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With the first confirmed positive tests of the coronavirus in the United States, public health officials are keeping a close watch on its progression.
The virus, which broke out in the central Chinese city of Wuhan in mid-December, had infected thousands of people at a skyrocketing rate by the end of January, killing more than 100. Meanwhile, the virus has begun to appear in other countries. In the U.S., more than 100 patients in 26 states were being evaluated as of Jan. 27, five of them testing positive, according to the Centers for Disease Control and Prevention.
The risk of infection in the U.S. is low, at least for now, but the CDC is keeping close watch and screening passengers arriving from China.
Of course, we hope that public health officials will be able to contain it. But what if the infections dramatically increase? What power does the government have to impose quarantines or other restrictions to limit the spread of disease? The answer, which should come as no surprise, is: A lot.
Its powers are spelled out in the Commerce Clause of the U.S. Constitution. The section titled "Regulations to control communicable diseases" hands the power to the Surgeon General to take whatever actions are necessary to limit the spread of communicable diseases from foreign countries into the U.S. or from state to state within the U.S.
If a person is suspected of being infected, they may be apprehended and examined. If they are found to be infected, they can be indefinitely detained in relative isolation. And if groups are thought to have been exposed to communicable disease, they may be quarantined.
In addition, states have the ability to protect people within their borders, under their police power functions. But if the measures taken by state health authorities are insufficient to prevent the spread of the disease, the CDC has the power to step in and order any isolation and quarantines deemed necessary.
In China, authorities are scrambling to contain the virus by imposing an extraordinary quarantine. Initially, the government locked down the entire city of Wuhan and its 11 million inhabitants. By Jan. 25, however, 11 more cities and about 40 million more people were added to the quarantine. The images that we've seen from the quarantined areas — empty streets, stores, public-transit stations — have indeed been eerie.
The questions on many Americans' minds, of course, are: Could that happen here? How serious is the threat in the U.S.?
Nobody really knows.
The CDC says the risk in the U.S. is low, and the World Health Organization is also refraining from sounding alarm bells. WHO's director-general, Dr. Tedros Adhanom Ghebreyesus, said that while China is experiencing an emergency, "it has not yet become a global health emergency."
The problem is that we still don't know how easily the virus is spread from person to person, and we don't know how deadly it is.
It could be no more deadly than season flu. But might it become a "global health emergency"?
Mike Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota, says the likelihood of a full-blown pandemic is low. But other experts are voicing concern. "If it's not contained shortly," said Trevor Bedford, a computational biologist at the Fred Hutchinson Cancer Research Center in Seattle, "I think we're looking at a pandemic."
As long as the word "pandemic" is being bandied about, it's probably worth mentioning the last one we had: The Spanish flu pandemic of 1918-19, which killed about 670,000 Americans. Worldwide, the death toll was between 50 million and 100 million.
The CDC and WHO are issuing assurances, at least for now. But Tom Inglesby, director of the Center for Health Security at Johns Hopkins School of Public Health, tweeted on Jan. 26 that countries should make plans now for the possibility that the virus cannot be contained.
Meanwhile, the American Civil Liberties Union pointed out on Jan. 28 that the coronavirus carries an additional threat: panic and fear-mongering.
"Disproportionate hysteria and exaggerated fear" tend to accompany outbreaks of infectious diseases, the ACLU said, recalling the overreactions to the 2009 "swine flu" virus that turned out to be a normal flu strain.
In addition, the ACLU warned that politicians may see the threat of a foreign-origin virus as an opportunity to target and stigmatize vulnerable populations.
For now, it's safe to say we just don't know what the threat might be. So it's best to keep calm and let the scientists and the public health professionals do their thing.