Public health is a victim of its own success.
Americans used to kill each other with communicable diseases.
Now we are killing ourselves, one at a time.
We need to think of COVID as like VD, not cancer.
Disease and death used to come suddenly. Rich and poor, young and old, people caught smallpox, bubonic plague, yellow fever, polio, and a multitude of other diseases. We got them directly from each other or from some vector like fleas, mosquitoes, or bacteria from human waste. There were solutions that involved public cooperation. We had mass vaccinations. We built public sewerages. We have rules regarding wells and septic systems. It mostly worked.
My parents used to worry about polio, but by the time I was old enough to worry about it I stood in line and ate a sugar cube. Smallpox and bubonic plague were things in the history books, no more a worry than were dinosaurs. I got chicken pox, measles, and mumps, like all the kids my age, and I thought it was a rite of passage, like losing front teeth. I never really worried about Ebola, because it was so awful that Americans who had it were deathly sick and isolated in hospitals.
The exception in Americans' thinking regarding infectious diseases involves sexually transmitted ones. We know those are communicable. AIDS scared us. We know gonorrhea and syphilis are here. When I started my term as a County Commissioner I thought the county's role in controlling the spread of sexually transmitted diseases would be controversial. It wasn't. No one wanted to talk about it. Then and now, no one advocates for the God-given American right to spread gonorrhea.
Here is a 30 second clip from a Navy training film, USS VD: Ship of Shame
There has been a change in Americans' notion of where disease comes from. Except for sexually transmitted ones, disease has stopped being seen primarily as something that spreads. Disease is a consequence of lifestyle choices or unlucky DNA. Either way, it is on us.
The heart attack victim ate cheeseburgers. When a slender vegan marathoner dies young from heart disease, we see it as proof that you can't fight unlucky DNA. One does not "catch" heart disease. Nor cancer. There must have something in the environment, some chemical they ate or drank, or again, unlucky DNA. Old men get prostate cancer, so there is an explanation: They are old, and had unlucky DNA.
Good health is self-care. We value early detection; get your mammograms; get that mole checked. And of course, get regular exercise, take 10,000 steps. Since disease is on us, disease prevention is on us. If someone smokes at home or eats cheeseburgers, it is nobody's business but that person.
That brings us to COVID. The GOP/Fox News line in the sand has moved from vaccinations to "vaccine mandates." A few people criticize vaccinations per se, but most of the opposition and outrage goes like this: "We're not anti-vaxxers, but we strongly oppose vaccine mandates. Mandates are tyranny!" That position is possible because it floats atop the idea in general circulation that health decisions are inherently personal, not social. People analogize COVID to the other great killers of Americans: heart disease, cancer, diabetes, strokes, accidents. It is a false analogy. People with COVID give it to others, some of whom get very sick and die from it.
COVID is like VD. Not cancer.
At my local Costco store, people are required to put on masks as they enter. Mask-wearing is enforced at the door. Once in the store, by my count on Saturday, about 7% of shoppers take off their masks. A mask does little to protect oneself. One wears a mask to protect others. Maskless shoppers don't appear embarrassed at having taken off their masks. They look "normal" and at ease. They appear to consider COVID is a personal choice, not a social one, so going maskless is a different category from smoking a cigar, having a dog that is pooping in the aisle, or walking down the aisle pointing a loaded gun. Those would be a public act, affecting others. Surely they would be embarrassed. Going maskless is in the category of a private matter, like whether or not they had gotten a colonoscopy in the past ten years, their own business.
Thousands of Americans every year would avoid dying from colon cancer if people over age 40 got colonoscopy screens. Insurance companies encourage colonoscopies but there are no colonoscopy mandates. Colon cancer is not communicable. COVID is.