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Leslie Francis is Professor of Philosophy, Professor of Law, and Adjunct Professor of Internal Medicine in the Division of Medical Ethics and Humanities at the University of Utah.  Together with Margaret P. Battin, Jay A. Jacobson and Charles B. Smith, she wrote The Patient as Victim and Vector: Ethics and Infectious Disease which explores how traditional and new issues in clinical medicine, research, public health, and health policy might look different if infectious disease were treated as central. The authors argue that both practice and policy must recognize that a patient with a communicable infectious disease is not only a victim of that disease, but also a potential vector- someone who may transmit an illness that will sicken or kill others.  In the post below Francis looks specifically at the H1N1 outbreak.

The recent outbreak of H1N1 influenza in Mexico has been greeted with great concern to prevent spread. Trips have been cancelled, travelers have been quarantined, schools have been closed, and sporting events will go uncontested. Preventing spread is important, to be sure, especially of a novel agent with unknown infectivity and lethality. But there is a down side to all the worry about spread: it encourages us to think of each other as vectors, sources of disease to be feared.

We are all vectors or potential; that’s a biological fact. But it’s only one side of our biology. We’re “way-station” selves, breeding grounds and launching pads for literally trillions of microorganisms, all the time—but we’re also recipients of them too. In short: we’re all victims,
just as we are vectors. We live in a state of perpetual uncertainty about whether we’re victims, vectors, or both, at any given time.

As we are caught up in the fear of pandemic spread, we need to remember our victim-side, too. There’s been some discussion of this in the press reports: stories of empty hotels, the cancelled U-17 Concacaf tournament, travelers quarantined in airports, workers without
childcare, or pigs slaughtered unnecessarily in Egypt. But there have been no comprehensive reminders that people stricken with the flu or suspected as vectors are victims as well and in need of support: medical care if they are ill, economic consideration if their livelihoods are
lost, and just plain concern when events that are important to them must be cancelled to enforce the social distancing that is hoped to prevent spread.

In pandemic planning, much effort has been devoted to preventing disease spread. We are seeing the importance of these measures in the current situation. As fears wane, or refocus on later, perhaps more virulent phases of an epidemic or on future emergences of new infectious diseases, however, it is equally important for us to plan for victims and to ask what we owe them. Such planning efforts may be particularly important to encourage the sharing of epidemiological data in the future, if the economic impacts on Mexico are dire and left unattended, where data sharing and international cooperation is crucial in disease control. That’s a prudential imperative, but it’s an ethical one, too. After all, we’re all in this together,working together not only to prevent the spread of infectious disease but also to mitigate the impact of disease where it strikes.

By Edward Zelinsky

The swine flu is back. Gerald Ford was president the last time Americans confronted the swine flu. In response to the current emergence of this disease, public health authorities advise us to take precautions including the avoidance of crowds and of unnecessary travel. For many Americans, the most significant exposure to the danger of communicable disease occurs at the workplace.

While this workplace-based exposure cannot be eliminated, it can be minimized. To combat swine flu, we should encourage employees to telecommute from their homes rather than travel to their employers’ offices with their attendant danger of communicable disease.

Modern technologies – the internet, email, cell phones, electronic data bases – enable many employees to work from their homes for at least part of the week. Telecommuting extends job opportunities to individuals for whom traditional commuting is difficult, for example, the disabled, parents of small children, persons who live far from major employment centers. Telecommuting is also good for the environment, reducing the carbon footprints of employees who spend some of their work days at home and need not physically commute to work on those days.

Now, telecommuting can achieve yet another important benefit by reducing individuals’ potential exposure to swine flu on the days they work at home rather than travel to their employers’ offices.

A major impediment to telecommuting is New York State’s extraterritorial taxation of nonresidents’ incomes. When a nonresident works at home for a New York employer, New York imposes income tax on the telecommuting nonresident for this out-of-state day even though the nonresident never sets foot in New York on that day and even though New York provides no public services to the nonresident telecommuter on his day working at his out-of-state home. The result of New York’s extraterritorial taxation is typically double income taxation of the nonresident for telecommuting from outside the Empire State, a classic confirmation that no good deed goes unpunished.

I am something of a poster boy for the irrationality of New York’s extraterritorial taxation of nonresident telecommuters. I am a law professor in Manhattan at the Benjamin N. Cardozo School of Law of Yeshiva University. I live in New Haven, Connecticut. When New York sought to impose its income tax on me for the days I wrote and researched at home in Connecticut, I challenged this extraterritorial tax on constitutional grounds. Virtually all independent legal commentators concluded that this challenge should have prevailed since the Due Process and Commerce Clauses of the U.S. Constitution prevent the states from taxing activity which occurs outside their respective borders.

Nevertheless, despite these constitutional principles, New York’s courts held that New York can tax me (and other telecommuters) on days worked at home outside the Empire State. New York’s Court of Appeals, that state’s highest court, specifically approved New York’s tax-based discouragement of nonresidents’ telecommuting from their out-of-state homes.

Enter the swine flu.

For the duration of swine flu problem, New York should encourage telecommuting or at least not impede it. In particular, New York Governor David Paterson should announce that, to stimulate telecommuting to combat potential exposure to the new swine flu, New York will suspend its extraterritorial income taxation of nonresidents for all days such nonresidents work at their out-of-state homes.

In any event, Congress should pass the Telecommuter Tax Fairness Act which, if enacted into law, would prevent states from taxing telecommuting nonresidents on the days they work at their out-of-state homes.

And who knows? After the swine flu danger is over, Governor Paterson and New York’s other policymakers may discover the long-term benefits to New York of reforming permanently New York’s extraterritorial (and unconstitutional) taxation of telecommuters like me.