A group of over 450 public health experts signed a public letter today warning that widespread transmission of the Covid-19 coronavirus within the United States is “inevitable.” Their letter urges government decisionmakers to enact policies that will have the best chance of minimizing the effects of the virus: those based strictly on the best available scientific information, and those that are imposed in a fair and equitable fashion.

It is essential that all government officials follow these experts’ recommendations to help ensure a response plan that protects the health, safety, and civil liberties of all.

At the ACLU, we have always recognized that, during a disease outbreak, individual rights must sometimes give way to the greater good. After all, when it comes to disease, we are not just individuals but also one big bio-mass. That is why people can sometimes be deprived of their liberty through quarantine, for example. And this is as it should be, provided — and this is a crucial and sometimes violated condition — that the science supports the effectiveness and proportionality of measures such as quarantine. And even if a quarantine is imposed, people do not lose their due process rights, which at a minimum require that they be able to challenge their quarantine.

The public health experts remind us in their letter that there is a flip side to the limits on liberty, however. Just as a disease cares little for our notions of individualism — as crucial as they are to our happiness in other contexts — neither does it care about other artifacts of our individualistic society, such as differences in wealth, status, ethnicity, or immigration status. If the authorities want to be effective in limiting the transmission of this virus, they will need to pay particular attention to the most vulnerable people in our society.

A disease does not care who has health insurance, for example. You may have the best insurance in the world, but if 30 million others who are part of your bio-mass are not getting tested or treated because they lack insurance, that will increase your risk. Similarly, if members of immigrant communities fear they’re going to fall into the hands of an ICE officer if they seek treatment, that is a public health problem for all of us. A disease does not care who is undocumented.

In their letter, the public health experts call for officials to work with insurance companies to make sure that lack of insurance and high costs do not become a barrier to testing and treatment. They call for health care facilities to be declared as “immigration enforcement-free zones” — a step that has been taken before during hurricanes and other emergencies. And they call for extra help to be provided to under-resourced front-line hospitals and community health centers, which need more help than wealthy institutions in acquiring materials and equipment.

The experts draw attention to the need to support minimum-wage workers and others who live on the economic margins, cannot telecommute, and cannot afford to lose their job. While an office worker who is starting to feel ill may be able to self-isolate, someone in a more precarious situation may calculate the different risks they face in their life and conclude their only option is to hide their condition and head to work. A disease does not care whose employers offer good sick leave.

The experts also stress the importance of the free flow of information, stressing that “honest, transparent and timely reporting of developments will be crucial to maintaining public trust and cooperation.” Political leaders need to scrupulously ensure that their public messages are accurate and guided by science. There is a sad history of responses to emergencies that are hindered by politics, including China’s response to the SARS outbreak, China’s attempts to repress information about this outbreak, and, as millions of viewers have seen in the recent HBO series, the Soviet government’s response to the Chernobyl disaster. Open government is effective government.

Finally, the experts echo some of the longstanding lessons of their field: Voluntary self-isolation measures are more likely to induce cooperation — and therefore be effective — than coercive measures. Mandatory restrictions such as quarantines and travel bans “can be effective only under specific circumstances” and “must be guided by science, with appropriate protection of the rights of those impacted.” Those rights include due process rights to appeal confinement and the right to legal counsel. While leaders in outbreaks can be tempted to impose draconian measures as a show of strength, the letter’s signers also remind us that a disease also does not care how tough a leader looks.

The ACLU will be watching closely to make sure the government heeds these experts’ recommendations, and that its response is ​scientifically justified and no more intrusive on civil liberties than absolutely necessary.

Jay Stanley, Senior Policy Analyst, ACLU Speech, Privacy, and Technology Project

I was denied healthcare because I am transgender. The justification, according to the hospital, was that religious doctrine permits them to refuse transgender patients, just because of who we are. 

The Trump administration agrees: Over the past few years, the government has tried to greenlight sex discrimination under the guise of religious liberty. They’re doing this through a series of policy changes targeting our access to healthcare, workplaces, schools, and other spaces that we belong in, like everybody else. It seems like the administration and discriminatory healthcare providers wish that trans people didn’t even exist, but we do, and we have medical needs just like all other people.

My story is unfortunately one of many cases of sex-based discrimination that the administration is trying to allow against LGBTQ people.

In August 2016, I was in the process of undergoing gender-affirming care through a series of medical treatments. I made an appointment to undergo a treatment at Mercy San Juan Medical Center, a hospital in the Dignity Health chain, near Sacramento, California, where I live.

Two days before my appointment date, a nurse called me to go over the details, and I mentioned that I was transgender. The very next day — a day before my procedure was supposed to take place — the hospital called my doctor to inform her that the appointment had been canceled because the procedure was related to my gender transition. When I heard the news, I was so devastated that I collapsed on the floor. Once I was able to pick myself up, I remember just stumbling around the house, blinded by my tears.

I was fortunate to be able to undergo the procedure at a different hospital. But the experience left scars. I had no idea prior to this that my local, community hospital was a Catholic hospital, or that they would argue that religious doctrine permits them to prevent doctors from providing patients with the care they need just because those patients are transgender. It should never be okay to deny transgender people — or anyone else — the care we need just because of who we are.

Dignity Health is the fifth largest health system in the U.S., with billions of dollars in revenue. But according to the Trump administration, I’m a threat to Dignity Health. My life — and the lives of every other transgender American — doesn’t seem to matter to this administration. 

In California, however, the law prohibits businesses open to the general public — including hospitals — from discriminating on the basis of gender identity. In 2017, the ACLU and the law firm Covington & Burling LLP filed a lawsuit against Dignity Health on my behalf. Just last fall, a court agreed that I suffered discrimination when the hospital cancelled my surgery. The court also said that Dignity Health does not have a right to violate California’s nondiscrimination law.

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While my case has moved through the courts, the Trump administration weighed in. Less than a year after I filed my case, the Department of Health and Human Services issued the Refusal of Care Rule to support religious people and entities in limiting the care they provide to patients. HHS is supposed to protect patients and expand access to healthcare — not allow providers to use religion as a license to discriminate. In justifying their Refusal of Care Rule, the Trump administration cited three court cases that they said showed why this discriminatory rule was necessary. Mine was one of them.

My name is now in the Federal Register. The fact that the Trump administration singled me out truly knocked me down for almost a year. When I try to explain this to people, some folks think I should see this as a badge of honor; that I must be doing something right if the administration is coming after me personally. But it doesn’t feel that way to me. It’s emotionally draining, it’s overwhelming and it’s a huge burden I have to carry. The truth of the matter is that I’m still trying to process it.

The impact of the Refusal of Care Rule will reach far beyond trans people. It will profoundly impact access to reproductive health care, particularly for the millions of patients — who are disproportionately Black and Latinx — seeking options counseling and a referral for abortion in the Title X program. It’s also part of the administration’s larger goal of erasing trans people and greenlighting religious-based discrimination. 

Today, I’m speaking truth to power in Congress and defending my right and my community’s right to access healthcare. Despite the repeated efforts of the Trump administration, trans people will not be erased.

Evan Minton