We are now almost three years into dealing with COVID. Between changes to the virus and the development of vaccines, COVID has become one of those serious diseases that we just have to deal with rather than an all consuming emergency. But the response to COVID has created a political firestorm that will take years for our system to adjust.

Prior to COVID, those outside of county health departments (and their attorneys) rarely paid much attention to the laws in place to deal with contagious diseases. One of the major problems in our government (at all levels) is that (especially in those states with part time legislatures) is that nobody pays much attention to laws on the books until flaws in those laws create a serious problem. As a result, in many areas of the country, the laws still reflect a very traditional approach to pandemics and potential pandemics. For the most part, those laws allowed quarantine of sick patients and local restrictions designed to prevent the spread of disease. At the national level, quarantines of incoming travelers could also be imposed to assure that nobody was bringing in diseases.  (With all modes of travel being, compared to modern times, relatively slow, the potential for an extended quarantine was simply assumed in the planning for a business trip (and social travel of long distances was simply not common). 

These laws made sense in the nineteenth century. A significant part of the population lived in rural areas where it was easy for a family that had smallpox or similar life-threatening disease to isolate for a period of time.   And for people who lived in town, it was possible to get needed supplies to the quarantined homes by simply leaving them outside the home to be picked up after the delivery person left.  More significantly, travel was very limited and the number of jobs that were “essential” were relatively few.  While there were exceptions to the rule, goods that had to be transported from one part of the country to another tended to be more in the nature of luxury goods rather than necessities.  In short, it was possible to have a degree of success in stopping the spread of diseases by imposing strict quarantine rules without causing much of an impact on the economy.   And because of the limited contact between different parts of the country, the area subject to quarantine at any one time would be very limited as well.

In one of those coincidences, the science of fighting disease progressed somewhat faster than the science of transportation.  By the time that the car and the jet made it possible to have social travel between countries and for business people to hit six major cities in three countries within the same week, vaccines made most of the previously common deadly communicable diseases relatively rare.  In my personal experience, as an attorney to a county government, I can only remember quarantine coming up a handful of times, and some of those discussions were merely periodic reviews of policies and planning for worst case scenarios.  Because of the progression of medical science, the laws on quarantine became an “in case of emergency” backstop that were almost never used. 

Meanwhile, the changes to the global economy caused by the improvements in transportation have increased our dependency on products made by other people.  And urban/suburban vs. rural population has essentially flipped from urban areas representing around 20% of the national population prior to the Civil War to the rural population now fast approaching only 20% of the total population. 

And our experience with responding to COVID quickly revealed how these changes had impacted our ability to successfully and quickly deal with a pandemic.  We did try a variation on the old quarantine system, but it only partially worked.  Because of international and domestic travel, by the time that people noticed that there was a new, highly contagious, and highly fatal disease, it had already spread over the entire world and throughout the U.S.  And, while some people had the type of jobs that could be partially done from home (for at least a limited period) through the use of phones and the internet, other people had the type of jobs that required them to work at a crowded central location so that the rest of us could have food and drinking water and clothes, etc.  In short, the effort to quarantine came too late and our economy precluded it from being long enough and comprehensive enough for it to fully succeed.

And the incompleteness of the quarantine effort and its failure to be fully and quickly effective caused the inevitable backlash from the burden that it did impose on individuals.  The lockdown protocols followed by the masking protocols did save a large number of lives, but still a large number of people died,  And convincing people to sacrifice when the result is mixed is a hard thing to convince people to do.

The backlash has caused politicians to take a look at the existing laws on the books.  And, it is clear that, at the very least, the playbook of how public health agencies respond to pandemics needs to be updated.  But there is also the tendency to throw the baby out with the bath water.  And right now, the push in many parts of the U.S. is to strip public health authorities of the power to impose restrictions in response to pandemics.  But, it should be clear that legislative bodies will not be able to fine tune a response to the next pandemic after it hits in time to be effective.  In many states, legislatures — wisely — recessed for a period when COVID hit until the legislatures could devise ways to meet and conduct business without exposing all of the legislators to this new disease.  And even if legislatures were composed entirely of geniuses, most legislators are not experts in public health.  When faced with a new disease, even the experts are going to be guessing with limited data.  (Which is one of the problems when a new disease reaches pandemic status as today’s best idea has to be revised tomorrow based on new data causing people who know nothing to pontificate that the experts should be ignored.)  The only people who have any hope of managing the next pandemic are our public health authorities.  Yes, a review of what went right and wrong in our response to COVID needs to be undertaken.  But, at the end of the day, we need our public health authorities to have the tools needed to respond to all types of health care disasters.  The  push by demagogues to hamstring public health authorities is exactly the wrong response to the lessons that need to be learned from COVID.