And when they bombed other people’s houses, we protested but not enough, we opposed them but not enough... In the sixth month of a disastrous reign in the house of money.
(Ilya Kaminsky, Deaf Republic, 2019)
What’s wrong with the world asked The Times of London? Dear Sirs, I am. answered G. K. Chesterton.
Covid-19 is disruptive on a scale the modern world has not seen. Lives are being destroyed and international cooperation is compromised. In the time of Covid peoples, the world over are experiencing deprivation of many kinds, economic, social, and spiritual and demonstrate great anger, anxiety and sadness. All over the world families wake up from nightmare sleep to the absence of any sense of equality or humanitarian future. To stop Covid-19 is the aim of public health by reducing its health damage to society by removal or modification, by intervention, population measures at any and all points along its timeline trajectory or ultimately by a vaccine. How effectively it is done depends on our knowledge of the hazard (Coronavirus), its associated risk to man and the degree of natural population vulnerability and immunity induced resilience as well as the level of governmental support and the efficiency of functioning of Basic Societal Functions (BSF). It depends on unity and trust. The current best evidence suggests that lockdown of some area large or small with mask-wearing, social distancing and general and personal hygiene are the best measures to curb Covid’s spread. One layman disputed measure is that of keeping schools open in lockdown; the age based probability of transmission is at the moment greater from older to younger than from children to grandparents. However, zero transmission or zero risk does not exist. Extra care is needed in long-term care facilities where older people are clustered, something little done in wave one.
Government is ill-prepared to deal with either Covid or any existential threat says Igor Kondrashin a Russian philosopher who believes that the state is managed by a political cortex of less refinement than the human higher cortex. He chides the international community (UN Security Council, UN itself, UNESCO and the WHO, World Leaders (G7, G20) and Academia and National Scientific Academies for their garbled response to Covid. He contends that it is easier to understand where existential issues come from than to find solutions. His way forward is that scholastic philosophy should give way to classical Greek philosophy.
I think that public health needs rethinking and reinventing but to do so means crossing horns with a global elite who are intent on reshaping global society to serve other purposes. While the antidote to many of Covid’s detrimental outcomes are the instruments of underfunded public health, authoritarian regimes with narcissistic leaders tied to commercial or private interests do not understand the impact of infectious diseases on population health and may actively oppose public health.
During any upheaval (war, disaster, epidemic) profits are made and courageous and humanitarian acts occur. Covid is a lucrative profit field and within a commercial and legal framework as well as illicitly. In any upheaval some get richer while many, many, more become poorer as inequality increases. WWII saw soldiers killed by friendly bullets, vast profits made by the sale of arms which left Europe in a dreadful state and need of the Marshall Plan to recover and atom bombs dropped on Japan. No Marshall Plan will god forbid help in the event of a horrendous nuclear upheaval.
In complex situations cause, effects, affects, measures and interventions can comingle into the mind and in models. In a complex problem space like Covid, we may infer that an imposed and mistaken measure like lockdown has gone viral, when only its cause a coronavirus has gone viral. Imposed and official measures to combat its spread have given rise to differing approaches and opinions in the scientific community. So far, what has been learned will be extremely useful in dealing with the second and anticipated third waves and in the problematic interval between now and the arrival of an effective vaccine? Applied solutions to space resulted from a policy which may be summarized in the first wave as lockdown (Greece), the middle way (WHO, UK) and herd immunity (Sweden). Some may accept a world controlled by big government and support lockdown; some a business dominated society and accept big tobacco as a natural stakeholder in health, some may call for less government and accept a limited public health function.
My brief perspective on Covid-19 is that:
1) it did not create a new reality but greatly aggravated what already existed and contributed to the growing social dementia or global madness that we see today;
2) economic systems rejuvenate better than people systems after a crisis;
3) public health constitutes one fundamental element and practical ingredient for mankind’s hope for the future.
With poor population health a country’s systems, function poorly, its institutions lose autonomy; health disaster preparedness and public health functions weaken. When a society is overwhelmed by catastrophe (Covid, Chernobyl, Fukushima) only the State has the capacity to protect population health. The state can also damage its people for which the concept of human security has emerged. How well the state does it is another question. A democracy does better.
These are dark times, thankfully with silver linings; many beautiful things, activities and creative undertakings, our senses will never have enough of seeing, hearing, sensing; our cultivated cognition will never cease from striving in the direction of knowing. We have much to be thankful for. We have much to be concerned about! Covid is an already opened Pandora’s Box from which we hope, a butterfly will soon emerge.
The Skopje Declaration: public health, peace and human rights (2001) codify the expression of the social conscience of public health. It proclaims a union between public health, peace and human rights, in close keeping with the value system of the United Nations, the World Health Organization and the Council of Europe. In it, we (Donev, Laaser, Levett) said, the future well-being of our one and only world, Mother Earth, resides in the prevention of violence; the eradication of poverty, and the promotion of democratic principles…. we can build a better world, closer to the human heart's desire. Its sentiment, namely, to resist narrowness in approach and all forms of discrimination was repeated in the Athens Aspher Accord (2016), an appeal to the European political world for greater support of public health and its Schools. We need intelligence, compassion, and high ideals.
In accepting the Gusi International Peace Prize (Philippines, 2019) I said that as thinking beings we have to wonder which system will collapse next: another part of the environment as a result of climate change; health from a global pandemic; a button pressed initiating nuclear conflagration? Or will it be the voice of water in every region telling of endless disaster or some other unexpected disaster for which we are ill prepared as told by poets, Hedrik Marsman and C.P. Cavafy, respectively.
Who listens? Recently funding for healthcare was cut by European Member States while a few MEPs see the need for a more ambitious EU approach to ensure that its health systems can face future threats. Who can we count on to fight against nuclear weapons and environmental catastrophe or to reduce inequality and build peace? We can count on well supported interdisciplinary public health. Under the patronage of goddess Hygiene, public health can protect the vulnerable. Peitho can persuade and Asclepius can heal.
In spite of instant media coverage but with attention mainly on Covid-19, dangerous and power hungry autocrats savour their nuclear ambitions aided by the arms race which is producing more lethal weapons supported by digital technology and artificial intelligence. It occurs to a background of deliberate cultivation of fear and violence in pursuit of political dominance. Public health says John Middleton President, Aspher, is fundamentally an issue of equality and equity, social justice and human rights. With Covid all four issues are being degraded. They are all Covid compromised! But there is hope! Hope and inspiration.
I like very much the two statements, we are waves from the same sea, leaves from the same tree, flowers from the same garden. (Public health for the future of humanity: One planet, One people, One health) and voting is a public health issue (Covid-19, Time to Reinvent Public Health). One is Chinese, the other American.
Two recent documents neither of which I have signed, namely, The Great Barrington Declaration (GBD) and The John Snow Memorandum (JSM) signed by 30,000 and 3,300 distinguished scientists, researchers and healthcare professionals respectively are stirring up the waters. They are divided by the measure of lockdown. Both aim to minimize health damage from Covid. They are also portrayed as warriors countering each other on some battlefield; one acting in self-serving criticism of lockdown policies and measures, seemingly with over-enthusiasm. They run the risk of polarizing science. Critiques of the GBD are polarized; a recipe for disaster – a turning point, a moment when the moral courage of a few broke through the pro-lockdown opinion consensus. Even so it struggles how to proceed in the face of great uncertainty. One metaphorical description for lockdown I’ve heard is burning down the building when only one room is on fire. The JSM argues that controlling the community spread of Covid-19 is the best protection until we have safe and effective vaccines and therapeutics.
They are well-intentioned and state several truths, demonstrate a willingness to consider new information and adjust Covid policy and interventions as its horizon shifts. The GBD presents an approach to better control Covid designated focused protection, which approximates to “herd immunity”. It presents what is called a more compassionate plan, a singular plan to return the world to normal life in the middle of a pandemic; a more effective and a better strategy than lockdown and that will minimize overall mortality and lessen the disproportionate burden of lockdowns in less privileged. According to the authors of the GBD focused protection will minimize mortality and limit lockdown-induced collateral damage and friendly fire on other health outcomes. Returning the world to normalcy with greater compassion a highly desirable attribute. One inference is that lockdown as a measure to reign in Covid has no justification. Certainly it may not be heeded by all groups of the population. Leaving people alone as the best way to beat the Coronavirus may be just as effective as a prayer to control Covid.
The Great Barrington Declaration (GBD) is created by Sunetra Gupta (Oxford), Jay Bhattacharya (Stanford) and Martin Kulldorff (Harvard) scientists of great expertise and its website reports over 340,000 signatories. The GBD brings public health into sharp focus through the window of one of its basic sciences, epidemiology. One difficulty is that the couplet vulnerability-resilience is a complex concept. Others include the absence of a guarantee of Covid immunity, the finding of so called long-Covid and what might happen if someone young and resilient in long Covid becomes more vulnerable. The Great Barrington Declaration poses anew the dilemma of human rights and responsibilities and returns us to the question of collective versus individual good.
I find it disquieting to think that White House officials are intrigued by a scientific treatise that calls for allowing the Coronavirus to spread naturally in order to achieve herd immunity. There are some indications that the White House may have endorsed the GBD having already politicized science and its absence of science support for climate change and health, is criticized by experts. Within such thickets lurk elements of social dementia and a place where the baloney of non-experts count in the political arena and political engagement of main stream media is dangerously influential. When politics and populism merge, fanaticism emerges and disaster is never far behind. The question now being put is whether we can trust science. Some regimes have clearly indicated that they are suspicious of scientists since they frown on transparency.
Lockdown with its fuzzy logic works and has worked well and best in China where it was massive and enforced but has created delays of other treatments, increased inequality and precipitated additional problems. Since our snapshot of the Covid situation deviates from reality but we do not know how much, until we learn more, no country is out of the woods. Comparing waves, namely, the second and third are only approximations. While the situation can get worse, life darker and living more difficult there are still many questions to answer. Lockdown-lite is necessary here and now but it may be insufficient.
In the time of Covid progress in general and in science is not held firmly in the hands of those with highly refined cortices but is influenced more or less by those who Kondrashin refers to as reptiloids and who at a different time gave hemlock to Socrates. So government that belatedly took Covid seriously has a chance to reinforce public health and health disaster management in preparation for the third wave. Science has a chance to improve its communications, strengthen its role, cultivate healthy competition, revitalize its system of evaluation and restore its dignity. It requires a strong altruistic international community. The world will become one and safe for the most vulnerable with a collective global effort.
Another phrase I like comes from the philosopher Rudolf Schmitz-Perrin: “Let’s have a first and fresh look at proposals that sincerely aim at formulating a better chance for a healthy and happier life for us all: One Humanity on One Earth. We do deserve it. Let’s claim our birthright: let us break free”.
In a succinct appraisal of the GBD James Naismith, FRS used the phrase humility and willingness to consider alternatives are hallmarks of good science, which reiterates the phrase we have an opinion… let’s consider it ... if it is not confirmed we can change it! This by Asklepios and his student Hippocrates who said first do no harm. These are concepts that characterize cultured minds, minds that have the capacity to examine a proposal without necessarily accepting it. Naismith would support the signatories giving their full consideration to all the scientific issues surrounding their prescription so that they might give more actionable policy advice. I find this sound advice.
Dengue yesterday, Covid today: Dengue fever (1927-30) in its most virulent form jumped borders and temperature zones to knock Greece off the European continent for months. In Covid’s first wave Greece succeeded though vigilance of the authorities, appropriate emergency measures and a relatively positive response of society. Greece may soon enter more stormy weather. One metaphorically stated opposition to lockdown, we do not put out a fire in an apartment by raising the building to the ground. One health disaster model (Utstein Template, WADEM) added several parameters to disaster’s analysis in an approach that facilitates distinctions between risk, hazard, vulnerability, mitigation. Health damage (HD) from Covid is expressed as a probability (p), namely, p (HD) = ƒ (Risk)X(H)X(V). Reducing any one of the three factors minimizes damage. Risk is better controlled with good scientific preparation, when population vulnerability is low and societal governance is effective.
Wear Covid out Quarantine, keep devils at bay
Wear Covid down lockdown, contagion give way
Trace, test, and test for Covid, test til we know
Where the pest comes from where do he go
Two big Qs
Mother of all Plagues will you ever give way?
Donald, the Donald will you er’ go away?