The Wall Street Journal - 04.03.2020

THE WALL STREET JOURNAL. Wednesday, March 4, 2020 |A

OPINION

Covid-

May Have

You Working

At Home

By Luciana Borio

And Scott Gottlieb

T

he numbers don’t tell the

whole story. Nine Americans

have died of Covid-19, and the

Centers for Disease Control and Pre-

vention confirms more than 100

cases in 15 states. But there are

probably already several thousand

Americans who have been infected.

For now, the average person’s risk is

low in a nation of 330 million, but

that may soon change. The highest

risk is for those who live in regional

hot zones such as Washington state

or Northern California.

Measures that limit social activity

may soon be in place. China tried to

curb transmission by shutting down

entire cities and mandatory mass

quarantines. That won’t fly in the

U.S., socially or legally. Iran is taking

the opposite approach amid what

may be a wider epidemic. Tehran ap-

pears resigned to letting the virus

rage through the country’s popula-

tion. Iran’s official reports say there

are 2,300 cases in the country with

77 deaths, but the true number is

likely much higher.

There’s still a chance to delay an

American epidemic, though full con-

tainment is no longer possible. The

key is to develop a strategy of miti-

gation, which will buy time to pre-

pare hospitals, expand testing, and

develop vaccines and therapies. This

doesn’t mean the U.S. needs to ban

people from moving freely in the

country, which has happened in

China and even Italy. Public-health

authorities must develop an ap-

proach suited to American law, tech-

nology and social structures.

The original priority was tighten-

ing travel to and from China. But

travel restrictions and advisories

will become obsolete as the number

of affected countries grows. Any of

the thousands of airplanes that land

in the U.S. each day could be carry-

ing people who are infected. Airports

should remind incoming travelers to

isolate themselves and seek medical

care if they develop symptoms. Deci-

sions to travel outside the U.S. will

largely depend on factors such as in-

dividual’s risk tolerance, health sta-

tus, and the ability to access medical

care in a foreign country.

As the number of cases expands,

other time-worn public-health mea-

sures for containing disease—detect-

ing infected individuals and tracing

their contacts—will no longer be

enough. Slowing down community

spread may require aggressive steps

aimed at “social distancing”—keep-

ing people who are sick away from

others. The CDC provides guidance

to help states and cities put these

measures into place—for example,

canceling mass gatherings or closing

schools and conducting classes on-

line. But it’s up to local authorities

to decide what measures to imple-

ment. A patchwork of policies may

initially confuse the public.

The usual flu-season advice ap-

plies: Wash your hands frequently,

avoid handshakes, and try not to

touch your face. Most important, stay

home when you or someone in your

household is sick. For home isolation

and quarantine to work, employers

need to be as understanding and flex-

ible as possible. They can help by

holding videoconferences instead of

meetings and letting employees work

from home. Some may consider alter-

native schedules or staggered shifts.

These measures will be most ef-

fective if applied early and widely.

Singapore suspended mass gather-

ings at schools and eldercare facili-

ties immediately after detecting lo-

cal disease transmission. This

appears to have slowed the number

of new infections. But it is important

to acknowledge that these measures

can cost workers money and even

their jobs.

The coming weeks will be hard as

more Americans become infected

and some die of the disease. Mitiga-

tion efforts will be disruptive. But

these steps are the best defense until

innovation can produce an effective

treatment or vaccine that can arrest

the virus’s spread.

Dr. Borio is a vice president at In-

Q-Tel and was director for medical

and biodefense preparedness policy

at the National Security Council,

2017-19. Dr. Gottlieb is a resident fel-

low at the American Enterprise Insti-

tute and a partner at New Enterprise

Associates. He was commissioner of

the Food and Drug Administration,

2017-19.

Preventing the virus’s

spread will likely require

‘social distancing’ tactics

like canceling events.

A Republican Vote for Bernie Sanders

W

hat’s the best way to ease
tensions in a divided repub-
lic? Address them squarely
in a national election.
Donald Trump, longtime business-
man, versus Bernie Sanders, lifelong
socialist, would give us that once-in-
a-lifetime political contest. Both are
larger-than-life personalities whose
virtues and drawbacks are well
known. The other Democrats running
for president may differ from Mr.
Sanders only marginally on many is-
sues, but he alone genuinely personi-
fies leftist orthodoxy. That’s why he’s
still standing while so many of his
competitors have fallen.
With Mr. Sanders on the ballot, vot-
ers’ choices are suddenly stark: Do
Americans want a health-care system
with more choices and free-market
competition, or should the govern-
ment abolish private health insurance
and seize the entire industry? When
Americans are told Medicare for All

would mean the end of private insur-

ance, majorities tell pollsters they’d

rather keep their doctors.

Do we celebrate U.S. energy inde-

pendence and admire how fracking

has shrunk the country’s carbon

footprint? Or in the name of fighting

climate change should we drive every

fossil-fuel company out of business?

That’s what the Green New Deal envi-

sions, which Mr. Sanders has repeat-

edly endorsed. The senator insists on

a prohibition against fracking and

held firm when asked about the jobs

it would cost: “This is a moral issue.”

Should we discourage illegal immi-

gration, fortify our border, and en-

force the law, particularly when it

comes to illegal aliens who commit

felonies? Or should we end almost all

deportations and promise anyone

who makes it over the border free

health care and tuition-free college?

That’s Mr. Sanders’s current posi-

tion—a switcheroo from five years

ago.

Are we one nation bound by a

common creed of equal rights and

responsibilities? That’s the conserva-

tive position today—and was the lib-

eral belief half a century ago. Or are

Americans primarily defined by their

race, sex, religion and sexual orienta-

tion? That’s the contemporary pro-

gressive vision, driven by the ideol-

ogy of identity politics.

Each of these positions fundamen-

tally contradicts the other. There’s

no real compromise to be had.

So let’s have a six-month-long, im-

passioned debate over the future of

our country. At the end of it all, our

differences may remain, but they’ll be

tempered by the will of the people.

The candidate at the top of the

ticket can determine down-ballot

races too. If Mr. Trump fires up GOP

voters and independents, it could

mean more Republican governors,

representatives, senators and state

legislators. If Mr. Sanders is right and

his bold agenda inspires voters out of

their apathy, down-ballot Democrats

could benefit from his new majority.

Let’s find out.

When Washington state holds its

primary on March 10, I’ll be a Demo-

crat for a day and vote for Mr. Sand-

ers. Washington allows voters to se-

lect any candidate, so long as they

pledge not to also participate in the

presidential nomination process of

another party. My goal isn’t to make

mischief, but to help force a choice

America needs to make: Freedom or

socialism?

Mr. Carlson, a co-founder of

Washington Policy Center, hosts a

morning radio show in Seattle on 570

KVI.

I’ll cast a ballot for him

next week so Americans

will have a clear choice

next November.

By John Carlson

P

rime Minister Benjamin
Netanyahu declared vic-
tory in Monday’s Israeli
election, the third since
April, following two incon-
clusive results. Although Mr. Netan-
yahu may be frustrated in his at-
tempt to form a government, his
Likud Party won 35 seats, a strong
showing. During the campaign, Likud
candidates stressed their support for
President Trump’s “Peace to Pros-
perity” plan, unveiled in January.
The plan won’t bring peace between
Israelis and Palestinians, but it may
expose deeper processes of change
under way in the Middle East. It
could even advance those changes—
and Israel stands to benefit.
Both the Palestinian cause and
the broader Arab political bloc that
long championed it are in disarray.
The Palestinians are divided geo-
graphically, each group locked in
with divergent interests and
strategies.

Gaza has been ruled as an Isla-
mist enclave by Hamas for 13 years.
The movement’s first generation of
leaders is now retiring; Khaled
Mashal stepped down in 2017 and is
set to spend his golden years in his
villa in Doha, Qatar. The upshot is
that Hamas-controlled Gaza is no
longer a provisional entity. Hamas
maintains its rule as an example of
uncompromising Islamist resistance
to Israel, trimmed where necessary
according to the needs of Egypt and
Qatar, who respectively control ac-
cess to and financing of the Hamas
enclave.
Palestinians in the West Bank live
mainly under the administrative
control of the Palestinian Authority,

Israel’s New Diplomatic Moment

which is run by an unpopular but

immovable elite. President Mahmoud

Abbas hasn’t held an election since

2005, and security is handled be-

tween his Jordan-trained police

force and the Israel Defense Forces.

Mr. Abbas pursues a strategy of de-

nouncing Israeli policy in all avail-

able forums while quietly cooperat-

ing with the security structures that

keep Hamas and other Islamists at

bay.

Jerusalem’s Palestinians remain

in a kind of limbo. Israel places bar-

riers before their acquisition of full

citizenship, and they can complain

justly of large discrepancies in mu-

nicipal funding. Still, something is

stirring from below. The number of

Palestinian Jerusalemites electing to

educate their children in schools of-

fering an Israeli matriculation exam

is tripling each year, according to

David Koren, an Education Ministry

official. Hebrew courses for Arabs

are flourishing. Given the choice,

Jerusalem’s Palestinians are choos-

ing attachment to stable, First

World Israel over absorption into

the corrupt, dysfunctional Palestin-

ian Authority.

This trend is even clearer among

Israel’s Arab citizens, especially its

rising middle class. The furious reac-

tion among Israeli Arabs in the “Tri-

angle”—an area the Trump peace

plan suggests a future Palestinian

state might include—says it all.

Sha’a Mansour Massarwa, mayor of

the Arab city of Tayibe, described

the proposal as a “nightmare.”

What can unify Arabs in Gaza, the

West Bank, Jerusalem and the rest

of Israel? Religious beliefs and per-

ceptions of a threat to Jerusalem’s

al-Aqsa Mosque cross boundaries.

But the pattern of Palestinians com-

partmentalizing themselves is as un-

mistakable as it is disastrous for re-

vanchist Palestinian nationalism.

The internal weakening has been

made worse by external develop-

ments. The Palestinian cause used to

be the great standard of Arab na-

tionalism, uniting Arab police states

in their rejection of Israel. But Sad-

dam Hussein’s Iraq is by now a dis-

tant memory. Bashar Assad presides

over rubble in Syria. Moammar Gad-

hafi’s Libya is broken up. Egypt is Is-

rael’s strategic partner, enforcing its

own partial blockade of Gaza.

The eclipse of the power edifice

that stood behind the Palestinian

cause is raising new possibilities.

While the Arab League predictably

rejected the Trump peace plan, the

responses of individual Arab states,

particularly in the Persian Gulf, were

more nuanced.

Yousef Al Otaiba, the United Arab

Emirates’ ambassador to the U.S.,

tweeted after the plan’s release that it

was “a serious initiative that ad-

dresses many issues raised over the

years” and “an important starting

point.” Mr. Otaiba, along with the am-

bassadors of Bahrain and Oman, at-

tended Mr. Trump’s unveiling of the

plan. Saudi Arabia, Egypt and Mo-

rocco also cautiously praised the U.S.

effort and some of its elements. Ab-

dullah Bin-Zayed, foreign minister of

the U.A.E., shared an article on Twit-

ter about the emerging alliance be-

tween Israel and the Gulf states.

The Gulf monarchies have clear

interests in closer relations with Is-

rael, centering on shared concerns

about Iran and Sunni political Islam.

The need to pay lip service to the

Palestinian cause now constitutes a

barrier to closer relations. But a

stance that criticizes some parts of

the Trump plan while encouraging

the Palestinians to work with it

could thread the needle. The talk be-

hind the scenes is now of nonbellig-

erency agreements, open economic

and business ties, overflights and

visits of trade delegations between

the Gulf states and Israel.

It has fallen to Iran and Turkey to

continue the Palestinian fight. Iran

supplies the missiles that enable its

clients in Lebanon and Gaza to

threaten Israel. Turkey offers Hamas

a haven and pursues a “soft war” in

Jerusalem, investing in property,

nongovernmental organizations and

projects intended to reverse the nor-

malization of Israeli rule.

That non-Arab states must take

up the Arab world’s traditional ban-

ner confirms it: The old Arab order

is gone, and Mr. Trump’s plan may

usher its departure into the daylight.

If Mr. Netanyahu can assemble a co-

alition at home, he’ll be first in line

to reap the diplomatic fruits abroad.

Mr. Spyer is director of the Mid-

dle East Center for Reporting and

Analysis and a research fellow at the

Jerusalem Institute for Strategy and

Security and at the Middle East Fo-

rum. He is author of “Days of the

Fall: A Reporter’s Journey in the

Syria and Iraq Wars.”

By Jonathan Spyer

ARIEL SCHALIT/ASSOCIATED PRESS

Trump’s peace plan calls

attention to Palestinian

division and the collapse

of the Arab political order.

Netanyahu (with his wife, Sarah) declares victory Monday.

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The OB-GYNs Who Play Politics With Women’s Lives

A

s the Supreme Court gets
ready to hear another abortion
case, the American College of
Obstetricians and Gynecologists—the
specialty’s main professional organi-
zation—has weighed in with a
friend-of-the-court brief. ACOG is of-
fering a medically unsound recom-
mendation in the furtherance of its
extreme position on abortion.
At issue inJune Medical Services
v. Russois a Louisiana law requiring
abortion providers to have admit-
ting privileges at a hospital within
30 miles of the site of the abortion.
ACOG’s brief argues that the re-
quirement isn’t “medically justified”
and therefore constitutes an “undue

burden” on a woman’s right to

abortion.

Yet every second counts in an ob-

stetric emergency. A pregnant

woman experiencing severe uterine

hemorrhage can bleed to death in as

little as 10 minutes. That’s why its

essential that anyone performing an

abortion have the ability to admit a

patient to a nearby hospital—prefer-

ably one closer than 30 miles away.

ACOG routinely puts politics

ahead of medicine by adopting the

most extreme positions on abortion.

It has lobbied and briefed against

parental notification of minors and

informed-consent laws, and in favor

of taxpayer-funded abortion. It has

advocated for laws restricting

speech around clinics and compel-

ling pro-life pregnancy centers to

tell women where they can go to ob-

tain state-subsidized abortions.

ACOG’s work has gotten so political

that in 2008 it added a lobbying

arm. I was refused when I asked if I

could direct our dues only to the or-

ganization’s nonlobbying arm.

Eighty-six percent of OB-GYNs

don’t perform abortions, but ACOG’s

position is that you either support

the most extreme abortion lobbying

or you’re off the island. Most of

ACOG’s abortion advocacy is under-

taken free of consultation with its

almost 60,000 members. Physicians

who’ve left the organization, like

me, support its general work but

don’t want to support abortion lob-

bying, especially when it comes to

watering down or eliminating safety

standards.

When a woman is brought into

the hospital experiencing post-

abortive complications, she is likely

to see a doctor like me—an OB-GYN

hospitalist—with whom she has no

previous relationship. Rarely do pa-

tients arrive with a medical file; of-

ten there hasn’t been so much as a

phone call from the clinic. By the

time I see a patient, she has typically

wasted precious time—hours in

some cases—filling out forms and

navigating the emergency room.

In any practice area other than

abortion, a doctor performing an op-

eration would have hospital-admit-

ting privileges. In the case of compli-

cations that doctor would, at a

minimum, call ahead to fast-track

the patient to the appropriate emer-

gency care. Abortion-clinic patients,

on the other hand, are frequently

kicked to the curb and told to make

their own way to the emergency

room.

ACOG’s own committee on patient

safety and quality improvement rec-

ommended in 2012—and reaffirmed

two years ago—that the “face-to-face

exchange of information” between

physicians is the ideal way to ensure

safety and quality of care during a

patient handoff: “In the era of col-

laborative care, effective clinician-

to-clinician communication is impor-

tant to facilitate continuity of care,

eliminate preventable errors, and

provide a safe patient environment.”

In my experience, there’s seldom

any clinician-to-clinician communi-

cation between an abortion provider

and an emergency-room doctor. This

puts women at risk of serious harm,

even death. To decrease a woman’s

risk of dying from obstetric hemor-

rhage, a qualified physician should

initiate treatment within minutes

and a hysterectomy, if needed,

should be performed within an hour.

This requires a quick and seamless

patient hand-off between two cre-

dentialed physicians. If ACOG truly

cares about women’s rights, it

should demand they be provided

that level of care.

Dr. Francis is a board-certified

obstetrician-gynecologist and the

chairman of the board of the Ameri-

can Association of Prolife OB/GYNs.

Abortion is more important

than safety to the American

College of Obstetricians

and Gynecologists.

By Christina Francis