The scope and sweep of this viral pandemic gripping the world didn’t hit me until late last week, as I walked to meet a friend for coffee in downtown Spokane.
Yes, the streets were quieter. Fewer cars. Fewer people. This is kinda nice, I remember thinking. It was a sunny day and I’m a healthy 30-year-old, with healthy parents and a job that can be done from home.
A COVID-19 lottery winner, if there ever was one.
As I rounded the corner of Pine and Riverside, a block east of Division Street in downtown Spokane, lost in my privileged reverie, I didn’t notice the old woman clutching the parking meter until I was nearly past her.
“Can you help me?” she asked.
She did not look well. An understatement. She looked terrible; struggling to stay standing, she grasped the metal meter with hands so oxygen-starved they were nearly purple. Her eyes were runny and her face pallid.
She waited for my answer and I wavered.
What if she gets me sick? I thought. What if I get her sick?
The greatest good for the greatest number
This scenario illustrates a fundamental tension in public health policy, said Maria Howard, an ethicist and assistant professor of philosophy at Gonzaga University. Howard’s research focuses mostly on the ethics of assisted suicide, although recently she’s worked with the Spokane Regional Health District to develop a public health ethics committee.
“At the end of the day, public health ethics is incredibly data-driven,” she said. “It’s incredibly important that we focus on population health overall.”
Which is to say, public health subscribes to a utilitarian model of ethics. Decisions are judged on whether they do the greatest good for the greatest number of people.
This puts it in opposition to a founding American myth: life, liberty and the pursuit of happiness.
That tension is part of what makes the COVID-19 pandemic challenging from an ethical standpoint, Howard said. China’s quarantine of 50 million people was an “incredible infringement on personal liberty.” But it seems to have worked. Preliminary research indicates the massive lockdown helped cut new infections from more than 3,500 a day to less than 20.
Meanwhile, the initial U.S. response may have emphasized individual liberty too much, although that seems to be changing, with Gov. Jay Inslee ordering restaurants and other businesses to close Sunday.
“We are a little behind the curve,” Howard said. “But I’m starting to see some good moves.”
That widespread curtailing of individual freedom has saved lives in past pandemics. During the 1918 flu pandemic, for instance, leaders in Philadelphia resisted implementing social distancing rules, while their counterparts in St. Louis instituted measures much faster.
The result? St. Louis’ death rate peaked at 50 per 100,000 while Philadelphia’s was more than 250 per 100,000. A similar, tragic scenario is playing out in Italy. After delaying and resisting social distancing measures, many rural hospitals in northern Italy are now choosing which patients to treat in conditions “reminiscent of war.”
All of which is to say that the “most ethical thing to do right now is social isolation,” Howard said.
‘Our intrinsic moral compass’
But what about the suffering woman standing in front of me asking for help?
Or bartenders, waiters, dishwashers, baristas and others who are suddenly jobless? Or the mothers and fathers scrambling to figure out child care?
That’s the problem with utilitarian ethics: The individual can get lost in the collective. Some of that unease has bubbled up online and elsewhere, with charges of an overreaction.
The more reasoned and rational questions focus on the cost: What are the economic and social consequences of closing schools and restaurants? How will the focus on social isolation, including calls to “hunker down” from state officials, change how we respond to people in crisis? What about mental health and domestic violence? Or the link between chronic social isolation and increased mortality?
“Your experience, I think, really points to the tension that a lot of people are feeling,” Howard said. “Most public health experts would say help the lady. That’s an immediate danger.”
She continued, “But I think the impulse to be careful, especially when it comes to infecting others, is really, really important. We don’t have enough tests in this country to really know how it’s moving.”
Others echoed Howard’s advice. While refraining from close contact with others – particularly strangers and the medically vulnerable – is the right thing to do from a public health standpoint, it shouldn’t cost us our humanity.
“We can’t panic and we can’t lose our intrinsic moral compass and doing right by our fellow human beings,” said Dr. Darryl Potyk, chief for medical education at the University of Washington School of Medicine in Spokane. “I would worry more about me giving it to her. But if she’s in danger, the present danger is apparent. I want to deal with the apparent danger right now.”
And so, last week, I approached the ailing woman.
She needed to go to the bus plaza. She’d taken a bus from her home in the Spokane Valley, where she lives alone, to drop off some paperwork downtown. While she was walking back, she had some sort of attack or episode, she didn’t know what exactly, maybe something to do with her diabetes.
She grasped the crook of my arm and, I’m not proud to admit, I recoiled at first, worried she might touch my hand.
Five people had already passed and not helped, she said. We walked slowly to the plaza. She stumbled often, her back arching backward, threatening to upend her precarious grasp on gravity. A Spokane Transit Authority employee saw us and, without any visible hesitation, took her other arm. The three of us shuffled to the waiting area for her Paratransit bus.
I bought her a slice of pizza and she thanked us.
If we are lucky, the experts say, the measures being implemented now – closed schools, remote work, shuttered restaurants – will limit the spread of this virus.
But those acts will cost us, and my experience raises questions we will all have to grapple with in the coming months.
As Howard said, the decisions public health systems are making now are utilitarian. Looking at the big picture, they make choices designed to benefit the greatest number of people.
This is the only reasonable way to deal with a pandemic.
But it’s no way to live as an individual in the world.
I fear that the necessary and prudent recommendations will reinforce our worst, and most selfish, impulses. The hoarding of supplies is an early indication of this. While buying three months’ worth of canned beans may be good for those with the money, it’s bad for the families living paycheck to paycheck, suddenly confronted with empty grocery shelves.
There is something remarkable in the fact that, right now, many of the world’s 7.7 billion humans are thinking about the same thing; a world so often at odds suddenly united, at least in common concern. It’s a testament to the fact that we breath the same air. We share the same water. We live on the same miraculous rock hurtling through space and time.
And so, as we follow the guidelines and advice of the experts looking at the big picture, let’s not forget our own humanity and the responsibility we have to our fellow humans, both individually and collectively.
“I’m hoping this pandemic results in us coming together,” said Potyk, “rather than being further divisive.”
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