by Stephen P. Wood, MS,ACNP
Mary Mallon, better known as Typhoid Mary, was an asymptomatic carrier of Salmonella typhi, the organism known to cause typhoid fever. Mallon worked as a cook for eight different families in and around New York city, infecting seven of the families she worked for. There were a number of deaths in these families as typhoid had a 10% mortality rate at the time. George Soper, a sanitary engineer enlisted by one of the families affected, is credited with discovering Mallon as the source of this outbreak and he followed her around, collecting samples of her urine and fecal matter for testing.
Soper later enlisted the help of the New York Department of Health and Mallon was confined to the North Brother Island to Riverside Hospital in a cottage. She was at one point released, but returned to working as a cook, causing another outbreak at a maternity hospital. She was returned to North Brother for infinite quarantine where she eventually died.
Ethicists have debated the impact of this quarantine on Mallon’s civil rights and other carriers were later identified who were not similarly quarantined. Antibiotics to treat the disease as well as a vaccine were later developed, and typhoid is no longer a disease of concern in the United States.
The emergence of the SARS-COV2 virus and the subsequent constellation of COVID-19 disease has required people to self-quarantine and social distancing has entered the vernacular of casual conversation worldwide. Masks, a practice with dep roots in disease prevention, have been recognized as a simple and effective method to reduce disease transmission.
Despite knowing the ever-mounting data supporting masks, social distancing and handwashing to decrease spread of this disease, a new Typhoid Mary has emerged. Current United States President Donald Trump, a known symptomatic carrier of SARS-COV2 has become a public health threat, and despite warnings from his own federal health agencies, continues to put people at risk.
Trump has denounced masks, ridiculed those who wear them and even in the grips of the disease has travelled with Secret Service staff in a hermetically sealed SUV to thank onlookers outside of Walter Reed Military Hospital where he is being treated. This is a reckless act that put everyone around him, especially to his Secret Service detail and staff that serves him, at great risk.
The lack of accountability and responsibility by Trump has endangered his staff as well as the general public. He has appeared mask-less at indoor meetings, large public rallies and an array of other functions. In doing so, he has become a vector of disease and while it’s uncertain who else was affected, the First [CK1] [CK2] [SW3] Lady, several staff members as well as members of Congress in close contact are now COVID-19 positive. It is unlikely that contact tracing will be publicized[CK4] , and he in fact attended an indoor event at Bedminster golf club in New Jersey while aware that aide Hope Hicks had tested positive. He undoubtedly put hundreds of other citizens at risk during his rallies not only by not wearing a mask, but by also denouncing the science behind their use. In doing so Trump has become a public health threat.
There is precedent in the United States to civilly confine an individual with a known infectious disease. Persons with tuberculosis (TB) , in particular multi-drug resistant tuberculosis (MDR-TB) have been confined for treatment. In Greene vs. Edwards, a West Virginia statute permitted judges to civilly confine persons with active TB based upon testimony by the state board of health that (1) a person has communicable TB and (2) his/her physical condition endangers the health of others. Allowing for due process, there is precedent to enact a similar requirement for those, like Trump, with wanton disregard for the safety of others.
The Federal government and each individual state have laws that serve to protect the general well-being of their citizens. In many instances this includes language allowing for observed quarantine, compulsory treatment and even detention. Trump is a public health threat and should be under mandatory quarantine until he is no longer a risk to the general public. The message from the White House should be congruent with science and encourage mask wearing and social distancing, as the right to free speech does not extend to circumstances that create a public threat. If he cannot adhere to these measures, the very measures that ensure the safety of millions of Americans, there is a little cottage in New York that is currently vacant and ready for its next occupant.