Hindsight, Irony, and the Ethical: A Commentary on Pandemics, Social Distancing, and Community Mitigation Strategies Involving African American Clergy

Hindsight is said to be 20/20. I am unsure if I agree with this adage because often the intentions of certain actors in a narrative are invisible to hindsight's gaze. Yet restrospection sometimes yields insights unseen as events emerge and unfold. In this way, hindsight may have even better than 20/20 vision. It should be agreed that the efficacy of hindsight varies depending upon one's exposure to the facts.

With this as a guiding thought, I considered the remarks given by federal, state, and local health officials at the conference hosted by the Interdenominational Theological Center in January 2008: Pandemic Influenza and an Emergency Response: Reaching the Beloved Community. As I studied the transcript of morning presentations, I was deeply troubled by what appeared to be the unfurling of an imminent and certain catastrophe of epic proportions, a call for full African American clerical investment in containment efforts, but absolutely no commitment or allocation of resources to carry out objectives that these governmental agencies were mandated and funded to execute.

The federal health official representing the Centers for Disease Control and Prevention (CDC) began by chronicling a brief history of influenza pandemics in the 20th century. He recounted how the 1918 pandemic killed between 40 and 50 million people worldwide, while the 1957 and 1968 pandemics killed between one and two million people, respectively. The speaker went on to argue that whereas it could not be known exactly when the next massive influenza outbreak would occur, because the observation that they tend to occur every 40 years is only a statistical generalization; quoting Michael Leavitt (then U.S. Secretary of Health and Human Services) the speaker asserted, "We are overdue and underprepared for the next pandemic" (transcript, pg. 4). Using the full weight of the federal government's perceived "greater knowledge differential," the canvas was prepared to lay out in broad strokes a plan for an emergency response to an anticipated, contemporary influenza pandemic.

The first two lines of defense, antiviral medications and vaccines, were dismissed as largely ineffective first responses. The reasons given were that antiviral medications might not work and that vaccines take time to produce, thereby lessening their potential as a core around which a robust, initial emergency response to a pandemic could be built. From there, the federal health official presented a program for "community mitigation strategies" that were held as more viable frontline approaches to an ensuing outbreak. Around 15 minutes into the transcription, he listed some of the steps these strategies would entail:

So let me just outline what the CDC's community mitigation strategies involve. One, dismissing children from schools and closing childcare. Two, asking sick people to stay at home, and asking people who have a household member who is sick to also stay at home and third, we'll call social distancing and work in the community and I'm going to talk more about this.

(Transcript, pg. 5)

It is perfectly understandable that steps to minimize spread of pandemic infection would involve some sort of social distancing; that is, self or societal quarantine of sick individuals to obstruct widespread communication of germs to uninfected populations. Simultaneously, such language immediately arrests my sensibilities regarding impoverished, working-poor, and middle-class people for whom adopting this approach would severely damage the fragile balance of their lives.

Even though the federal health official's portrayal was a sketch, it seemed to presuppose that people, while incubating themselves to prevent the spread of influenza, will have enough money and food to survive prolonged isolation in a way that does not unalterably damage their futures. Naturally, if death by influenza is the alternative, this is a non-issue. But as was conveyed in the second presentation by a state public health official, "If we have an attack rate as we would expect of around 30%, the numbers for Georgia mean that we're going to have about three million people who are going...