I recently attended a fascinating talk by Prof. Judith W. Leavett, Emeritus, from the University of Wisconsin courtesy of No. 7 Bedford Row Chambers. In the talk the Professor raised some interesting issues which I propose to mention here not least because of where we are with the pandemic but also because it could help us appreciate what other factors might impede on the management of this crisis. It seems there are lessons to be learnt from history.
The three lessons from the Mary Mallon story for Covid-19 are set out below.
The labelling and indirect stigmatisation of people. Mary Mallon became known as typhoid Mary. Transformation from Mary Mallon into typhoid Mary meant the control of her disease much more difficult and this may have impacted on her response as well as her willingness to engage with the public health bodies.
The pros and cons of isolation especially when this is for a prolonged period.
The issue of blame, who do we blame and why do we blame if we have a situation like Covid19 ?
The overall theme as per Prof. Leavett was that trust and justice are essential to successful public health programmes. Her view being people who know history can make better choices.
We recognise there is a difficult dilemma between individual liberty and public health. It cannot easily be resolved as there is no easy answer but we can collectively do our best to ensure equity and fairness for all stakeholders.
The story of ‘Typhoid Mary’ is an example to modern public health policy. Of course typhoid fever is different to Covid-19. Typhoid fever is a bacterial diseases transmitted through food and water that gets contaminated. At the turn of the 20th century there were 3,000 to 5,000 new typhoid cases each year. People with no symptoms could still be transmitters. So a bit like Covid-19 asymptomatic people can still be carriers of the coronavirus.
Mary Mallon was born in Ireland in 1868 came to USA 1883 like many Irish women back then she took domestic work and became a cook. This was the highest paid job in domestic work. She worked for wealthy families as a cook from 1987 to 1907 but from 1907 she was isolated on an island. She appeared before a judge who concluded it was fine to keep her isolation in 1910. By now she was in her 30s and was allowed to return to society so long as she did not work as a cook . She did not work for 5 years but she went back to work again as a cook this led to her being forced into isolation again from 1915 and 1938. In total she spent 26 years of her life in isolation.
During her life she fought bitterly against her arrest. At first she was detained in an infectious disease hospital but a health inspector brought her into isolation. Mary felt the law was against her.
On the island she was given a bungalow but when she returned to work as a cook again she found herself in total isolation. During this period she was an intermittent carrier for typhoid fever.
This story highlights the issue that seemingly healthy people can be carriers so a bit like Covid-19. To help manage this co-operation is important. She was described as Typhoid Mary and described as a dangerous person as opposed to a healthy person who was a carrier. This made it hard to help her as it was dehumanising to her and the stigma followed her all her life. The power to identify is linked to the power to control.
Mary said she was Mary Mallon not Typhoid Mary. She was made to feel like a victim. She was made to feel she did this intentionally which was not the case at all. The fact that she felt discriminated against led to resistance and perhaps an unwillingness to engage. Now she was already vulnerable being on the lower part of the social ladder so she did not have others to protect her interest.
The lessons from this is that we can avoid the same mistakes from the past. Past history can help us better manage crisis in the future such as Covid-19. Not all healthy carriers can be isolated as it would be inappropriate. We should not label the virus as the China virus either. Identifying the wearing of the mask as weakness can led to some not wearing it.
Stigma and discrimination are enemies of public health. Isolation is a typical response from public health though this can be usually a temporary denial of liberty to protect others. Mumps, measles and chicken pox patients used to be isolated. Concerns for those affected must take place above those unaffected but aren’t we all important. Safeguards and abuse are issues that should be balanced. The problem with isolation is that it does not usually by itself stop all infections but it might give a false sense of security. There is a dilemma when isolation is the best course but how do we do this without taking people’s civil liberties?
Sadly, isolation usually affect those socially deprived. In Mary’s case she could have been retrained in a job that did not involve food preparation. They did that for men who were carriers. They could have given her a financial incentive to not work as a cook or to re train. This would have been a more equitable way of supporting her rather than forcing her into isolation.
On the issue of blame it is not about who is to blame but it is more to do with how can the public work in harmony with all relevant agencies for their own safety and for the safety of others. If we build trust people are more inclined to co-operate. Fairness and justice will ensure no group feels ostracized. When Mary returned to her job as a cook she lost public sympathy and it came across as if she had deliberately acted in a way so as to throw away her ‘freedom’. She was physically separated all that she was familiar with. There was no welfare system to support her which meant she went back into the work she knew. Was she to blame or was it the health officials or was there shared blame? If economic security is taken care of people are more likely to co-operate with public health officials.
When we hear of riots and of those standing in line for vaccinations we see two contrast. Of course it is appreciated that we have to strike a balance between individual liberty and the common good.
Health of the public should be promoted while respecting individual rights and liberty as they have a right to dignity and information.
With Covid-19 it is important we avoid direct or indirect stigmatisation by race, occupation, age, ethnicity, gender or religion. It is equally important that justice and fairness prevails and the emphasis should be on education, equity, co-operation and trust to move forward so that everyone acts responsibly. Of course some will not buy into public health authority guidance but this does not mean we should not strive to get the balance right.
This article is for general information only and does not constitute legal or professional advice. Please note that the law may have changed since this article was published.
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