(2020/02/13)US Emergency Legal Responses to Novel Coronavirus Balancing Public Health and Civil Liberties +中文摘要轉譯

本篇文章論述,在新冠肺炎疫情告急時,政府仍有責任在公共衛生與人民自由間取得平衡。目前美國政府採取措施有:旅遊警告及撤回非必要人員、直航班機停飛或繞道、禁止2周內有中國旅遊史之非美國籍旅客入境、並對自武漢撤離之近200名美國公民進行14天之隔離。然而,強制之公衛手段仍須符合法律及道德標準:(1)此人確有傳播危險感染性疾病之風險,(2)介入措施必須能降低此風險,(3)使用限制性最小之手段,(4)強迫性措施應與風險成比例,(5)評估方法應有科學依據。在此原則下,未經個人風險評估,即禁止非美國籍旅客入境,為過當之措施。居家隔離對個人權益及隱私較為尊重,應為較合理、有效之措施。(國衛院莊淑鈞博士整理)

With increasing numbers of cases of coronavirus disease 2019 (COVID-19) globally and in the United States, Health and Human Services (HHS) Secretary Alex Azar declared a national public health emergency on January 31.1 The emergency declaration of the HHS authorizes additional resources, enhanced federal powers, interjurisdictional coordination, and waivers of specific regulations. State and local public health emergency declarations are also likely. During crises, government has a special responsibility to thoughtfully balance public health protections and civil liberties.

Public Health Risk Assessment

While epidemiological data are evolving, human-to-human transmission of COVID-19 has been documented over an incubation period of 2 to 14 days.2 Based on available data, the case fatality rate appears lower than that associated with other novel coronaviruses (severe acute respiratory syndrome [SARS] and Middle East respiratory syndrome [MERS]), likely no more than 2%. China has reported the majority of cases and deaths, especially in Wuhan and surrounding Hubei Province. The US population currently is at low risk, but infections could escalate if sustained transmission occurs. Absent rapid diagnostic tests, effective vaccines, or antiviral medications, health officials are focused on identifying cases and separating persons exposed or infected.

Emergency Health Powers

Emergency declarations enhance national or regional response capabilities through limited liability protections for first responders and volunteers; reciprocal licensure requirements; and real-time development and acquisition of countermeasures (eg, vaccines, antivirals, medical equipment). Hospitals that have staffing or supply shortages can shift to crisis standards of care.3 Declarations also expedite public health powers to test, screen, or isolate individuals and restrict travel.

The US Constitution grants primary public health powers to the states, which they may delegate to localities. Narrower federal health powers historically center on preventing spread of infectious diseases into the US or across states. However, the HHS has exercised federal powers in response to COVID-19 beyond those used for previous health emergencies such as SARS, H1N1 influenza, and Ebola. The administration premised the exercise of federal powers on the need to avert “cascading public health, economic, national security, and societal consequences.”4

Author: Lawrence O. Gostin, James G. Hodge Jr

Link: https://jamanetwork.com/journals/jama/fullarticle/2761556