The covid-19 pandemic: strategies and consequences
During these past weeks and months the world has been grappling with an emergency the size of which had not been witnessed since World War II. People are suffering physically, emotionally and financially; economies slow down and seem to almost draw to a halt, straining businesses to the brink of bankruptcy; and countries become isolated and unable to access most needed supplies and equipment. Furthermore, the ultimate social and economic consequences of this crisis are still difficult to anticipate. Sad as it is, the present situation calls for some reflection on current developments and their potential impact in the future.
At the onset of the pandemic some countries advocated for a do-nothing strategy, downplaying the severity of the disease and hoping for the population to acquire a kind of herd immunity at the expense of many lives, particularly of those most vulnerable. Taking into account how contagious and deadly the virus is, it doesn’t seem very reasonable to keep an ‘open door’ policy. A rapidly increasing number of infected people could collapse healthcare systems, pushing medical staff to their limits and potentially claiming their lives, particularly in the absence of proven medical protocols and adequate equipment. It could also greatly reduce the chances of survival of patients suffering other types of diseases since medical resources are inevitably limited.
This risk-denial attitude is akin to the idea that we can bury our heads in the sand to avoid seeing our problems and just wait until they disappear (falsely attributed to ostriches but fairly common among humans). In modern times, herd immunity is acquired through vaccines, thanks to the advancement of medicine, and without the loss of human lives.
Further, the do-nothing strategy — justified, in part, on the grounds that people would resist any attempt made to restrict their freedom — may cause irrational behaviors (from purchasing guns and weapons to hoarding toilet paper) and long-lasting, individualistic and aggressive attitudes, which have already been described in the past, as the Latin proverb ‘homo homini lupus’ (man is wolf to man) or Rudyard Kipling’s ‘law of the jungle’ (kill or be killed) attest. The end result may be a defiance of civil norms and a loss of allegiance to social institutions, including all levels of government.
Other countries chose a passive strategy, imposing nationwide lockdowns and confining individuals to their homes as the best way to fight the virus and contain its spread. The idea that confining the population, patrolling and policing the streets and hoping for the best can be a good strategy to end the pandemic sounds a bit preposterous. Actually, the main reason why most people stay isolated in their homes is because we still don’t know who might be a virus carrier. Not surprisingly, there are small villages and low-density areas in those countries that have remained in complete isolation for more that 40 days without a single positive case of covid-19 being reported. Nationwide lockdown as a ‘just-in-case’ measure seems disproportionate.
Further, the passive strategy is bringing about a very unsettling development. The ‘presumption of innocence’, in terms of health, by which one is considered innocent or healthy until proven guilty or infected is being sidelined. By confining all the population we are considering everyone a suspect or potential virus carrier until proven otherwise. This is not only unfair but might also have a significant impact on our freedoms.
It is unfair because those individuals or areas free from the virus could, in theory, maintain a normal life, but also because the spread of the virus and its severity depends on the type of neighborhood and home you live in. Furthermore, not everyone is equally able to stay at home for a long time without an income or the ability to claim a subsidy. Economic stability, social cohesion and equality are on the line.
The idea of considering everybody a suspect has a clear social effect; you can notice suspicion and distrust in the faces of the people you might see on the street or at the supermarket. But it also has a distinct political effect; it entitles governments to conduct massive surveillance and information control plans, circumventing existing legal restrictions, parliamentary control and public scrutiny. The rationale is simple and straightforward: since we don’t know who is infected we have to monitor everyone and to do so governments may skip inconvenient legal hurdles. This might lead to control-freak societies, autocratic governments and megalomaniac leaders, who know better than anyone else — even the most expert specialist — what to do in such a dire situation. Further, such an environment is the perfect setting for fake news and disinformation, since no one knows exactly what is happening — and some are not even interested and just take advantage of the situation. Confinement is the result of a combination of lack of preparedness and poor management, if not outright incompetence.
It’s no wonder that these countries are now proposing a very complex and slow easing of the lockdown measures, dependent on geographical area, economic activity, people’s age, time of the day, etc. The underlying idea is that individuals are not reliable and cannot be trusted — we continue to ignore who is infected — , or are like children who need to be taken care of. While this might be partially true, this is definitely not the way to build a smart and resilient society.
Further, if we don’t manage to find a vaccine in the short term or it becomes difficult to acquire immunity to the virus, new outbreaks may occur worldwide leading to a new pandemic. Will we confine the entire population and stop the economy again? If this pandemic crisis becomes a recurrent event, are we prepared to isolate the world and shut down economic activity for several months every year? Are we really willing to forgo the advantages of globalization while retaining its disadvantages, since viruses will always be global?
It seems reasonable to think that the best way to fight and contain the pandemic would be to find out who is infected in the first place. Countries which have fared better during this crisis have chosen such an active strategy, combining mobility restrictions (not confinement to homes), social distancing and aggressive testing and tracing to identify infected individuals and clusters. This strategy aims to solve the problem, although locally, and not just contain it, while respecting the presumption of innocence and creating a more fair and free environment.
According to official statistics, countries show infection rates ranging from negligible to 0.5 percent of the total population (5,000 cases per million inhabitants). I am ready to admit that the real number of cases is five to ten times the official figure. But even so, in the worst-case scenario only around 5 percent of the population might be infected in any given country. That means that 95 percent of the population may not be carrying the virus. Does it make sense to isolate the entire population then?
We could imagine an even better strategy, a proactive strategy, which would entail not only massive but comprehensive testing, meaning that the entire population would be tested, not just at-risk groups, and not only once but probably every week, since the incubation period of the coronavirus most commonly ranges around 5 days, and we also need to test for antibodies and acquired immunity. Obviously, certain mobility restrictions, social distancing and proper hygiene and sanitation practices would also be encouraged. But since virus carriers would be identified, isolated and treated appropriately, the rest of the population could feel relatively safe. The objective is to prevent and contain the virus but also to diagnose and treat every single individual carrying it.
While I am sure it is difficult, complex and expensive to test the entire population and repeat the test every week, that doesn’t mean it’s not the right strategy. Some countries have tested 1 million individuals per week and can increase that number to 2 million or even more. This is still not enough but is definitely the way forward. And not only in terms of health but also in social and political terms.
With a proactive strategy we would empower individuals with health-checking tools and trust their judgment and responsibility, allowing them to take the lead in the fight against the virus. This is an instance of an all-time dilemma in human societies: create a heavily regulated society (dependent on massive surveillance and control) in which even dumb or evil individuals cannot be a burden or danger, or favor intelligent, informed and engaged individuals so society can be based on very simple rules. It seems to me that we should try to give individuals the means to become smart citizens, not dumb subjects or children who need to be taken care of. To attain a resilient society we first have to achieve a smart society.
In order for this proactive strategy to take hold in the future, since unfortunately we may witness new pandemics, medicine — particularly primary healthcare — should transition from hospitals and laboratories to our homes, through the encouragement of innovation and technology. Online medical consultation and prescription delivery, simple health-checking devices, inexpensive health tests delivered by mail, online test results reviews, etc., should become the ‘new normal’. People would have better access to quality healthcare and authorities would be able to pick up early warning signals and react faster. Obviously, careful use of personal information to safeguard privacy and prevent abuse of the data would be paramount.
This proactive strategy will require preparedness (agreed and approved plans and protocols, involving public and private sectors, and robust supply chains to assure massive production and distribution of medical and emergency equipment, and basic supplies), technology (widespread and powerful communication tools, online medical care, reliable and inexpensive tests and treatments, simple and efficient processes to conduct medical research and approve vaccines and drugs) and social resilience (the result of a combination of human intelligence, cooperation and trust).
We have to wisely choose our strategy because it will not only help us fight the pandemic in the most effective way but will also have significant consequences for the future. Times are changing and so should our mindsets.
