Some medical experiments are planned. Some are not. We are in the middle of a massive unplanned medical experiment due to the new coronavirus, Covid-19, which is now infecting people in 156 countries and counting. As we wonder about the future, there are lessons to learn from our history of medical experiments.
In planned medical experiments — many of which are clinical trials run by scientists — we are supposed to get to choose whether or not we participate. Our efforts to have “informed consent” began early in the 20th century, though we didn’t accomplish much until the Nuremberg Trials, which were our reaction to Nazi war crimes, including medical experiments, of World War II. Americans like to think we’re better than the Nazis, but we began the “Tuskegee Study of Untreated Syphilis in the Negro Male” in 1932 and kept it running unchecked until 1972. The experimenters lied to nearly 400 men with syphilis by telling them they were receiving treatment, when in fact they were intentionally deprived of treatment so researchers could document how unchecked syphilis would ravage the human body. The experiment wasn’t even a secret; doctors wrote about it in medical journals and the decision was repeatedly made to keep it going even though by 1945 there was a cure, penicillin. We were able to conduct this racist and cruel experiment for so long because our society didn’t really mind. For utilitarian purposes — the pursuit of knowledge for the great population — we were willing to sacrifice certain people we considered expendable. We could have done something to protect them, but we didn’t.
During the forty years the Tuskegee experiment was running, the federal government, universities, and industry experimented on vast numbers of vulnerable people. We injected unsuspecting people in hospitals and state-run institutions with radiation. We performed experiments on newborns without their parents’ consent. We forcibly sterilized tens of thousands of poor people with the blessing of the U.S. Supreme Court. The history of medical experimentation in the U.S. reveals that we have consistently chosen to use the most vulnerable members of our population as subjects in medical experiments. Until the 1970s, when ethical standards truly began to change, we routinely used children, prisoners, the enslaved, the disabled, people of color, the poor, and the institutionalized as our research subjects.
In the case of the novel coronavirus, Covid-19, we are in the midst of an unfurling informal experiment. The virus cannot live without a “host” and we are it. We have some control over how this experiment turns out. We are all at risk of becoming sick and infecting another person. The variables that determine our risk are in our collective hands: preventing exposure and effective response to those who get sick.
We have heard disturbing stories from those who have gotten very sick, only to be told that they didn’t meet the criteria for being tested. We lack test kits. South Korea has had over 5,000 test kits for every million people; as of this week, we have 125 kits for every million people. We have now moved to the stage where state governments are looking hard at what they will do if hospitals run out of respirators and sick people must be triaged to decide, essentially, who lives and who dies. All experiments involve — or should involve — ethics, and Covid-19 is no exception.
The number of Covid-19 cases is skyrocketing because we are starting to witness a very steep, exponential growth curve. The caseload can double in less than 48 hours, as it nearly did in New York yesterday. We don’t yet have nearly enough testing capacity to identify all of the cases, but they are nonetheless there. Think of the iceberg metaphor — where we see the 10% of the iceberg above sea level, with 90% of the hulking berg out of sight below. And every day we keep learning something new, including that infected people who experience no symptoms may nonetheless have a high “viral load” and may be able to infect people around them. More than one in ten cases are currently thought to be transmitted this way.
Now that we know we’re in big trouble as a country, the steps we are taking to “flatten the curve” and have fewer Covid-19 cases over a longer period of time — so we don’t run out of hospital beds and respirators for those who need them most — are essential. And yet, some of us are balking. This can partly be attributed to mixed messages from our political leadership and, until recently, a very decentralized response. The virus is invisible, so even with information, it’s easy to think our government officials and people in general are overreacting. A PBS News Hour/Marist poll revealed that as of March 17, more than a third of Americans said the talk about the coronavirus risk was “blown out of proportion”. And more Americans think this in March than did in February, even as our caseload has exploded. At the beginning of March, we had 70 cases in the U.S. 17 days later, we have over 8,000 cases. They are burying hundreds of people every day in Italy, and what is happening there is likely to be happening in American cities soon as well.
Unless you live deep in a cave and someone drops food and supplies to you from a bucket on a long rope, the risk of being infected with Covid-19 is present for each of us. Unlike with experiments conducted in laboratory situations, we have embarked on a collective social action experiment. It’s our experiment, and the variables are how each of us behaves day by day. We need to look at how our behavior impacts the risks others are facing, as they are not equally distributed. The people on the front lines of providing essential services and goods are most at risk. These are our medical providers, the people who supply our food, and others who, because their labor is essential, cannot stay home and “shelter in place”. We owe them a special duty of care. This is our moment to show that we can do better than we did in the past. We can be the ones the history books write about as having done something truly remarkable. We can flatten the curve by following the guidelines of the public health experts, whom Americans do trust. That’s the best way to try to protect our most vulnerable workers. Ultimately, it is how we will save one another.