What Have We Learned?

What has the pandemic taught us? Andre Picard writes:

For the longest time, we didn’t take viruses (and other pathogens that cause infectious disease outbreaks) all that seriously. Indeed, one of biomedicine’s most infamous and oft-quoted declarations is that “it is time to close the book on infectious diseases and declare the war against pestilence won.” But while the line itself is actually an urban legend – the man it was widely attributed to, former U.S. surgeon general Dr. William H. Stewart, never said it – the overconfident sentiment behind it is all too real, and all too common.

COVID-19, though, has been humbling. It has challenged many of our assumptions about viral illnesses. That a coronavirus, a type of virus that usually causes colds, could kill millions – 6.7 million deaths worldwide, by the official numbers – was unexpected. That the virus could leave countless more with potentially permanent sequelae in the form of long-COVID – even more so.

The mitigation measures that were undertaken, at least in the early days of the pandemic – such as lockdowns, working from home and masking – also created an unprecedented living laboratory that produced some eye-opening findings. By dramatically reducing social interaction, we all but eliminated influenza and other respiratory illnesses in 2020 and 2021. But they came back with a vengeance in 2022.

With all of this experience behind us, some of us have learned the wrong lesson:

Some have taken this to mean that getting infected with viruses is actually good for us, because it strengthens the immune system. This is one of the many ideas that has fallen under the too-broad, unscientific umbrella term of “immunity debt.” But this thinking is wrong. There is no evidence of any such “debt” that needs to be paid.

What is the right lesson?

The lesson is that we should not see infections as inevitable. We have tools to prevent them, from masking to vaccination, and we don’t use them effectively. At the very least, we can reduce harm by not letting viruses run wild.

Yet, flu vaccination rates are poor, even for those at highest risk, such as elders and young children. COVID-19 booster uptake has been middling.

The current “tripledemic” that is hammering children and filling up pediatric hospitals is also a reminder that no illness exists in isolation.

If anything, COVID-19 infections may have caused immune dysregulation that makes people (particularly children) more susceptible to other infections.

This may explain why Canadians are seeing not only surges in strep A (a bacterial infection that is usually mild), but also rare invasive cases that prove deadly. Same goes for the outbreaks of scarlet fever (also caused by strep A) and chickenpox we’ve seen in some countries.

Unfortunately, we can expect what is happening to children to happen among the elderly, another high-risk group. We are already seeing outbreaks of influenza, RSV and strep A in nursing homes, which have already been devastated by the pandemic.

In some ways, these more recent viral challenges have distracted us from the main event: COVID-19. While we largely returned to “pre-pandemic” normalcy this year, this has actually been the deadliest year yet for COVID-19; in 2022, Canada will surpass 17,000 deaths, more than the 14,642 deaths we recorded in 2020 or the 16,489 in 2021. A fifth wave of Omicron is just beginning.

So, what have we learned? First, viruses are not going away. And second, we have to use the tools we have -- over what could be a very long run -- to save lives.

Image: Britannica

COVID Speaks

Andrew Nikiforuk, in The Tyee, gives COVID a voice. It's a must-read piece. The virus offers ten lessons. I'll only deal with three of those lessons. 

The first involves eternal growth:

Do you think your kind can just keep growing forever? Not even bacteria live such a fiction.

Maybe you should have listened to that German economist who said, “Man makes his own history but not always as he pleases.” Well, that’s me, a cultivator of displeasure.

Your overshoot is of another dangerous nature. Your future is no longer a reflection of your past, because you do not understand the dynamics of complexity in your own networked universe, let alone mine.

Since my last truly memorable visit in 1918 with my Spanish Flu (and it wasn’t Spanish, but no matter), you have made the world more connected and more complex with your machines and systems. You never bothered to calculate how steam ships could transform influenza from a regional delight to a global scourge, did you? Let me thank you again for that splendid innovation.

Every day you multiply this hazard. Every time you add another airplane route to a finite planet you accelerate the speed of my viral servants. All seems stable until your complexity brings down the house with a well-transported contagion on every doorstep.

Growth does not raise all boats. And the virus simply sinks many of them. 

The second lesson is inequity:

Show me a pandemic that equally afflicted the rich and the poor? I know. I have not made one. Your kind underestimates my unprogressive nature, which holds but a mirror to the flaws of your social relations.

My coronavirus has struck down the usual victims: the poor; immigrants who must work of a living; people of colour burdened with disease because they have no access to health care. People incarcerated in buildings like cattle in feedlots. It never ceases to amaze me how you concentrate people and animals in the name of efficiency, heedless of the inevitable biological price to pay.

The reality is this. Pandemics like myself don’t create inequalities. We merely exploit them and play with the opportunities.

The third lesson is all about hubris:

Your vulnerability is a product of your hubris. Think of me, this fine pandemic, as a Mongolian cavalry probing the defenses of an overconfident Chinese city. Even after SARS and Ebola (you can’t say I didn’t provide a fair warning), I marveled at your porous defenses. All about my feet I found a global tableau of disbelief, denial and timidity.

Almost everywhere I ventured, I found the powerful unprepared and inattentive. I moved through open borders and took advantage of overextended supply chains. I found politicians who minimized me as another “flu.” Your leaders actually believed that they could muddle through an extreme event with impunity.

Everywhere I probed, I discovered familiar vulnerabilities. I found a stubborn resistance to act quickly and a denial of the exponential function. I found the precautionary principle abandoned like an orphan on the Silk Road. I found an expert class reluctant to don masks or to consider the dominance of aerosol transmission. I found democracies who stupidly elected to fight a viral fire in their hospitals instead of in their communities or at their borders.

In sum, I found inept bureaucracies incapable of managing catastrophic risk led by a callous political elite that prized money more than workers. What a marvelous and entirely predictable reception!

A few lessons to ponder over this holiday weekend.

Image: Failwise