Public health ethics


An article in today’s Dallas Morning News about H1N1 influenza did a pretty good job of covering the bases: vaccination (and vaccine safety and availability), prevention, and the possible effect of a pandemic on the ability of health providers to care for large numbers of flu sufferers. This part of the story caught my eye:

Last spring, news stories popped up about airlines pulling sick passengers from planes as a precaution against spreading the H1N1 virus. We could well see repeats of this scenario: ushers asking sick people to leave the theater, bus drivers yanking people out of their seats and depositing them onto the street.

These enforcement tactics are unethical, according to Carlo, who also is an expert in the esoteric realm of public health ethics. He said that removing symptomatic people from public places is discriminatory. For every sneezing and coughing person in a public place, there may be another contagious person who shows no symptoms at all but is just as dangerous as the sneezing person.

Carlo’s opinion is based on research in which flu patients report that they were never around anyone who appeared to be sick before they themselves got sick.

“Hence, asymptomatic transmission is used to explain this,” he said. “It’s really unfair to take enforcement action against people who have symptoms and leave the others alone. It’s unethical.”

I am not sure I get the logic of this. Just because there are infected people out there who are asymptomatic and therefore unknown to us, we can’t deal with the infected people who are symptomatic and therefore identifiable? Is that how we deal with TB? If the reason we isolate TB patients, even though there are others with TB who are asymptomatic and unknown to us, is because the threat to public health is greater than appears to be the case with H1N1 influenza, then fine, that’s a distinction I understand, but it’s not the argument being made by the health department.

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