Without poetry our science will appear incomplete; and most of what now passes for religion and philosophy will be replaced by poetry.
Public Health constitutes one basic element and practical ingredient for mankind’s hope for the future.
(Skopje Declaration: Public Health, Peace and Human Rights)
World, of course, it’s not your fault. Things happen. And boy, did this “thing” happen.
Autocratic regimes are seriously handicapped by sociopathic narcissistic leaders who are incapable of understanding the health consequences of infectious diseases or the impact on their population.
I would argue that the most signiﬁcant driving forces damaging to population health are enormous levels of inequality coupled with reluctant political recognition for public health and a rejection of the wisdom of the golden mean. Socio-economic inequalities can be exacerbated in a disaster and find expression in the damaging outcome and now demonstrated with the COVID pandemic. With advancing environmental crisis in the time of COVID, inequality can only get worse; society is being pushed and nudged towards increasing instability by an inadequate system. The system demonstrates riches for the few, enormous profits and corruption as well as tremendous insensitivity towards the many with crumbs for their families and a fragile and failing safety net. Inequality blocks appropriate social progress, puts a brake on development and augments instability. While COVID undermines population health and economics it just might illuminate a road to a better future. Without a determined concerted effort it will be, a slight, might. We live at a time when the policy is applied without preparation such as with austerity and now COVID.
COVID-19 can’t be blamed for all sins, but who should be blamed for COVID? Dying gasping for breath, horrifies, while accumulating patient information shows that SARS-CoV-2 can attack other organ systems, besides the lungs. With global lockdown, psychological issues have increased underscoring Homer’s phrase there is nothing alive more agonized than man. We see science (interdisciplinary public health) telling COVID as it really is, while the government is business much as usual. Politics offers empty reassurances while escalating multilevel tensions between America and China. While the international community needs retrofitting, it seems reckless and nothing less than reprehensible to undermine the World Health Organization. To jeopardize trust in the World Health Organization at this the time of COVID to cover up failure at home with suggestions that it is somehow connected to the Chinese Communist Party or that Ethiopia is in the pocket of China is reckless and reprehensible; the world has little else going for it. Its parent body, the United Nations has done incredible things for women, children, education, health and philosophy and strengthened the concepts of health for all, a society for all ages and the sustainable development goals. In the skirmishes, these are being forgotten. No less reprehensible is a priest or church that defends communion in the time of Coronavirus.
In the post-SARS period, much more could have been done in preparation to deal with expected-unexpected SARS-CoV-2. Garret‘s advice that ultimately, humanity will have to change its perspective on its place in Earth’s ecology if the species hopes to stave off or survive the next plague has been treated far too lightly. Plagues came, MERS and Ebola, and then late in 2019, COVID. This time around the Coronavirus has taken hundreds of thousands of lives in about four months striking at the more vulnerable citizens of the 3rd and 4th worlds where death is an ongoing affair with or without the virus. Now, in the time of response to SARS-CoV-2, we have to deal with climate change and its denied threat as well as staggering levels of migration, which is resettlement elsewhere as the only practical policy and possible path, in flight from violent death.
Nothing though can compare to potential devastation posed by nuclear weapons. They are the greatest hazard to life on earth. The risk of absolute disaster is close to one or close to certainty. Should a nuclear weapons launch button be pressed, by accident or intent, time will have run out on humanity; any planning of disaster preparation and the protection of people and society for tomorrow will have no meaning. At the dreaded moment, millions of years of evolution will unravel and human consciousness and culture will disintegrate. Then, there will be no further need for the olive branch. At 90 symbolic seconds to midnight, the world is in grave danger.
No longer will there be a need to lower the ongoing pandemic’s peak, examine the differences between institutionalized public health and clinical medicine within epidemiology, or try to reverse the political denial of global warming or the rejection by mothers of child vaccination. In the absence of all reasons, there will be nothing left to fight inequality, understand vulnerability or ask why a virus interacts differently in two different hosts. There will be no more haves and have nots; no filthy rich, no dirty and abject poor and not one religion. Oh that the gods should die.
Should a nuclear war erupt, science will cease to be practiced and all the bold initiatives and innovative problem-solving underway for the second wave of COVID or a coming crisis will be deprived of meaning. Hiroshima’s blast of nuclear light, brighter than a thousand suns drenched an actress of incredible beauty, a national icon. She was one kilometer removed from the nuclear epicenter. After regaining senses, her one thought was to reach Tokyo, to inform the Emperor of the horror. She made it to the river, floated down it for some time and was then pulled out by soldiers. Two weeks later, in Tokyo, her skin was gone, corroded; she had no hair; nothing remained of her youth and beauty. No beauty, no beholder.
The Utstein Template (UT) was developed under the guidance of Marvin Birnbaum (USA) and Knut Ole Sundnes (Norway), through the WHO Center, Kobe (Japan) and under the umbrella of WADEM; it was a global effort. It added several parameters to disaster’s analysis and resulted in a different and interesting approach, facilitating distinctions between risk, hazard, vulnerability, mitigation. It is a practical guide to management when governments deal with a disaster. Health damage (HD) from an event is expressed as a probability (p), namely, p (HD)= ƒ (Risk)X(H)X(V). The present event is the emergence of a hazard named COVID-19. Reducing any one of the three factors minimizes damage. The ultimate objective of disaster management is to prepare ahead of a disastrous event, minimize damage when one occurs and restore society to normalcy or better still, prevent disasters happening in the first place.
At the time of SARS, we used the Utstein Template to examine its spread and trajectory from its cradle, the resulting health disturbance and applied mitigation measures to provide a road map for damage accumulation over geographical space and time. The dynamics of the Coronavirus was expressed by a theoretical construct designated the B-Curve in tribute to Skip Burkle. It would be referred to today, in terms of flattening the curve or in our jargon lowering the hump. It focused on the interrelationship between pre-Event preparedness of society (P) and vulnerability of the population (V). Management focused on what to do in readying for an event and what to do if the event occurs. Consequently, the UT is a before and after event instrument.
Based on the unexpected appearance of SARS, its global spread and then some still unknown properties we argued for the enactment and implementation of appropriate public health policy, modernization of surveillance systems and control capacities and the mandatory development of a European Union Center for Disease Control. We also called for an improved response from the international community (UN, WHO, Council of Europe, and others) with more efficient and effective coordination of global health issues. Easy to understand algorithms for decision-makers were thought necessary.
In our initial examination of COVID-19, we did not know that its IQ would be higher than that of SARS and no one knew for sure the future course of health damage. So we made guesstimates using information from SARS and MERS and unfolding knowledge. In our considerations of non-containment, the B Curve for global health disturbance can become “double-humped” (dromedary-bimodal) as the disease returns in waves and then remains, endemic. Today the pandemic is in its first wave, the virus still circulates and population immunity is low. Keeping a distance and following the rules can hold back or flatten the hump of a second wave. Scenarios contemplated include a worst case; health services cease to cope. This we have seen in Italy and are now seeing in Brazil where political madness prevails and jet skiing and cookouts, replace fiddling while your world burns as well as in Iran where sanctions also jeopardize health. It seems clear that the numbers are fuzzy and questionable in some country cases. Taiwan’s noted performance is a result of early management of COVID, strong public health and experience with SARS.
Evidence-based scenarios and mathematical extrapolations attempt to see into the future. They are useful but usually wrong. If fabricated at the highest level they can destabilize. Examples from past and present; weapons of mass destruction linked to Baghdad, or in COVID’s case when President Trump blames China, suggests remedies and jeopardizes the trust that we all must have in the World Health Organization. President Trump has by hunch, falsified the Coronavirus death rate as a "false number", saying the real rate is way under 1 percent. In spite of viral damage to the world and the disruption of societies in lockdown, COVID-19 presents a great learning opportunity. In a note, a friend said news inside China suggests that some nasty issues are emerging about the Coronavirus that the West knows not. I responded; many nasty things are happening in the West that should not. We both asked, will we learn? Where technological censorship and propaganda are more entrenched public health has a rougher passage.
SARS was reluctantly seen as a shining example of the success of public health and interdisciplinary science. Doctors in China were harassed by the authorities for telling the COVID story as it is while in Turkey some received jail sentences for calling war a man-made public health problem. Turkey like China is extremely autocratic having control over the population and media. Wislawa Szymborska (Nobelist in Literature) saw things clearly when he said there are those who know well what is going on and what it is all about but are pushed aside by politics to make way for those who know little and as little as nothing. All Faucies beware!
In America, considered by many, a flawed democracy, a Secretary of Health and expert witness in the US Congress once indicated that the administrative plan was to promote prevention by spending as little as possible. At the time a proposal made by D.A. Henderson was being discussed to develop a network of health-promoting and disease-preventing institutions. Henderson was the second of 3 expert witnesses called to Capitol Hill by Senator Hatch, the third was the renowned heart surgeon Denton Cooley. As Cooley entered, a Senatorial stampede occurred with Hatch out in front to touch his white coat. Meanwhile, Henderson sat through an embarrassing fuss going over his notes; a man who had saved millions of lives through smallpox eradication, while America’s Senatorial finest, was fawning over the great surgeon. Prevention always had a hard time in the arena of medicine and with property owners. In the arena of politics, it has little leverage. In Spain, a prestigious school of public health runs the gauntlet of politics while in Greece the Ministry of Education oversaw the downgrading of its historic school to a department during the previous government. President Trump is now hell bent on ridding America of Obama Care. With a distinct possibility for a second wave of the novel Coronavirus, he says that the U.S. should not issue widespread lockdowns or stay-at-home orders to fight the next outbreak. Trump says lockdown is not an acceptable answer. Much of what he says is in opposition to the advice from his top epidemiologist. In Greece the top epidemiologist went home in the wake of poetry: I can sing sometimes and there are music and scents that fascinate me, helping us through lockdown.
Andrija Štampar, founding President of the WHO remained deeply troubled whether public health would ever pay off in the China he visited, where he was both praised and chastised respectively, for services to public health and as a meddling foreign devil as well as at home, in a Yugoslavia where he was sacked by the King for incompetence. He saw government in the hands of bandits and fearful decision-makers of having to give up crumbs from their opulent tables if too much public health was allowed. The Chinese authorities turned a deaf ear when he told them that social problems cannot be solved by cannons and guns. President Xi Jinping, China called the current epidemic a devil, which we cannot let hide. President Putin took a back seat. But while much has been learned about COVID many aspects still remain unrevealed.
In the Soviet Union Nikolai Vavilov, Russian geneticist, plant geographer and man of public health looked to a future in which world hunger would be eliminated. He travelled the world on what he called a mission for all humanity collecting and storing seeds at the Institute of Plant Industry. Ironically, he died of starvation in the gulag eating frozen cabbage and moldy flour before being tossed into an unmarked grave. Vavilov was the main opponent of Stalin’s favored scientist, Lysenko who rejected Mendelian genetics, applied quack theories to improve crop yields following on from famine and a significant loss of productivity resulting from forced collectivization in several regions of the Soviet Union. Russia is also autocratic. Its low level of public health undermines development a result of a low health status and life expectancy. One has to question both its political competence to manage a serious COVID-19 epidemic and the reported death data.
The effective response that will contain COVID will also provide promise, especially to the young and restore faith in the system. We cannot be sure that the Coronavirus pandemic is under control in what is designated its first wave and we can’t be sure that the system can be repaired. In continuum the best global, regional and national response to COVID-19 comes with scholastic vigilance, transparency, no cover-up, the encouragement of global health and support of interdisciplinary public health, health diplomacy and the WHO. This would be a good start to pulling humanity through!
World Association of Disaster Emergency Medicine (WADEM)-mission is the evidence-based improvement, education, and advocacy of emergency and disaster health care and disaster risk reduction. The Utstein Template was developed under the guidance of Marvin Birnbaum and Knut Ole Sundnes sequential Presidents. Frederick "Skip" Burkle, Professor; Senior Fellow, Harvard Humanitarian Initiative was associated with both. Our B-Curve can be seen on WADEM’s web page. It was a product of a collaboration between the National School of Public Health, Greece and WADEM and covered specific projects with Egypt, Turkey and the Balkan Region.
Burkle F.M. Jr. Declining public health protections within autocratic regimes: impact on global public health security, infectious disease outbreaks, epidemics, and pandemics. Prehosp Disaster Med. 2020;35(3):237–246.
Cao Zhidong et al. Estimating the effective reproduction number of the 2019-nCoV in China, 2020.
Chappell Paul K. Peace Literacy for Navigating Struggle, Uncertainty, and Crisis, Part 9: Transcendence.
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Levett Jeffrey. Hidden Devils, Lepers and Warning Bells: we have to put our faith in science, 16 February 2020.
Levett Jeffrey. Severe Acute Respiratory Syndrome (SARS): Loud Clang of the Leper’s Bell, 2003.
Mohr Boudewijn. A destiny in the making: From Wall Street to UNICEF in Africa.
Ted Tulchinsky’s interaction with ASPHER’s position paper on COVID-19: Comments on the ASPHER Statement on the Novel Coronavirus Disease (COVID-19) Outbreak Emergency.