Covid, mother of all plagues will you ever give way?
Donald, Oh Donald, will you not go away?
Covid and Donald are both here to stay.
One will be vanquished by vaccines we hope.
For Donald, Oh Donald, there may be no anti-vote-dote.
2020, the ever-never ending year, Covid, carols and clown’s coup.
If you are advocating for lockdowns, you are complicit in tearing families apart...
in inflicting untold suffering on millions of people around the world…
in casting the poorest and most vulnerable in our societies into even further grinding poverty…
and complicit in murder.
(Corbett Report, 2020)
We have all considered revenge at some time for something. It is a natural response to what is considered personal injustice or to a loved one but rarely orchestrated since it is self-defeating and never sweet. For months and through two lockdowns I have wondered how to get my own back on devil Covid. Having seen a headline on lost time I decided to change my focus and start thinking of how to take it out in the year 2020. Time passed, days dwindled down and I came to the point of not wanting to take it out of an already dying year. But suddenly, we found a way shuffling through papers and bills, through cards and calendars. At some point a small unused pocket diary for 2020 surfaced. It was a perfect victim. It became the endpoint of my symbolic-shambolic vengeful focal act. Page by page and ritualistically I tore out, pulled and ripped out page by page. With each vengeful tear, I tried to forget. Did it feel good, do I feel better? No, not at all.
One great writer tells us to forgive our enemies but only after they have been hanged. One great physicist philosopher says weak people revenge, strong people forgive, intelligent people, ignore while the one great Confucius tells us before embarking on a journey of revenge, dig two graves. An arrow shot into the sky carried a prayer to the gods to facilitate vengeance on the Athenians. In another space, in Northern England, an arrow shot into the air fell to earth but no one knows where. Emily Brontë's first and only novel Wuthering Heights set on the forlorn Yorkshire Moors examined how vengeance can destroy with its actions unfolding in hell on earth. So it was back to my native Yorkshire for inspiration but for what?
There will be a Covid reckoning, an audit, and an inquiry, within countries and in the international community. Will mistakes will be acknowledged and prevented from happening again? Will lessons practiced before the next crisis? The biggest lessons? Countries must invest in and expand capacity and expertise in public health; systems for public health protection must be improved or built. The value of the multi-disciplinary nature of public health and its profession must be better recognized.
Public health is all about exits and entrances (birth and death) and what goes on in between (quality of life, human rights). It is Shakespearian! Interdisciplinary public health actions (policy, strategy, interventions) can extend the interval between entry and passing (life expectancy) and improve the conditions around arrival (prenatal, maternal and infant mortality) and demise (death with dignity) as well as the quality of life’s course in between (drugs, accidents, and chronic disease). It is Asclepiad! Unobtrusive and poorly funded, it goes on mostly unseen (sanitation, clean water, good nutrition, vaccination and health education). It is responsive, altruistic and full of surprise. In the relative lull between storms it can be neglected, bureaucratized, usurped and left unprepared, nevertheless an efficient and effective response is expected by the public. It can be thwarted by politicians and through pressure to push and peddle much greater support of non-profit clinical medicine than for the health of the public. Periodically, the world is overly shocked and greatly shaken (earthquake, tsunami, contagion). Today it is Covid. Fatalities grow as cases rise more so with age where citizens over 70 face elevated risk. The public’s health can be compromised by its own behavior (smoking, sedentary living, overeating) by the government removing safety platforms, systems and by limiting education as well as by racism, ethnic cleansing and economic inequality. Covid gets a boost in the absence of sanitation, finds its host easier when crowding occurs and when its entry or exit from the airway is not impeded by a mask. While public health goes unseen in the best of times, it is immediately called upon when the world takes a wrong turn. Public health can be seen as the response to unexpected and unwanted surprises.
We live in a world of dysfunctional relationships between humanity and nature. Misinformation, disinformation and reduced autonomy of science pose serious threats to democracy and public health. The loud voice of the private sector continues to shout for the ousting of the public sector while politics supports the overwhelming use of fossil fuels. A virus having killed so many is denied, explained as a conspiracy or its imperfect countermeasure, lockdown gets presented as the cause. Economists become epidemiologists and hijack of all trades. Expertise is acquired in a day. Cronies can take over. Top medical journals can be accused of widespread dissemination of incomplete and misleading scientific inferences and the only international instrument we have the WHO can be criminalized. Faucies beware! The state is in commercial hands, overly influenced by private foundations. Today democratic and authoritarian regimes face serious disadvantages and threats from sociopathic narcissistic leaders who cannot understand the consequences of infectious disease's impact on the health of their populations. We have seen politicians with little or no concern for the sick and dying. Wislawa Szymborska (Nobelist in Literature) put it succinctly when he said that there are those who know well what is going on, what it is all about but pushed aside by politics to make way for those who know little and as little as nothing. The current burden of death from COVID is about 2 million globally with a total caseload of 88 million.
Covid is being encouraged in groups, crowds and congregations. The global madness, or universal social dementia that we see today, was slowly prepared until late yesterday to which Covid is making its own contribution. Covid attacks the immune system. With greater ease it strikes down the elderly, more so, those with chronic disease and is precipitating mental health issues especially in children whose physical activity has been restricted by the measure of lockdown. Lockdown is a very large bone of contention that has caused a cold war within science. In the last half of 2020, about 8 million people have fallen into poverty.
The world can be demolished with nuclear weapons or gradually disintegrate over longer time constants as a result of climate change. Setting aside arms control and environmental protection agreements makes the world more open to folly and misadventure; a more dangerous place. More diseases relating to mental health and the autoimmune system will emerge to burden health systems. Phillip W Magness says 2020 has been a year of astonishing policy failure to which I would add, also for an avalanche of articles that have made little or no difference to Covid except at a level of self-satisfaction, personal enjoyment or author gratification. Mine reflects personal satisfaction, an attempt to inform and challenge students as well as a creative way to fill in my hours in active retirement. I am sure that there is a genuine attempt to be accurate and exact. It becomes more difficult as the complexity of the problem space increases and as decisions can slip into the realm of the counterintuitive. With respect to all writings my principle is that of Voltaire; respect and defense of the right to write it without necessarily accepting what is written. With respect to mine, I hope that I am guided by Asclepios and his disciple Hippocrates, father of Western medicine, who acted as rational and wise change agents when they proclaimed: “We have an opinion, let’s discuss it if the evidence warrants keeping it, ok. if not let’s change it”. Today we have evidence-based medicine, health technology assessment and frequently modified clinical guidelines. Half of what may be true today will be questioned in the next few years. Can we predict which half? The concept of a role model is slipping and models of Covid’s complex phenomena are embryonic.
I must say though that while we are surrounded by a devastating Covid that no one conceived of, I don’t see myself as a cheerleading intellectual or a political handmaiden. For the record, although two-thirds of global cases have recovered there is far from sufficient cumulative antibodies to bestow herd immunity on the population, 1.9 million have died in countries where deaths per one million of population, range from less than 1 (Taiwan, Tanzania, Viet Nam) to more than 1000 (Ukraine, UK, USA) and currently where more than 110,000 patients are seriously sick a significant number of will fall to Covid.
In my unpublished email response to the New York Times (21/3/2020) I wrote the thoughts of your Editorial Board informed by expertise, research, debate and certain longstanding values bring some relief, if not a vaccine and given the power of the media, the initiative if multiplied, could make the difference. My message was while there is no way of knowing when or how this pandemic will end, one big hope for the world resides in strong public health response to all threats, devils and demons and future ones lurking somewhere down the road. Thoughts of the Editorial Board, separated from newsroom cacophony are a good example of quality signaled advocacy by the media. Actions taken did slow disease transmission and spread to free up intensive care beds and ventilators. It still seemed to me that politics is the heavyweight player in the arena of the coronavirus; Covid wears the crown, not science. However, like other entities, the prestigious Editorial Board seemed to hit and run.
From Guangzhou, China late in 2019 and early 2020, a friend told me I am getting the inside news about the Coronavirus, some nasty issues coming out that the west is not being told! My first thought on Covid was that it would outdo Sars. It has, but far more than I ever imagined and has even split science. I did not reject a worst-case outcome of 1.7 million dead but I found it unlikely and being an optimist, I hoped I was right. Today in 2021, China stalls, on the origin of the Covid probe, which increases the chance of its scent going cold. One big question is, just as science has reduced the probability of contagion could it also have cranked up Covid’s competence to do damage? The suggestion that Covid-19 is a hoax must be laid to rest.
In Hidden Devils, Lepers and Warning Bells I said (16 February 2020) I said that the new virus Covid may not be containable to China and that the world cannot afford to wait to act on or to presume a best-case scenario outcome. I recalled the Indian Ocean combo (earthquake, tsunami, nuclear disaster) in Fukushima’s nuclear power plant that is causing radioactive contamination, a more serious replication of Chernobyl. Today in both regions, people struggle with poverty. Neither the Russian nor Japanese government nor the nuclear industry has resolved the socio-political challenges of nuclear energy.
Not knowing the future course of health damage from Covid guesstimates were made and interventions chosen. Mine was that in the event of a worst-case scenario it is doubtful whether any health service in Europe could cope. They didn’t! I opted for quarantine that took on the name lockdown. Covid I said was an alarm that underscores the need to strengthen public health and facilitate the improvement of any existing human security "umbrella" or sanitary shield in the event of future disasters, which seem certain as climate change goes unchecked and denied in high places. Covid is a call for further interdisciplinary public health development as an instrument for the universal public good. The only thing not knowing this is the virus. While containment seemed probable and the risk of transmission to Europe low I said that we cannot rule out its visitation to Greece or death in Venice. So at the time of the third wave once again to Greece I say, do not unlock stay put, Lay low, protect the loved ones that you know, while in the words of a Nobel, noble poet, just a little more and we shall see almond trees in blossom, marbles shining in the sun. Don’t frit away again the glory there, Coronavirus is not fair. Six months later in Chinese Chernobyl, American Waterloo, Russian Borodino I argued that the most signiﬁcant driving force damaging to population health is inequality which is exacerbated by a disaster such as the Covid pandemic and will worsen much more with advancing environmental damage as society is being pushed and nudged towards increasing instability by an inadequate and imbalanced system. Expecting that things could not get worse became a losing proposition.
Quietly and with predictability, effluents containing considerable radiation are being pumped into the ocean in a steady flow connecting with plastic where it will be mixed with a greater volume of water, by current and tide to make sure it is distributed evenly and much better than the food production of the planet. Quietly also and with little media interests, seven courageous and elderly catholic activists entered the largest nuclear submarine base in the world, illegally, to symbolically disarm the US Trident of its nuclear weapons. While many other kinds of trespasser have received presidential pardons the seven will work out their sentences. A virtual Festival of Hope took place for Patrick O'Neill as he entered prison for actions at the Kings Bay Trident base in Georgia. A request for a delay until he could be vaccinated for Covid was denied.
The pandemic has emphasized fault lines in already flawed societies. Life and its purpose must be reimagined and seen through the prism of what in ancient Greece was the concept of a well-fulfilled life; wisdom, reason, morality, responsibility and obligation encapsulated in classical philosophy. Opinions are good and they can be tested, informed opinions are better, they can be refined. We must fight social dementia and the confusions surrounding it which include nonsense peddling and conspiracy theories. We must reject the ugly duckling role of public health and move it up the political agenda to better benefit population health and wellbeing and by reinforcing human rights. We must also celebrate and embrace the public’s role in public health. Rights and obligations are everybody’s concern. We also know how to celebrate. Science is good, good science is better, good interdisciplinary science is best.