So far, COVID-19 has killed more than 90,000 Americans—at least that's the official count. More than 1.5 million have been infected, and every day another 25,000 or so test positive. Despite this, across the country there is an increasing push to ease social-distancing restrictions. Florida, Wisconsin, and many other states are moving to reopen. Most public-health experts say it is too soon, and that easing restrictions will lead to a spike in transmissions.
Many of the people pushing to reopen see the issue in terms of freedom. They argue that quarantine and government-mandated closures infringe on their individual rights to do as they please, to make their own choices about health risks. The United States was founded on the idea that individual liberty—for white men, at the time—is inviolable, and for many of its residents this argument resonates deeply.
But there is more than one way to understand freedom—something public-health reformers in England 150 years ago found made all the difference. Their approach could provide a powerful blueprint for how to effectively counter the “my body, my choice” anti-quarantine arguments of today.
In the 19th century, public-health officials weren’t facing just one infectious disease, but many: scarlet fever, diphtheria, typhus, cholera, tuberculosis, and smallpox, which together killed tens of thousands every year. Epidemics were common, and doctors could do almost nothing to stop them. Vaccination was available for just one disease, smallpox; testing didn’t exist, nor did many effective treatments other than rest and hydration; and doctors had little understanding of what caused these diseases. For much of the century, the leading theory was that they were triggered by “miasma,” mysterious vapors from rotting vegetation and organic matter.
Over decades, a group of pioneering scientists, doctors, and government officials realized that isolation, disinfection, contact tracing, and other now-familiar public-health strategies had the potential to decrease the spread of many diseases. Scientists such as Robert Koch and Louis Pasteur developed the germ theory of disease, which showed that infectious illness was caused by microbes passed from person to person. This idea provided more evidence for the measures advocated by the reformers.
But, just as today, a significant minority strongly resisted, arguing that these measures impinged on their freedom. For instance, in 1890,16,000 people in Nottingham signed a petition against mandatory hospitalization for those sick with infectious diseases. The petition described isolation in the hospital as a "prison [that] deprives us of our right to nurse our sick and claim our dead." Sometimes resistance to such measures became violent: During a cholera epidemic in 1832, riots broke out in Liverpool and other English cities when people rebelled against doctors’ attempts to move patients from their homes to hospitals. Widespread rumors claimed that these patients would be killed and their bodies dissected for medical research.
A variety of civic groups formed, such as the Vigilance Association for the Defence of Personal Rights and the Anti-Compulsion Society. The names have an ornate 19th-century quality, but their point of view is recognizable to anyone following the current anti-quarantine protests.
One prominent voice in this movement was Charles Bell Taylor, a wealthy ophthalmic surgeon from Nottingham. “Local government has become a curse,” he wrote in the Nottingham Journal in 1883. “The meddlesome philanthropist and compulsory fanatic have been enabled secretly to undermine the constitution, and set at naught the just rights and legal liberties of the people … There is no evil so great as loss of liberty; nothing can ever compensate us for.” The language may be old-fashioned, but the sentiment feels utterly familiar.
In response to these vehement appeals to individual freedom, public-health leaders in London, Liverpool, Manchester and elsewhere developed a powerful counterargument. They too framed their argument in terms of freedom—freedom from disease. To protect citizens’ right to be free from disease, in their view, governments and officials needed the authority to isolate those who were sick, vaccinate people, and take other steps to reduce the risk of infectious disease.
One of the most important reformers was George Buchanan, the chief medical officer for England from 1879 to 1892. He argued that cities and towns had the authority to take necessary steps to ensure the communal “sanitary welfare.” He and other reformers based their arguments on an idea developed by the 19th-century English philosopher John Stuart Mill, who is, ironically, remembered largely as a staunch defender of individual liberty. Mill articulated what he called the “harm principle,” which asserts that while individual liberty is sacrosanct, it should be limited when it will harm others: “The sole end for which mankind are warranted, individually or collectively, in interfering with the liberty and action of any of their number, is self-protection,” Mill wrote in On Liberty in 1859. Public-health reformers argued that the harm principle gave them the authority to pursue their aims.
An essay published in The Lancet in 1883 sums up this view nicely: “We cannot see that there is any undue violation of personal liberty in the sanitary authority acting for the whole community, requiring to be informed of the existence of diseases dangerous to others. A man’s liberty is not to involve risk to others,” the author wrote. “A man with smallpox has the natural liberty to travel in a cab or an omnibus; but society has a right that overrides his natural liberty, and says he shall not.”
Backed up by these arguments, as well as the new science of microbes, the reformers carried the day. From the 1860s to the 1890s, the English government, as well as many English cities and counties, used this interpretation of freedom to pass a series of laws allowing authorities to track and report infectious diseases, isolate and hospitalize people who were sick with these diseases, and inspect and disinfect people’s homes and other buildings to ensure they were sanitary. Partly because of these interventions, rates of many infectious diseases in England dropped.
Today, however, American public-health leaders and politicians are for the most part ignoring this approach; instead, they have built their argument on numbers, and particularly on the continued rise in COVID-19 cases and deaths. This is certainly a plausible, and rational, response. But for some, the call to protect individual liberty, and to kick-start the economy in the process, is more compelling than data and statistics.
State by state, people are being asked to make a false choice between a rapid economic recovery and protecting the lives of vulnerable Americans. In a country where the idea of freedom is cherished so deeply, a compelling argument can and should be made that curtailing personal liberties is sometimes necessary to secure freedom for everyone.
Within the space of a few months, COVID-19 has joined diseases like scarlet fever, diphtheria, and cholera as a quintessential example of a threat that requires giving up one sort of liberty in order for people everywhere to enjoy their right to be healthy. Contagious and lethal, it so far cannot be cured or vaccinated against. Those who want to ignore social distancing, spurn masks, and crowd together in malls and on beaches might be making a statement in defense of personal liberty, but they are also undeniably endangering the freedoms of thousands of others.
Freedom, after all, is a flexible concept, and Americans’ freedoms surely include the opportunity to minimize the collective risk of random viral death.