage, that you don’t get a traffic light at an intersection where drivers speed through just because they can, until someone gets killed, is right on target today. There have been people dying here at home and around the world, of an infectious disease that groups have spread by gathering in their busy activities, just because they can. Government has to and will continue to step in, take action, and impose rules. Because it has to, that is the role of administration. Rights can be argued all day long, but if they do not come with responsibilities, rights are meaningless.

In the history of public health in the USA there are many diseases that were mysteries, which when solved resulted in protest against the solutions. Inoculations have been protested since they were first used in the colonies in the early 1700s.

Laws against spitting in public, written in the last 100 years and beyond, are on the books to this day because we understand how different diseases are spread.

For example, here is a twentieth century reference to the Frederick City Code of Ordinances, Chapter 15.—MISCELLANEOUS § 15-36. Spitting in public places states: It shall be unlawful for any person to expectorate or spit in or upon any paved sidewalk or footpath of any public street or public square in the city or in or upon any part of any public building under the control of the city, or upon the floor, platform or steps of any public vehicle carrying passengers for hire or upon the floor of any depot, station or other common carrier, or upon the floor or steps of any theater, store, factory or any building which is used in common by the public, or upon the floor of any hall or office, in any hotel or lodging-house which is used in common by the guests thereof. Violation of this section is declared to be a municipal infraction. The penalty for violation shall be the sum of twenty-five dollars ($25.00).

When medical science found solutions to diseases by vaccinating our children, public schools required vaccinations. Maryland requires vaccinations before a child can attend public school. Starting in PreK— polio, smallpox, measles, mumps, rubella, chickenpox, hepatitis B, PVC, DTaP/DTP/DT, Hib, and adding Meningococcal for grade 7.

Medical science does not have all the answers to everything right now, that is why we study and gain new insights. But we do have some constants. Viruses can live in humans. Viruses can make some people sick, and not others. Viruses mutate, and if allowed to grow in multiple hosts, unchecked by the hosts’ antibodies, mutations will grow faster, and likely in more variations. Vaccines slow the factors that cause mortality in humans, masks slow the spread of a virus. Both of these things protect the majority of the population, especially people who cannot take a vaccine for medical reasons, or have a compromised immune system. The Washington Post reported that in the last month virus-linked hospitalizations are at 80,000, and in the US coronavirus infections have gone from 13,000 a day in July to more than 128,000 a day as of August 14.

I don’t know what Typhoid Mary Mallon was thinking as she provided delicious ice cream and disease to her employers. My guess is that she was thinking she needed to go to work to earn a living, she wasn’t sick so what’s the problem? The problem is that we do know that disease operates invisibly, and that how you or I feel is not how things are. Mary had a natural immunity to typhus, but she was a vector for the disease. Government may not have the right to supersede your right to decide what to put into your body—vaccine—but government does have the responsibility to protect the populace, and that means if you don’t have a vaccine you don’t get to go everywhere in public that you want to. Private businesses do have the right to refuse to hire or do business with people who do not get vaccinated or wear masks.

You may not be sick, you may have medical reasons to not get a vaccine. My hope is that everyone who is eligible, will get the vaccine, and like me, go back to wearing a mask indoors and be mindful of social distancing. To those that refuse vaccines or masks because "I don’t want to and you can’t make me" you are at a high risk of going to the ICU. At least most hospitals have ice cream.