Have the Public Health Restrictions Gone Too Far for COVID-19?

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FEBRUARY 19, 2020 — On January 31, Health and Human Services (HHS) Secretary Alex M. Azar II declared a formal public health emergency in response to the rising number of cases of coronavirus disease 2019 (COVID-19) around the world and in the United States.

The declaration allows the government to introduce temporary measures to help contain the spread of the virus. But some legal experts question the efficacy and legality of certain approaches the US government has instituted.

During such crises, the government must thoughtfully balance public health protections and civil liberties, emphasize Lawrence O. Gostin, JD, from Georgetown University Law Center, Washington, DC, and James G. Hodge Jr, JD, LLM, from the Sandra Day O’Connor College of Law, Arizona State University, Phoenix, in a viewpoint article published online February 13 in JAMA.

On the basis of current epidemiologic data, the incubation period of COVID-19 is estimated to range from 2 to 14 days. The case fatality rate seems to be 2% or less, which is lower than that associated with other novel coronaviruses (eg, severeacuterespiratorysyndrome [SARS], Middle East respiratory syndrome [MERS]).

Most cases of COVID-19 and associated deaths have occurred in China, especially in Wuhan and surrounding regions of Hubei province, Gostin and Hodge note.

The immediate health risk from COVID-19 remains low, though sustained transmission of the virus could lead to a rise in cases in the United States. With this in mind, the public health response has focused on confirming COVID-19 illness and separating individuals who are infected or have been exposed to the virus.

Despite the lower mortality rate and the limited risk to the US public, the HHS has exerted federal powers in response to COVID-19 that exceed those used in response to SARS, H1N1 influenza, and Ebola, Gostin and Hodge write. Aiming to avoid “cascading public health, economic, national security, and societal consequences,” the administration implemented travel warnings, entry bans, and border protections.

The State Department has issued stringent travel restrictions. These include a highest-level advisory against travel to China, the rerouting of direct flights from China to select US airports for health screening and self-quarantine for up to 14 days, and temporarily banning entry of at-risk foreign nationals into the United States. Major US airlines have also suspended flights to and from China.

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