For decades, public health experts have warned of the possibility of a viral outbreak that would rapidly spread across the globe, causing sickness and death. It is now clear that COVID-19 may be such an event in the U.S., and widespread coronavirus transmission is probably inevitable.
One of the greatest challenges ahead is to make sure the burdens of COVID-19 and our response measures do not fall unfairly on people who are vulnerable because of their economic, social, or health status. Our federal, state, and local leaders need to act swiftly with not only clear public communication and science-based policies, but with an unprecedented surge in social and economic support, all while protecting human rights.
To that end, with more than 300 other experts and organizations in public health and law, we identified a series of measures that federal, state, and local leaders must consider to achieve a fair and effective response.
Many of the recommendations may seem obvious. We need major funding, science-based policies, and clear public messaging that avoids panic. We need to encourage and facilitate social distancing to minimize new infections, protect our health-care workforce, and reduce mortality among those who get the disease. Yet, key elements of a fair and effective response have been overlooked, or bear repeating.
Firstly, measures like contact tracing and quarantine will not work unless they are used in accordance with the law and accompanied by comprehensive social support measures and protections. Voluntary self-isolation measures are more likely to induce cooperation and protect public trust than coercive measures. If people expect hardship, they will avoid public health officials or not honestly report their contacts. Mandatory quarantine, regional lockdowns, and travel bans are difficult to implement, have large societal and economic costs, and disproportionately affect the most vulnerable. They should only be used if they are necessary, the least restrictive means needed to protect public health, justified by scientific evidence, and accompanied by strong support and legal protections.
Second, direct funding will be needed to mitigate the impact of quarantine and social distancing. People who live paycheck to paycheck will not be able to sequester themselves and care for children whose schools have closed or the elderly who are ill at home. These burdens will have dramatic effects on women and caregivers and be amplified as large-scale quarantine and social distancing are rolled out. We need to follow the example of countries that have experienced the COVID-19 epidemic in offering direct payments to individuals to enable them to self-isolate, as well as care for the young and the elderly. We urgently need to provide sick pay to those who need to stay home as part of voluntary or mandated control measures.
Third, at a moment of extraordinarily high fear in our immigrant communities, governments at every level must immediately reassure the public that the COVID-19 response will not be linked to immigration enforcement. Health-care facilities must be immigration enforcement-free zones so that immigration status does not prevent a person from seeking care. If individuals do not feel safe to utilize care and respond to inquiries from public health officials, for example, during contact tracing, it will undermine individual and collective health. Similar enforcement-free zones have been declared during hurricanes and other emergencies like Sept. 11.
Fourth, policymakers must act swiftly to enable those with and without health insurance to follow their recommendations. The U.S. is exceptional among wealthy countries in the number of people uninsured — tens of millions will face the risk of COVID-19 without insurance. Those who are insured may be discouraged from seeking early care and testing from fear of high deductibles and copays — and later on, face the financial blow of out-of-network billing. We need comprehensive and affordable access to testing and treatment, including for the uninsured. As new therapeutics or vaccines are developed, policymakers must also assure they are affordable and available to all.
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Finally, people in close living quarters are especially vulnerable to COVID-19 and will need special attention, both to minimize transmission risk and address their health care needs. In nursing and other group homes, staffing and support under ordinary times are often inadequate, and outbreaks will be difficult to contain. These institutions need a major surge in support and funding. The U.S. is also exceptional among wealthy countries in the size of our prison population. We should consider not only how to effectively control transmission and treat people who are incarcerated, but also how we can avoid putting people in jails to whatever extent possible because they may amplify epidemics.
A large COVID-19 outbreak would be unprecedented in recent American history. There is no playbook for an epidemiological event of this scope and magnitude. To mitigate its impact, our leaders must act urgently so we are best protected from this unprecedented threat and the possible harms of a poorly conceived response.
Scott Burris is a professor of law and the director of the Center for Public Health Law Research at Temple Law School. Amy Kapczynski is a professor of law and a faculty director of the Global Health Justice Partnership at Yale Law School. Albert Ko is a professor of epidemiology and medicine at Yale Medical School.