AMERICA/ UNITED STATES - WHEN DO THE RIGHTS OF SOCIETY SUPERCEDE THE INALIENABLE RIGHTS OF THE INDIVIDUAL TO LIFE, LIBERTY AND THE PURSUIT OF HAPPINESS? An Editorial by Kevin M. Cahill, M.D.

New York (Agenzia Fides) - The Severe Acute Respiratory Syndrome (SARS) has had a devastating effect on thousands of victims, their families and close contacts, exposed health workers and the world economy.
The outbreak reminds us, as other epidemics have throughout recorded history, that a new, communicable infection can wreak almost unimaginable havoc in populations with no immunity. Epidemics, such as SARS, also pose ethical and moral questions: for example, when do the rights of society supercede the inalienable rights of the individual to life, liberty and the pursuit of happiness? Can whole populations be forcibly quarantined? Who defines a state of imminent peril and decides what draconian measures must be imposed for the public weal?
The SARS outbreak is still evolving and it is too early to know whether it will spread and establish itself, as did HIV/AIDS, as a global threat, or, whether, as in various plague epidemics in the past, this new danger will burn itself out. In either case the SARS epidemic reaffirms a number of fundamental public health lessons:

a) honest, transparent and timely information is the most essential ingredient in understanding, and controlling, an epidemic. The failure of some officials in China to admit to the existence of significant numbers of SARS cases allowed the infection to become established locally, and spread internationally, before any effective measures could be put in place to isolate infected patients and break the cycle of transmission.

b) The SARS outbreak introduces an entirely new virus to medicine and there is, therefore currently no available proven diagnostic tests or accepted therapy. Furthermore, viruses may mutate and produce multiple variants. The incredible achievement, first by Canadian scientists, of rapidly identifying the entire DNA structure of the SARS virus does not, contrary to media reports, assure the rapid development of a protective vaccine or effective anti viral drug. The HIV virus was identified in 1985 and there is still no vaccine against AIDS.

c) It is not necessary to know every detail about a disease before mounting an effective public health protection campaign. One can empirically use face masks, gloves, advanced isolation techniques and even quarantine to limit the spread of almost all airborne infections.

d) Quarantine is a legitimate tool in the face of imminent peril from a fatal communicable disease. The innocent public has a right to be protected from infectious individuals and enforced quarantine is an ancient and effective method of limiting localized epidemics.

e) At the present time SARS is endemic in large areas of Asia and in pockets, such as in Toronto, Canada, where imported infections spread among local contacts. If SARS were to become endemic in areas such as Africa, areas already crippled by high incidences of HIV/AIDS, tuberculosis and multiple parasitic diseases, the current death rate of 6% would undoubtedly escalate sharply. Furthermore, these affected African areas already have grossly inadequate health services, and the medical system would be rapidly overwhelmed by SARS.

f) Finally, it is well to remember that the light of hope and discovery continues to shine even throughout the worst epidemics. When Albert Camus summarized the long ordeal of the citizens of Oran during a plague epidemic he did not merely cite death and deprivation. His main physician/character at the end of the novel, Le Peste
"resolved to compile this chronicle, so that he should not be one of those who hold their peace but should bear witness in favor of those plague-stricken people; so that some memorial of the injustice and outrage done them might endure; and to state quite simply what we learn in time of pestilence; that there are more things to admire in men than to despise."
(28/4/2003 Agenzia Fides)