Network of Mutuality: We

“It really boils down to this: that all life is interrelated. We are all caught in an inescapable network of mutuality, tired into a single garment of destiny. Whatever affects one destiny, affects all indirectly.” Martin Luther King Jr.

Today, I’ll be sharing the words of Wayde Dazelle, MS-GHPM. Read his words below:

“I wrote this earlier for a friend who reached out with questions about COVID-19 (the disease), figured I’d share it with everyone here.

For background for those reading this, I am an infectious disease epidemiologist, a health economist, and a student doctor. I’ve worked internationally in infectious disease control for several years, most recently on TB control (one of the greatest statistical killers of humanity) in Southern Africa.

This is a serious situation. It does not require panic, but it does require serious and decisive action. It’ll require changes to our day to day lives – cancellation of social events, athletic competitions, and the closure of classrooms. This is not without reason. Here’s why:

COVID-19 is an incredibly infectious, high mortality respiratory infection. The case fatality rate, at between 2-4%, is between 10 and 100 times as deadly as the seasonal flu. Being within 6 feet of an individual coughing or sneezing is enough for direct inoculation. With the wind carrying aerosolized particles even further, major public gatherings are hotspots for transmission. Each individual, on average, is infecting 2-4 other individuals; with large gatherings, the number is exponentially increased. The droplets can also remain infective for quite some time – meaning that railways, tables, jackets, any surface that respiratory secretions land on is potentially infectious.

There is also evidence to support fecal transmission. Public events mean public restrooms that are open pit. Human waste in sick individuals can also become aerosolized, hanging in the air in the bathroom for you to breath in while also covering all surfaces (including you).

In the beginning of the response process, we modeled it as something akin to its relative, SARS; however, now we recognize it as something unique in and of itself. The response that we are mounting is based entirely on the clinical characteristics of the infection, the projected morbidity/mortality, and the opinions of the experts in the field and on the cutting edge of the pandemic.

Even my institution, one of the nation’s most highly-respected centers for infectious disease and disaster medicine, is shutting its doors, moving to online courses, quarantining individuals, dramatically altering hospital policy, and implementing universal screening at out sites. Why? Because our clinicians, our ID experts, our disaster experts, our epidemiologists and clinicians serving presidents and Vice Presidents alike agree that the situation is dire.

The situation is rapidly developing in the US. Pandemics start small and rapidly expand by definition. It may seem small and inconsequential now, but this process will continue. We can easily observe its effect abroad – and we can state with confidence that it will get worse, potentially much worse, before it gets better.

Humans by nature prioritize immediate costs and benefits over future ones – behavioral psychology and economics have proven this beyond a doubt such that you won’t find a cogent analysis out there that ignores this fact. I factor for this in every analysis that I produce. We are terrible at objectively weighing issues in the future when faced with an immediate trade off. It’s easy to get frustrated at cancellations, to adopt the woe is me perspective, but think, really think, of the cost of not doing enough in the long run.

You may be healthy, but what about your parents? Your grandparents? The older couple down the street? The 60 year old with COPD? The 50 year old smoker? Each of these people we put at risk by failing to act, by flouting our responsibilities to our communities to keep them healthy and strong. Most will be fine, but many will not.

And that impact is not just with regard to COVID-19 disease. This is an infectious process superimposed over other deleterious conditions within the same season – of course we should care about influenza, measles, atherosclerosis, lung cancer, and others, but to care about one is not mutually exclusive to caring about another. This is especially apparent when we consider emergency departments, the impact on stroke and heart attack response times … COVID-19 will kill far more people than we ever give it credit for.

So, at the end of the day, cancellations, social distancing, and closing educational, manufacturing, and athletic institutions is the least we can do. But we also need to consider as well the impact of this emerging infection on low wage workers, the homeless, the retired, and others.

As a nation, we should be more prepared to provide support to those who need it most in times such as these. While many will be relatively unharmed by missing days of work, many will not. How are we to expect individuals to self-isolate and to stay home when they feel ill if this requires that they must then choose between feeding themselves and their families or following expert advice? Surely more can be done – if the present administration can provide stimulus for our nation’s largest corporations, surely we can find the money to provide stimulus for the individuals within our society that make the wheels of capitalism turn, the workers and the average consumers. Remember, public sector debt is private sector surplus.

The economic impact in the short term of measures such as these may seem steep, as do the opportunity costs and personal losses – but we as individuals, communities, and nations will benefit far more in the long run – in health and in wealth.

– Wayde D. H. Dazelle, MS-GHPM

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