Today, we are at the end of the beginning of this crisis: We have taken the steps needed to avert the worst immediate outcomes — namely, the risk of overwhelming the capacity of hospitals to deal with sick patients. We can argue about whether shutdown and stay-at-home orders might have been more selectively targeted, to maximize health benefits with somewhat less disruption, but for now, hospitals have the beds and ventilators they need, and so the calculus is changing. (States must keep a close watch to make sure that remains true.) The virus will be with us for months or years — at least until a vaccine is developed: We will all face difficult balancing acts as we attempt to live our lives and pursue our values, while still limiting the harm the virus causes as it continues to spread.
Fighting racism and opposing police brutality are issues most of us recognize as extremely important. Public health experts in particular prioritize this fight because we are painfully aware of the far-ranging health effects of poverty and stress. Such effects are forcefully illustrated by the disproportionate effect of the coronavirus on African Americans — who, in New York, are twice as likely as whites to die of the illness, studies show. It is no surprise, then, that so many public health experts are supportive of the current demonstrations.
Public health researchers pointed — correctly — to earlier protests in response to pandemic-prompted economic shutdowns and stay-at-home orders as opportunities for viral spread. The same is true, of course, of the present protests. A virus does not discriminate among crowds, regardless of the cause they espouse. In both cases, supporters of the protests argued that the risks — which, in the case of a communicable disease, transcend the risk to the individual — were outweighed by the potential value to be gained. In academia and in much of the news media, this argument has been treated with much more respect in the case of the protests against police brutality than it was in the case of the anti-shutdown protests, leading to understandable accusations of hypocrisy from conservatives.
True, the earlier protests can be dismissed by focusing on people who said they wanted shutdowns to end so they could get haircuts, or get their nails done. But some protesters made a reasonable argument that more business could be conducted safely, more livelihoods pursued, more non-coronavirus-related health-care procedures done, than stay-at-home orders and other policies permitted. And others protested for different reasons — for the right to take the risk of attending church, for example, in a socially distanced manner, in numbers larger than their states allowed. For such people, weekly religious services were central to their lives.
The point is not to dwell on the arguments about the protests and shutdown orders but to look ahead: In this new environment, as options to act open up, which values are worth risking some exposure to the coronavirus will be a deeply personal matter. Physicians and policymakers must respect that different people will be willing to risk exposure for different things; such pluralism is at the heart of a liberal society. Recommendations and policies should be crafted to enable people to pursue their values as safely as possible.
Governments will, and should, establish boundaries. Few localities will permit major sports events with fans, music concerts and other mass gatherings. Such events could set off a chain of transmission that could go unrecognized until it spilled into, and overwhelmed, a hospital. No one has the right to impose such a profound level of risk on their fellow citizens. Only the most serious causes (such as protesting the gravest social wrongs) can justify violations.
Similarly, public health professionals will continue to provide guidance on how people can reduce the risks of public activities, including protests. (Protesters should wear masks, for example, and consider banging a drum instead of chanting; if at all possible, they should stand six feet apart. Police departments should do everything they can to avoid using tear gas or any other weapon that induces coughing. Protesters would be well advised to self-quarantine afterward, avoid exposure to vulnerable people and seek testing.) But the decision of whether to join a protest will ultimately be an individual one.
As will many other decisions. Many people have stopped visiting their elderly parents, which may be prudent. But how many people are prepared to adhere to that decision for six more months, or a year, or two years, the prospect we now face? Allowing a grandparent to hug her grandchild again is another choice that some families may conclude is worth the risk. (It, too, can be mitigated by limiting other contacts outside the family.) A Zoom funeral will continue to be the safest course, but families may conclude that the healing process of gathering to mourn together outweighs complete safety. Dining out is not nearly as important, but some will choose to embrace it sooner than others, perhaps as a way to connect with a partner or friend.
We trade off risks all the time, based on the importance of the values at stake. The same person who thinks it is foolish to drive on a snow-laden road to pick up a snack might find it reasonable to do so to visit an ailing family member, even though doing so jeopardizes one’s own safety as well as that of others on the road, however marginally. It is only in the direst circumstances that governments intervene to prevent people from making their own choices about these trade-offs.
We must continue to aggressively test, trace and isolate to limit the spread of the virus. The search for a vaccine and antivirals will continue. People should be cautious; this is a pandemic. There will be difficult decisions, and some people may regret their choices, and some may take risks for what many think are trivial reasons. But in the uncertain period we’ve now entered, we need to be honest that the risks people undertake will be shaped by their preferences — and that not everyone’s are the same. We should embrace that plurality, rather than selectively discounting, or shaming, decisions that do not mirror our own.