Covid-19 - Third year and beyond

Three years into the Covid-19 pandemic, with endless streams of disease statistics, confusing public health recommendations, disinformation in social media leading to a vicious culture war on vaccines and facial masking, it is understandable that the public is tired about this topic. There is also an emerging acceptance of Covid as “just another cold or flu”, with minor health consequences. However, this pandemic has significantly changed our sense of the world, and we cannot easily walk away from it – not yet.

While the influenza and coronaviruses share some clinical similarities, the SARS-CoV-2 stands out as being more dangerous in causing widespread tissue inflammation attributed to an overactive immune response called “cytokine storm”. Scientists are also investigating the possibility of an associated viral toxin capable of causing damage to cell linings within many organs of the body, contributing to what is known as “vascular leak”. Although most recover within a year, 5 to 30% of Covid patients may develop a variety of chronic health issues (“long Covid”), from mild impairment to debilitating fatigue and multi-organ complications, most commonly respiratory, cardiovascular and neurocognitive symptoms. We should be ready for a looming crisis in how to provide and pay for the care of these chronic illnesses.

Another aspect of SARS-CoV-2 is its ability to mutate and escape our immune system more than any other viruses, even if one has mounted a hybrid immunity from vaccination and past infection. At the time of this writing, fortunately, currently used vaccines have shown continuous, albeit waning, protection against severe disease and death. However, as the virus rapidly evolves, the efficacy of current vaccines, therapies like monoclonal antibodies and antiviral drugs, or mitigating measures against new strains needs frequent re-evaluations.

As we reopen ourselves to the joy of safer travel, cultural and social activities, we should keep in mind that this virus is going to be with us for some time, and Covid-19 will not be our last pandemic of this century. Conditions for new variants to emerge continue to be present as viruses replicate in persons with low immunity level, and as new pathogens can jump to human communities from animal reservoirs.

Historians of medicine have studied how human communities responded to past pandemics, from the medieval plagues to the more recent HIV-AIDS infection, and little has changed in our behavior: fear, distrust and blame; but also our capacity for resilience and compassion. We are now too familiar with regional and global disruptions in social and economic activities, population migration, and setbacks in the care of other pre-existing medical problems. Covid’s toll on personal mental and physical health, and on educational and development delay in children will haunt us for years to come.

And while the Covid-19 pandemic has accelerated the development and application of some beneficial information technologies, it also brought to wider consciousness our social inequalities and exposed the vulnerability of national healthcare systems and global health governance. The infectivity of viruses does not discriminate nor stop at neighborhood fences or national borders, but disease tolls are highest among the working poor and their families who cannot afford healthcare or online professional and educational opportunities.

In the final analysis, controlling pandemics cannot be limited to disease surveillance, medical interventions and vaccines. We need stronger social engagement to ensure that health policies and medical recommendations are well trusted and do not compound more burden on the already most disadvantaged individuals. We have the scientific and technical tools to stop emerging diseases from becoming devastating pandemics. Let’s hope that we also have the moral conscience and the political will to do so.

The dark side of capitalism

On Nov 28 the Gazette Times paper ran an opinion piece from the Las Vegas Review Journal that claims “the US and its free market-oriented economic system has created much wealth for its citizens, as entrepreneurs make money by providing things that other people want”. It also quoted rock-star Bono saying that “capitalism creates prosperity by allowing people to keep the fruit of their creativity and labor”.

While this may be true, there is a darker side to capitalism as well. What followed 16^th century Dutch and British investors financing adventurers to look for spices and precious minerals around the world was four centuries of European colonization of Africa, Asia and the Americas. 

Under the pretense of Christianizing or civilizing primitive “savages”, gun boats followed missionaries, with capitalistic entrepreneurs not far behind, enslaving the labor of native populations, ravaging their lands and looting their cultural treasures, making money by bringing Europeans what they want. 

We know from our own history that capitalistic greed was behind slavery and oversea sweat shops, and if there is wealth, it has always been concentrated in a few, while the masses labor in overtime and falls behind in rents and loans. 

Free-markets sound like good competition, but it’s often on the back of cheap labor and devastated natural resources. When Mr. Bono said “globalization has brought more people out of poverty than any other-ism”, I wish he would also acknowledge that it should only be done without human exploitation, something that capitalism does not have a good historical record of."

(Submitted Dec 1, published in the GT Dec 18, 2022)

On SCOTUS, medicine and public health

In a well-functioning society, individuals and professional institutions work together, respect each other’s expertise and boundaries, and policy makers weigh in on the consequences of their decisions. In health matters, the SCOTUS has shown it is no longer willing to rule by these principles when they put their ideological interpretation of an 18^th century Constitution ahead of our 21^st century realities.

Does SCOTUS expect legislators to understand a woman’s reproductive biology and function better than medical providers? As “natural” as pregnancy is, practitioners never underestimate the fact that it is a biological state that imposes a heavy overload on a woman’s physiology and carries many risks, some of them with life-long consequences, especially for teenagers and those with underlying health issues. Patients and their medical providers already have clinical guidelines that are evidence-based and monitored by licensing boards to achieve the safest and best possible health outcomes. They don’t need politicians to tell them how to practice reproductive medicine.

For years, physicians have declared gun violence a public health epidemic. When SCOTUS puts individual right-to-bear-arms undisputedly above the horrible consequences of an unregulated gun culture, it endangers our communities.

Aware of the health problems associated with pollution, Congress previously decided that national environmental air standards are best set by climatologists and public health experts. By reversing the power to regulate pollution back to legislators, SCOTUS widens the door for fossil fuel lobbyists in Congress.

This regressive SCOTUS majority is a clear and present danger to the health of Americans.

(Submitted July 7, 2022 to the Gazette Times, Corvallis, OR)

On the US Constitution in our modern times

I am not a constitutional scholar, but neither are many people who quote the US Constitution to support a personal socio-political position.  If the Second Amendment right to bear arms is the ultimate legal ground to oppose any gun safety regulation, then consider this: “Arms” might include anything from a knife to a nuclear weapon; landmines around my yard and armored tanks to drive in city streets would qualify as legitimate self-defense arms. Similarly, Supreme Court originalists, asserting that all statements in the constitution must be interpreted based on the original understanding “at the time it was adopted”, are challenging the legality of Roe vs Wade, since reproductive rights were never mentioned in the original document.

Of course, nobody is currently advocating a ban on pocket-knifes, nor claiming individual rights to own atomic bombs, landmines or tanks. Scholars have also repeatedly pointed out that the Constitution was written and adopted as a compromise document written by a handful of males with wide vision but who chose to ignore the rights of half of humanity.

My point is: While respecting our Constitution, we should understand it as a historical document full of ambiguities and omissions. We have now challenging issues that aristocratic, paternalistic 18^th century men are not expected to know about, like public health safety and healthcare equity. In discussing the divisive issues of gun and abortion rights, we would be abdicating our communal responsibility to make reasonable, common-sense decisions if we use the Constitution as an obstacle to a more perfect Union.

(a slightly shorter version of this letter was published on June 22, 2022,  in the Gazetter Times, Corvallis, OR)

Reflections on the Covid pandemic, year 2

When I wrote in this column about the origin of SARS-CoV-2 (April 2, 2020), and pleaded that “we should give public health a chance” (Dec 18, 2020), I did not anticipate that, a year later, I would return to this topic. How can we, humans who count among ourselves Da Vinci, Pasteur, Einstein and Desmond Tutu, be brought to our knees by an invisible, brainless organism whose “raison d’être” is doing nothing but making more of its RNA?

What the pandemic has done is to reveal the fragility of our social fabric and the weaknesses of our institutions, here and globally. It exposes, and worsens, our socio-economic inequalities that have existed for decades: Wall Street investors and large corporations taking in large profits and benefiting from tax loopholes, while blue collar workers are earning less than livable wages under inflation; the meritocratic elite comfortably “working from home”, while “essential” front-line workers risk their lives, their children having unreliable access to online education and healthy activities;  worsening access and affordability of healthcare, resulting in higher rates of mental illnesses, and disproportionate disease morbidity and mortality for the underprivileged.

Inequality feeds anxiety, anger and despair, and invites distrust in the government and democratic institutions. We see increases in gun sales, senseless crimes, drug use and suicides, racial and class tensions; opportunities for extremists at both ends of the ideologic political spectrum to ride on righteous vitriols and mutual loathing, fabricating theories and narratives aimed at nothing less than fracturing our social fabric to its core – cracks and fractures through which Covid-19 can easily spread.

So, how can we respond? First, I would urge everyone to continue to “give public health a chance”. With Covid-19 being a fast-moving target, public health officials have to continuously adjust their recommendations based on new, albeit temporary scientific data. This gives rise to some degree of public frustration and distrust.  Medical sciences, despite their remarkable achievements (in vaccine, testing and treatment) are always embedded in some degree of uncertainty, but legitimate debates on their risks/costs/benefits to individuals and society should not be sensed as systemic incompetence, nor lead to dis-information campaigns.

All over the world, public health and medical experts are now drawing up plans on how to prevent and control the next pandemic(s), and I am sure that on paper they will do well. Some already have heralded in the “Golden Age of Medicine and Bio-tech”, giving us interventions that will quickly be claimed as “miracle drugs”, true or not. But vaccines and drugs, lockdowns and face masks will not work unless we also address the social determinants of health.

As Americans, we all cherish the same values - justice, patriotism, freedom, and the pursuit of happiness, but we now live in separate emotional matrices and mental realities, where the understanding of science, the empathy for others, the concern for our common future is filtered through the prisms of our own prejudices, fears and self-interests. Until we give up the language of degradation and violence that defines our culture wars, and the identity politics that separate “us vs them”, we cannot heal our national self-inflicted wounds. The vast majority of Americans are reasonable, caring and generous people. We cannot allow extremist fringes of our society speak for us and determine our common fate. 

Pandemics come and go, but medical and public health interventions alone will not prevent nor mitigate their damages unless we also face our social inequities, reform the faulty socio-economic structures of our nation and call an end to our tribal wars. Easier said than done, but perhaps worth a try, and it starts with you and me.

(Modified version of an essay submitted Dec 31, 2021 and published Jan 9, 2022 in the Gazette Times, Corvallis, OR)