Learning from the (Recent) Past

The Medical and Health Humanities have a lot to teach us about how to respond to COVID-19.

1. History is the laboratory of public health. Although the context of a specific outbreak shapes its trajectory, commonalities can still be found between epidemics from centuries ago and the pandemic today. But we seldom take advantage of that archive of evidence. In fact, we have found it difficult to learn even from the events of a few months ago. Whether that is down to complacency or anxiety, assuming that “it couldn’t happen here” meant we lost valuable time to act and prepare.

2. Panic about panic prevents timely action. Leaders overestimate the risk of mass hysteria and underestimate the capacity of citizens to respond. When governments withhold information and delay the implementation of restrictive measures in order to prevent public “overreaction,” they lose credibility. Many people will then take their own steps, but will lose faith in their leadership. And if the response needs to be on a scale that individuals cannot mobilise without state assistance, citizens will become anxious about the danger their own government has put them in. Governments also fear being criticized for overreacting, yet the consequences of underreacting are far more severe.

3. Origin stories are misleading. The search for the origins of an epidemic coalesce with the desire to contain it – within another country or culture, in someone else’s community, or other people’s behaviour. This leads to the blame that is characteristic of epidemics, with one group singled out and discriminated against (as we have seen in the assaults on Asian people in Europe). Moreover, while it might be possible to narrow down the first cases of illness, the search for a “patient zero” or one index case is flawed. As cases probably circulated long before they were recognized, there were likely several routes of transmission between countries or communities.

4. Blame and stigma undermine public health. The practice of blaming widens as public health restrictions are applied more broadly. With the rise of #Covidiots, people are using Twitter to call out the behaviour of others as irresponsible, or calling the police on their neighbours. Cases will be blamed on the actions of others, with people divided up into categories of innocence or guilt. Such moralizing directs attention away from the governments who have failed to successfully communicate or enforce the restrictions, and ignores the circumstances that might make it harder for individuals to comply – from the shock of coping with a rapid change of events, to previous negative experiences with government advice, or the challenges of staying home without support. Most importantly, chastising or shaming people rarely persuades them to act differently.

5. Assumptions are dangerous. The way we come to think about a disease shapes the way we respond, as individuals, healthcare teams, and policymakers. In the fast-moving emergence of a new epidemic, amidst uncertainty about who is affected, how far and fast the disease will spread, and how to treat it, assumptions made in the earliest stages prove hard to shift even as the evidence against them mounts up. For COVID-19, this is evident in the focus on the elderly as the highest risk category. Yet half of intensive care patients in the Netherlands are under 50, there are high rates of younger people seriously ill in France, and the US is also reporting a shifting demographic picture. Maybe older people were the first to succumb to serious illness, but we should be mindful that we may be under- or misdiagnosing cases amongst others who do not fit the profile.

6. Media framing matters. The dominant narrative of the pandemic has damned historically-proven strategies to limit the spread of infectious disease – such as surveillance and quarantine –  as “draconian measures.” Playing into geopolitical characterisations of the degree of individual liberty in each region, critics wonder if the same restrictions would be resisted in different, more democratic, settings. But if these restrictions were instead described as “classic” or “effective” public health strategies, governments and citizens might be more likely to adopt them early, and successfully.

7. Experts disagree. Narrow disciplinary perspectives may uncover specific aspects of the pandemic, but experts with different specialties need to pool their knowledge to get a wider picture of what is going on, and what the best response might be. Instead, only certain experts are given the authority to advise. In the UK, when the advice of behavioural scientists to delay strict measures came under criticism from a broader scientific community, the government did not shift away from its problematic “herd immunity” strategy until data modelling predicted a massive death toll. This research is now being used in the US, to the same effect. But an overreliance on big data ignores the evidence we already had, from the historical archive as well as the recent events elsewhere. The successful management of such a complex situation will require the expertise or a wide range of relevant specialties, including epidemiologists, public health professionals, and researchers in the medical and health humanities.

8. Misinformation comes from trusted sources. While concerns about fake health news dominate discussions of the role of social media during this pandemic, confusion is also generated by the bad advice of respected figures. In the Netherlands, this included the insistence, long after it had been disproven, that people without symptoms were unlikely to be contagious. In fact, we did not need to wait for evidence to acknowledge this possibility, as this is a common feature of coronaviruses as well as other forms of flu. Those in charge are not always those who know best. Yet people defending a certain approach or a specific authority try to minimize the critiques others propose, often by dismissing them as “armchair experts.” But shutting down the debate does not stop misinformation. Instead, it sanctions some voices and silences others, narrowing the frame needed to investigate and understand our options.

9. There is no “magic bullet”. The pandemic will not be solved by a medical breakthrough alone. While we are already discovering effective treatments, and the development of potential vaccines is well underway, we know that ensuring access for everyone will be a challenge. This is not just an immediate problem of overburdened health systems, but a long term reality. Like flu, the virus may develop different strains that require new vaccines, and not everyone will have the same opportunity to protect themselves.

10. Pandemics are not just biomedical phenomena. Like all other health issues, the virus is one component in a wider network that will shape its spread and severity. We cannot isolate the cause of infection from the social, cultural, environmental, political, and historical dimensions that are involved. The idea, for example, that economic health could be prioritized over public health, completely ignores their unavoidable interrelationship. Health is socially determined, affected by every other aspect of life – and that is as true for a novel virus as it is for alcoholism or cancer. To solve this crisis, we will need to combine diverse forms of expertise, create new collaborations between civil society and governments, and restructure many aspects of modern life. And if we leave any one group behind, we will all remain vulnerable.`

Manon Parry is professor of medical history and coordinates the MA in Medical and Health Humanities at VU University, Amsterdam. Twitter @ManonParry1

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