NEW HAVEN, CONN. — Responses to outbreaks of disease are ultimately shaped by more than just the disease itself. How we treat those who are sick reveals much about us, because diseases and their sufferers are canvases on which we project our deepest - often unexpressed - human emotions. Our attitudes toward the sick can be expressions of compassion, courage, hope, and understanding, and of fear, disgust, despair, and intolerance. Our attitudes reveal our true social priorities.
As the outbreak of SARS (severe acute respiratory syndrome), which was thought to have abated surges and claims new victims, the social responses grounded in fear and in panic are taking hold. Earlier in April, New York City Mayor Michael Bloomberg had to have lunch in a Chinatown restaurant to remind the city's residents that fears about SARS were hurting businesses in the neighborhood. In Los Angeles, one rumor spread that the owner of a popular Chinese restaurant had taken ill with SARS, while another rumor purported that Asian restaurants and groceries were being closed by the police. Government-issued alerts, advising against travel to Toronto, mainland China, Hong Kong, Singapore, and Vietnam, added to the already circulating rumors and misconceptions and have further heightened public fear and uncertainty.
While no one so far has died of SARS in the US, the American public-health system is better than most, steeled to face the medical challenges posed by SARS. After the Sept. 11 terrorist attacks, anticipating threats of biological and chemical terrorism, government agencies and officials at all levels stand ready against a deliberate attack on people's health. Those resources and preparations are now being marshaled and tested against SARS.
Far more difficult for the public-health community will be to control the social responses to the disease. The history of public health has shown repeatedly that the social and political responses to an outbreak of disease will diverge from its medical realities. The social and political responses will not necessarily be proportionate to the threat posed by the disease, and will not be the measured, careful responses demanded by the crisis.
Already the SARS outbreak has raised two potential concerns. First, the origins of the outbreak in the southern Chinese province of Guangdong, and the subsequent underreporting and coverup of cases by the Chinese health ministry, offer targets of blame for the current public-health emergency. The actions of the Chinese health officials were irresponsible and dangerous, but as damaging to the public-health effort against SARS would be for the public to heap suspicion on the Asian community. The historians Alan Kraut and Susan Craddock have written about how Chinese immigrants to the US in the late 19th and early 20th centuries were smeared by associations with outbreaks of bubonic plague in San Francisco. Outbreaks of disease regrettably offer opportunities for those possessing preconceived political and social agendas to advance them further, even if it is done so on the basis of rumor and misinformation.
In the post-Sept. 11 world, where debates about civil liberties abound, a second cause of concern is that government and public-health officials must be careful to preserve individual civil liberties while striving to safeguard the community's health. In practicing quarantine, isolation, and the identification of infected patients, public-health officials should be on guard that a diminution of individual civil liberties does not accompany an aggressive public health campaign against SARS. Since Sept. 11, government powers - what legal scholars call police powers - have expanded immeasurably, eroding the due process and civil rights of citizens and immigrants. In an atmosphere where civil liberties already are threatened, those vested with the public trust should be careful that public-health efforts against SARS and any other disease - whether natural or provoked by terrorism - does not become a vehicle that undermines individual liberties.
If responses to disease outbreaks are opportunities to reveal our true social priorities; or if, as Albert Camus wrote, "What we learn in time of pestilence [is] that there are more things to admire in men than to despise," our responses against SARS will be about more than just the disease.
• D. George Joseph is a doctoral candidate in the history of medicine at the Yale University School of Medicine.