Since the outbreak of COVID-19, many of us have encountered limitations on our choices and behaviors that would have been hard to imagine just a year ago. In an effort to curb the spread of the disease, limits have been placed on travel, social gatherings, and occupancy in places of business. The wearing of masks and social distancing have been mandated. Thousands of elective surgeries have been postponed and schools have gone virtual, all to stem the rising tide of illness and death.
While the limits and mandates are designed and intended for our good, they have met resistance. This should come as no surprise. People naturally resist restrictions on activities they find pleasurable or meaningful and likewise resist mandates to do certain things even when it can be shown that doing those things is in their best interests. Just ask any doctor, nurse or pharmacist — patients are notoriously non-compliant when it comes to taking their medicine as prescribed or following through on recommendations to diet, exercise more, or quit substance use.
The response to the limits and mandates associated with COVID-19 strongly resemble responses to previous attempts to influence health behavior. There were many anti-maskers during the Spanish flu outbreak just over 100 years ago. The slightly more recent attempt to improve public health known as Prohibition also provides intriguing parallels to our current experience.
Prohibition officially began with the passage of the Volstead Act, which put teeth into the Eighteenth Amendment. The 18th Amendment prohibited the sale and manufacture of alcoholic beverages and was ultimately overturned by the Twenty-first Amendment. However, for over a dozen years the United States was (in theory, if not in reality) “dry.”
Among the most interesting parallels between Prohibition and our current set of limitations and mandates are the following:
1. Then, as now, most people complied. Those who didn’t got much more attention in the press, but most folks adapted to the new requirements.
2. The restrictions yielded real benefits. During Prohibition, rates of cirrhosis, alcoholic psychosis and even infant mortality decreased significantly, as did absenteeism from work and public drunkenness. 18 million U.S. COVID cases and 320,000 deaths (as of Dec. 22) are staggering numbers, but it is important to recall that without quarantine, masks, and social distancing, COVID was expected to sicken over 250 million Americans and to cause over two million American deaths.
3. Over time, resistance increases for a variety of reasons, including economic ones. One of the major reasons Prohibition was discontinued was the fact that taxes on alcohol were a major source of government income at the federal, state and local levels. That money was lost when Prohibition was enacted, and after the Great Depression struck, alcohol taxes were recognized as a possible remedy for drastically reduced government income. In our time, the COVID restrictions have had a negative influence on employment and business income, while the government has spent enormous amounts on relief.
4. Both then and now, the imposition of limits and mandates generated political divisions. During Prohibition, politicians who opposed the restrictions were known as “wets.” In addition to pointing out the revenue potential of alcohol taxes, they argued Prohibition was a violation of individual freedom and contributed to a rise in organized crime. Current arguments also focus on individual freedoms and claims that the limits and mandates do more harm than good.
5. The experience of the restrictions associated with Prohibition and COVID were/are experienced differently by different economic classes. Prohibition, the wealthy still had ready legal access to alcohol, either from stockpiles they gathered before the law took effect or by paying doctors who granted them prescriptions for “medicinal” alcohol. In 2020, the wealthy have been least impacted economically and have been able to manage the various disruptions in their lives more effectively. Meanwhile, the poor — who tend to suffer from more pre-existing health problems — have experienced higher rates of morbidity and mortality from COVID.
Ultimately, Prohibition proved unsustainable. We could expect the same regarding the limits and mandates associated with COVID, if they were to last as long as Prohibition did. Fortunately, we are now seeing the rollout of a vaccination program that should bring this current crisis to an end, hopefully within 6 months or so. The limits and mandates, while burdensome, are yielding real benefits. So let’s hang in there just a little longer.
James Benedict writes from New Windsor. He is a scholar in residence with the Center for Global Health Ethics at Duquesne University.