Something's in the air: liberties in the face of SARS and other infectious diseases - Singapore

Reason, August, 2003 by Declan McCullagh

VISITING SINGAPORE IS a little like flying into some twisted Father Knows Best time warp. Lining the streets next to such familiar stores as Reebok, Esprit, and Timberland are government ministries with names like "Board of Film Censors," along with buildings housing the "Social Development Unit" state-run dating service and the "Home Ownership for the People Scheme."

For a few weeks in April and May, such downtown streets were speckled with gauzy white squares: mask-wearing Singaporeans fearful of catching the deadly SARS pneumonia. They had reason to be concerned. According to the World Health Organization, Sudden Acute Respiratory Syndrome kills roughly 15 to 20 percent of the people who contract it, and it had been spreading through parts of Asia faster than pirated copies of the latest Microsoft beta release. What's more, the average death rate can be misleading. SARS is an age-sensitive disease: If you're over 65 years old and you have the misfortune of being infected, the WHO believes your death-rate odds are a dismaying 50 percent or higher.

Singapore's nanny-state meddling and unabashed authoritarianism may have spared it the worst. Even though it had the third-worst outbreak of SARS, behind China and Hong Kong, Singapore's death rate was 15 percent, lower than the less severe North America outbreak centered in Toronto. (Canada's death rate, as of press time, was 17.5 percent.)

The reasons for the difference are complex and unclear. SARS has been mutating into strains of varying lethality, and a lone "super spreader" infectee can lay waste to an entire hospital that isn't properly prepared. Another explanation for Singapore's comparative success in containing SARS is its single-minded determination to take whatever steps necessary, with scant regard for such individual liberties as the right to travel and associate freely. This is the city-state the cyber-punk writer William Gibson once described as "Disneyland with the death penalty": While free trade is largely embraced, chaos is verboten. Chewing gum sales are prohibited. Sell drugs, you face the gallows. Canings are routine. Playboy, Penthouse, and Cosmo are all banned.

When SARS hit, the authoritarian proclivities of Singapore's government were channeled into aggressive quarantines. After a few possible SARS cases were identified at the popular Pasir Panjang Wholesale Market, the state took no chances. Nearly 2,000 people who had worked at the market between April 5 and April 19 were placed under mandatory home quarantine for 10 days. Health Minister Lim Hng Kiang said a team of 50 to 60 nurses would make house calls on quarantined homes, and the government would offer a daily home quarantine allowance of $41. Web cams were installed in quarantined homes for surveillance, with residents asked to step in front of the camera on demand, Anyone nabbed for flouting the quarantine was outfitted with an electronic tracking bracelet.

Medical Powers

The good news-for now-is that SARS is less of a threat than it was a few months ago, though it could return with a vengeance when winter comes to the northern hemisphere and people spend more time inside in close quarters. As of this writing (late May) there have been no confirmed SARS deaths in the U.S., and an analysis prepared by The New England Journal of Medicine indicates that the worldwide SARS growth rate is more arithmetic than exponential.

But if the virus does return, other nations besides Singapore will have to balance suggestions such as broad quarantine orders with the preservation of civil liberties and the rights to privacy, property, and freedom of movement.

What does this mean for the U.S.? What might happen is anyone's guess, but imagine if there were a serious outbreak this fall that threatened to overwheim the nation's health system. This is the kind of scenario the Centers for Disease Control and Prevention (CDC) dreads-one in which hospitals are deluged with scores or hundreds of patients showing up at the same time, As physicians in Singapore and Hong Kong found out, emergency rooms and critical care wards can be lethally efficient in spreading SARS. Government officials at the state and federal level have been warning since 9/II that the U.S. is not prepared for a biological attack. SARS appears to be natural in origin, but the effects could be the same.

So consider, as a thought experiment, what might happen in the U.S. after a major outbreak of SARS or a similar communicable disease.

We already know that President George W. Bush has signed an executive order triggering a World War I-era law that lets him add SARS to the ranks of such diseases as cholera, smallpox, and the plague. The current version of that law grew out of well-justified fears of the deadly flu epidemic of 1918m sometimes called Spanish influenza, which infected about 28 percent of all Americans and killed about 675,000-about 10 times the number of U.S. soldiers felled in battle during the war. Globally, over 30 million people died, and even President Woodrow Wilson was infected in early 1919 while negotiating the Treaty of Versailles.