Constitutional rights and public health go hand in (latex-covered) hand: Wearing a mask, keeping hands clean and physical distancing are necessary to keep citizens safe during a pandemic. Multiple states, including Florida, are now experiencing a surge in COVID-19 cases since their reopening. Within the past week, cases continue to rise with the largest increase among people between 25 and 34 years old. So far, hospitalizations have not significantly increased. However, there has been an increase in emergency department visits for COVID-like and influenza-like illness.
Unfortunately, we have no cure or effective drug treatment for COVID-19 and do not expect a vaccine any time soon since two large Phase III vaccine clinical trials will not start until July. Furthermore, there is no guarantee that the vaccine will come to market until there is proof of safety and effectiveness.
So here we are, stuck in limbo as we continue the reopening process. What measures can we take? Should each one of us assume personal responsibility amid inconsistent public health messaging and policy measures and wear a mask when close to others in the community? As a pediatric infectious diseases doctor and public health practitioner, our priority is to prevent disease and keep everyone healthy. Prevention is the key for COVID-19. The only measures we have are physical distancing, face masks, hand hygiene and environment cleaning. These interventions can go a long way if done consistently and by most of the public.
Last weekend I (David) rode my bike around St. Petersburg. I placed a mask on my face as I walked up to a window to pick up food. I was happy to see employees were wearing masks and sanitizing their hands. There were two customers in front of me wearing a mask but 15 to 20 others were not. Every single person in our community needs to take action to protect one another until we have an effective vaccine.
However, we need to create a behavioral environment that normalizes and encourages these practices. We are experiencing an unprecedented public health crisis; sometimes enforcement of measures can be helpful in these situations. Enforcement measures help clarify and reinforce public health messages and practices while creating an environment with clear standards and expectations for the public.
Many will ask if public health ordinances are constitutional? The answer is yes. In 1902, Boston experienced the last large smallpox epidemic. The Board of Health had 115 physicians at work to immunize the citizens of Boston against smallpox. If an individual refused the vaccine, they received a fine. A citizen named Henning Jacobson refused to take the vaccine for himself and his child. He claimed it was his individual right to refuse the vaccine and not pay the fine. Jacobson v. Massachusetts, a 1905 U.S. Supreme Court case, addressed the question of whether or not the state government had a right to protect the public’s health through enforcement measures. The Supreme Court upheld the Massachusetts Board of Health’s authority to require vaccination because the epidemic affected the health of everyone in the community. Justice John Marshall Harlan wrote that the Constitution protects individual liberty and that liberty is not “an absolute right in each person to be, in all times and in all circumstance, wholly free from restraint.”
All of us need to do the right thing to protect our family, friends and community from harm. Wear a mask, wash your hands and maintain physical distancing while socializing. We can fight COVID-19 only if we engage in these prevention practices together as a community. This is our new normal as we continue to reopen the economy and work to protect and strengthen our community.
Dr. David M. Berman is a pediatric infectious diseases specialist who lives in St. Petersburg. Linsey Grove is a public health practitioner.