Nothing is 100% sure in science, but, like fastening your seat belt, doctors play the odds to keep their patients and the public as safe as possible. Fortunately, many decisions are obvious. For example, the chance of getting lung cancer is 25% for smokers but only 1% for non-smokers, so not smoking is the safer choice. Even secondhand smoke raises risks significantly, so smoking in public places is no longer allowed.

Vaccines also have favorable odds.

For example, vaccines against the measles and polio viruses are 97% and 99% effective, respectively. Polio, once a feared childhood disease, crossed the United States each summer, causing death or paralysis to 15,000 children annually. Like COVID-19, personal safety was the only prevention, so places such as public swimming pools were often off-limits (parental choice) or closed (town choice) to prevent community infection. Fortunately, virologist Jonas Salk was able to develop a vaccine in the 1950s which ended that terrible disease. Older readers may recall being part of the clinical trials for that vaccine in grade school.

Herd immunity is easily misunderstood, as it may be achieved by either vaccination or infection with, exceptions to both.

Viruses reproduce by hijacking the genetic machinery of a living host. But, if enough people are vaccinated (95% for measles), the virus can’t easily find a host “in the herd” and will die out.

Herd immunity can also occur naturally if enough people are infected and develop antibodies. For COVID-19, about 70%, or 200 million people in the U.S., would need to get sick, resulting in overwhelming medical, social and economic problems and millions of deaths (source, Mayo Clinic). Nature is not always kind, so immunity by vaccination is, by far, the safer choice. Until then, the best way to slow the virus is basic prevention by avoiding crowds, social distancing, mask-wearing and washing hands.

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Ultimately, public health involves questions of social responsibility (ethics) and individual choice.

For example, do individuals have the right to do whatever they want if their actions harm others, such as smoking in public or texting while driving?

Ethics teaches that “with freedom comes responsibility” and that a simple way to determine responsible behavior is to ask, “If everyone behaves my way, will the result be better or worse?”

For example, if everyone texts while driving, accidents will soar, so texting is not the responsible choice. Conversely, if nobody vaccinates their children against measles or polio, those diseases will return, so vaccination is the responsible choice.

Similarly, if nobody wears masks, COVID-19 will surge and more will die, so mask-wearing is the responsible choice.

Medical ethics does respect individual rights when only the individual is affected, such as one’s right to refuse medical treatment. But for matters of public health where one’s actions also affect others, personal behaviors which benefit the whole community are the responsible choice.

Ken Sawyer is a former science teacher and educator who lives in Wilton.


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