Distance Articles

Distance: before, during and after Covid-19

Today is a time of hesitant exit from a nightmare and uncertainty about the forms of the future to give concrete form to innovative health policy projects

Rodolfo Saracci

Former President of the International Epidemiological Association

By June 2020July 3rd, 2020No Comments
Photo by Lorenzo De Simone

It is necessary to choose: rest or be free. Thucydides

How much time did we have to anticipate and prevent the epidemic? Zero, apart from a few rare exceptions. The pandemic was preannounced by the SARS (2003), the cases of MERS (2012), the reflections of some people like Bill Gates (2015) [1], the bad omen of autumn 2019 and the report of the global preparedness monitoring board of the World Health Organisation (WHO) and the World Bank [2] on the inadequate readiness of countries to manage healthcare emergencies, including respiratory viruses. Nonetheless, most countries did not want to acknowledge these warning signs. A clear reconstruction of the origin and evolution of the epidemic in China is yet to be defined but certainly the fact that it could grow to such a scale automatically reveals a significant prevision and prevention deficit. Once the alarm raised by China reached the WHO (1 January 2020) a voluntary blindness has prevailed in the west for a few weeks. The message was: “Don’t worry, in any case, we will deal with the epidemic if and when it will actually get to our country,” which means that prevention work would be done at the last minute, working under extreme pressure and with no time and distance from the events that needed to be prevented. We’ve seen the results of that approach. This attitude- already a constant, but an event such as the epidemic emphasizes it- reveals a serious problem with the organisational approach. Prevention is perceived as an important option for concrete situations and not just as a guidance principle (the concept of “prevention first”). Through prevention we can get perspective on (from a distance), prioritise and organise the countless sections of the healthcare system and manage their relationships with other sectors relevant to health (education, work, housing). In this sense the main direction and management of healthcare systems should put prevention at the centre; if this approach to healthcare policies is not implemented in a concrete way it is misleading to claim that prevention is a priority.

Some distances highlight the sinister contradictions of our society.

Distances are everywhere in the course of the epidemic; there are material, social, mental and language distances. Some distances highlight the sinister contradictions of our society. In the medium sized and larger cities of Italy and other high-income countries several elderly people passed away in nursing homes with no efficient care treatments available and a cold sense of loneliness. Just a few kilometres away extracorporeal membrane oxygenation machines were being used, an advanced technology that is cumbersome in terms of resources and specialised staffing requirements, this was an option just for very few patients that had a high chance of recovery. The United States provide an example of metaphorical and enormous distances. While on one end the number of Covid-19 deaths reached well over 100.000, on the other end the Crew Dragon spacecraft successfully brought two astronauts to a spatial station located 400 kilometres away from Earth, the first demonstration of the technology-privatisation combination applied to the conquest of space. These two examples, completely different in terms of genesis and meaning, rely on a common denominator that is typical of our current society: the enormous ability to produce technological answers for any problem affecting individuals or the collective (as recently discussed by Paolo Vineis [3]). Nevertheless, this results in a modest ability to solve the type of problems for which a technological answer is only partly appropriate.

There are many existential problems and social issues that technology cannot fully resolve. In spite of the potential for technological innovation it is simpler to treat these issues as if technology were a suitable answer for them, especially if this is economically advantageous. The consequences are the accumulation of personal and social problems that are partly or totally unresolved and an evolution that has left elderly people in precarious conditions. In the future, when planet Earth will be uninhabitable, only a handful of people will try to board a spacecraft to escape to Mars (and beyond), leaving behind the other eight or nine-billion terrestrials (this is the scenario that directly inspired Elon Musk’s Space-X program [4]). Just like with prevention, either the increasing role of technology in our society is managed and designed to benefit the collective, rather than the other way around, or it is misleading to rely on the moral integrity of those utilising it.

How distant our life post-Covid-19 will be to our previous situation will depend on us. When the writer Michel Houllebecq discussed the dominant trends of society that were in place before the epidemic he stated: “They have just manifested in a new way. After the lockdown we will not wake up in a new world. It will be the same, just a bit worse.” Even though this might be inevitable in the short term it might not be the case for our future world, beyond just a few months from now. The fight against the epidemic has been inappropriately referred to as a “war”, which is something very different in terms of the human loss, the material and psychological damages and the everyday life disruption. However, there is a commonality with war: all sections of the populations are mobilised due to the virus and also experience abnormal life circumstances.

Circumstances and mobilisation allow us to momentarily shake off the weight of the sense of impossibility that in normal times would stop us from viewing ideas that are distant from the present reality as feasible: all of a sudden they seem achievable and they can turn into projects. The National Health Service of the United Kingdom was directly inspired by the Beveridge Report, which was drafted amidst WWII (1942) [5]. The Consultative Health body of the Veneto National Liberation Committee created a very first draft of the Italian National Healthcare service in 1945 [6].

Today we hesitantly walk out of a nightmare with uncertainty around the future. There is a window in the next few months that will allow us to work on things before they go back to the previous landscape. Now is the time to work non-stop and innovative healthcare policies in a concrete way, focusing particularly on prevention, as this is essential.

Now is the time to work non-stop and innovate healthcare policies in a concrete way.

 

 

References
[1] Global preparedness monitoring board. A world at risk. Annual report on global preparedness for health emergencies. Geneva: World health organization, 2019.
[2] Wakefield J. TED 2015: Bill Gates warns on future disease epidemic. BBC News, 19 March 2015.
[3] Vineis P, Carra L, Cingolani R. Prevention. Manifest for technopolitics. Turin: Giulio Einaudi Editore, 2020.
[4] Musk E. Making humans a multi-planetary species. New Space 2017;5:46-61.
[5] Beveridge W. Social insurance and allied services. London: His majesty’s stationery office, 1942.
[6] Delogu S. Public healthcare, social security and economic programs. Turin: Giulio Einaudi, 1967.

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