Trust and Transparency in Quarantine

This post is a part of our Bioethics in the News series

By Parker Crutchfield, PhD

As of February 11, more than 1,000 people have died from the novel coronavirus, the vast majority of them in China. As the virus spreads, China has been implementing the largest quarantine in human history. The virus has spread beyond the borders of China, and has been observed in at least twenty-four countries. There is no way of knowing how effective the quarantine has been. It obviously didn’t prevent the virus’s spread, though it’s likely fewer people are infected because of it. Part of the reason that the quarantine has not worked to prevent the spread is that many in China evidently don’t trust those implementing the quarantine. About five million people left Wuhan before the quarantine locked down the city. And the images in this video are certainly not of a family trusting their government.

Trust and quarantine
A prominent account of what makes public health interventions permissible implies that public trust is necessary for public health interventions to be morally permissible. As a general rule, this is false. Public trust in Flint has been totally undermined. But in that city, public health interventions on the water supply are not only permissible, they are obligatory. So, it’s not true that trust is necessary. But that is not to say that public trust isn’t critical to the value of a public health intervention.

The value of a public health intervention, and its moral authority, is primarily a matter of the value of the benefit it achieves (the value of the cases prevented) minus the disvalue of the burdens it requires people to bear (the disvalue of social isolation). Trust may not be necessary, but it certainly impacts the benefits and burdens of a public health intervention. There is significant benefit in not having five million people evade a quarantine because they mistrust those implementing it. Who is more burdened, the family who fights tooth and nail the officials forcibly removing them from their home, or the family who goes willingly because they trust them? Mistrust creates burdens; trust promotes value. In other words, mistrust encourages people to break quarantine. If the goal is to encourage social isolation and compliance, public trust is key.

Trust and transparency
If trust is so important to the effectiveness of a quarantine, what factors promote trust? That same theory of the morality of public health interventions derives the value of transparency from the claim that transparency promotes trust. The idea is that the more open policy decisions, the more the public will trust them. As before, this is not generally true. Some research indicates that transparency actually undermines trust (De Fine Licht, 2011; Grimmelikhuijsen, 2014).

That is, the more people know about policy implementation the less they trust the people implementing it. If accurate, this research suggests instead that if we want people to trust public health policies, information should be withheld from them. This is in line with earlier research that suggests what people really want is for decision-makers to be empathetic and non-self-interested and that, if they are, for them to make mostly non-transparent decisions. People may want “stealth democracy” (Hibbing and Theiss-More, 2002).

So, probably it is not generally true that transparency promotes trust. But quarantine might be a special case. When the public already mistrusts those implementing public health policies, it’s not clear that there is any way to rebuild trust other than by being transparent. China was already in a tough spot, after their mishandling of the SARS outbreak in 2003, about which officials withheld information from the public and the global health community. Combined with the attempted silencing of the coronavirus whistleblower and his recent death, officials’ actions set the stage for a mistrustful public and less effective quarantine.

The next outbreak
Given officials’ actions in response to SARS, the public response to attempts to control coronavirus was probably never going to be trusting. Regardless of when the next outbreak occurred, the public was never going to trust the interventions to control it, whatever they happened to be. That was determined in 2003. Transparency now won’t help trust now, and so it won’t help the effectiveness of the present quarantine or any of the other interventions, such as the disinfectant now being sprayed. The damage to the present is done. Sadly, given that officials have responded like they did in 2003, interventions aimed at controlling their next outbreak, whenever that happens to be, will be upon a mistrusting public. When that time comes, if officials choose to quarantine, it seems likely that that quarantine will elicit similar responses: people will evade and resist, grabbing door frames as they are pulled from their homes. The virus will not be contained as well as it could have been, and more people will get sick and die. Present transparency could have promoted future trust, greater compliance, and prevented sickness and death, but that opportunity has come and gone.

There is a lesson for local officials as they try to intervene on the ongoing water crisis in Flint, the PFAS scare in West Michigan, and, in my hometown, the threat of mosquito-borne illness. The lesson is: transparency now purchases trust later. And that trust may prevent suffering and save lives.

Parker Crutchfield, PhD, is Associate Professor in the Program in Medical Ethics, Humanities, and Law at the Western Michigan University Homer Stryker M.D. School of Medicine, where he teaches medical ethics and provides ethics consultation. His research interests in bioethics include the epistemology of bioethics and the ethics of enhancement, gene editing, and research.

Join the discussion! Your comments and responses to this commentary are welcomed. The author will respond to all comments made by Thursday, March 5, 2020. With your participation, we hope to create discussions rich with insights from diverse perspectives.

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More Bioethics in the News from Dr. Crutchfield: Public Health Crisis Warrants Liberty Restrictions; We Should Tolerate and Regulate Clinical Use of Human Germline Editing

References

1. Shih, Gerry, Alex Hortonand Marisa Iati “Coronavirus deaths climb as China corrals sick in quarantine facilities in outbreak epicenter” (February 10, 2020). Washington Post. https://www.washingtonpost.com/world/asia_pacific/coronavirus-china-updates/2020/02/09/eb9e683c-4aa4-11ea-8a1f-de1597be6cbc_story.html.
2. Levenson, Michael. “Scale of China’s Wuhan Shutdown Is Believed to Be Without Precedent” (January 22, 2020). New York Times. https://nyti.ms/36pDxCU.
3. Ma, Josephine and Zhuang Pinghui. “5 million left Wuhan before lockdown, 1,000 new coronavirus cases expected in city” (January 26, 2020). South China Morning Post. https://www.scmp.com/news/china/society/article/3047720/chinese-premier-li-keqiang-head-coronavirus-crisis-team-outbreak.
4. Burke, Minyvonne, Suzanne Ciechalski, Leou Chen and Dawn Liu. “Video appears to show people in China forcibly taken for quarantine” (February 8, 2020). NBC News. https://www.nbcnews.com/news/world/video-appears-show-people-china-forcibly-taken-quarantine-over-coronavirus-n1133096.
5. Childress JF, Faden RR, Gaare RD, Gostin LO, Kahn J, Bonnie RJ, et al. Public Health Ethics: Mapping the Terrain. Journal of Law, Medicine and Ethics. 2002;30(2):170-8. http://journals.sagepub.com/doi/10.1111/j.1748-720X.2002.tb00384.x.
6. Fonger, Ron, Roberto Acosta and Zahra Ahmad. “It’s been 5 years. Flint still doesn’t trust the water” (April 25, 2019). MLive. https://www.mlive.com/news/2019/04/its-been-5-years-flint-still-doesnt-trust-the-water.html.
7. Markel, Howard. “Will the Largest Quarantine in History Just Make Things Worse?” (January 27, 2020). New York Times. https://nyti.ms/313KlFa.
8. De Fine Licht J. Do We Really Want to Know? The Potentially Negative Effect of Transparency in Decision Making on Perceived Legitimacy. Scandinavian Political Stud 2011;34(3):183-201. https://doi.org/10.1111/j.1467-9477.2011.00268.x.
9. Grimmelikhuijsen SG, Meijer AJ. Effects of Transparency on the Perceived Trustworthiness of a Government Organization: Evidence from an Online Experiment. Journal of Public Administration Research and Theory. 2014;24(1):137–57. https://doi.org/10.1093/jopart/mus048.
10. Hibbing JR, Theiss-Morse E, Stealth Democracy. Cambridge University Press; 2002.
11. Markel, Howard. “Why we should be skeptical of China’s coronavirus quarantine” (January 24, 2020). Washington Post. https://www.washingtonpost.com/outlook/why-we-should-be-skeptical-of-chinas-coronavirus-quarantine/2020/01/24/51b711ca-3e2d-11ea-8872-5df698785a4e_story.html.
12. Belluz, Julia. “China hid the severity of its coronavirus outbreak and muzzled whistleblowers — because it can” (February 10, 2020). Vox. https://www.vox.com/2020/2/10/21124881/coronavirus-outbreak-china-li-wenliang-world-health-organization.
13. Brueck, Hilary. “China is sending trucks to spray bleach on entire cities as the country struggles to contain the Wuhan coronavirus” (February 6, 2020). Business Insider. https://www.businessinsider.com/wuhan-coronavirus-china-dispatches-bleach-trucks-to-spray-down-cities-2020-2.
14. Malewitz, Jim.“Judge bars public from Wolverine World Wide PFAS hearing” (October 29, 2019). Bridge Magazine. https://www.bridgemi.com/michigan-environment-watch/michigan-environment-roundup-judge-bars-public-wolverine-world-wide-pfas.
15. Shamus, Kristen Jordan. “EEE virus in Michigan: Kalamazoo County opts out of pesticide spraying program” (October 1, 2019). Detroit Free Press. https://www.freep.com/story/news/local/michigan/2019/10/01/eee-virus-michigan-kalamazoo-co-opts-out-pesticide-spraying/3831934002/.
16. Crutchfield, Parker. “Opponents of mosquito spraying are the new anti-vaxxers” (September 30, 2019). MLive/Kalamazoo Gazette. https://www.mlive.com/opinion/2019/09/opponents-of-mosquito-spraying-are-the-new-anti-vaxxers-opinion.html.