Saturday, January 28, 2023

It's a Social Problem, not a Medical Problem

Carol Dumaine wrote about the Davos safety measures, and how the rest of us are playing Covid roulette. It's a solid read, but I got totally sidetracked by one of the links she provides: "Infection of Society," by Antoine Danchin, published in EMBO Reports back in April 2003 - almost exactly 20 years ago. 

He talks about a common psychological occurrence: we are affected by huge sudden events far more significantly than by regular daily events. We care more about lives lost in a tsunami than in traffic, for instance, even though car collision fatalities number much higher. We begin to tolerate a certain level of vehicular carnage because we get used to it. But then he gets into how diseases have evolved to exploit ever growing weakness in our defences, most recently, 

"a societal shift such that we value the individual more than the community, which creates the new weaknesses that bacteria and viruses can exploit. In fact, there is a strong connection between diseases and society, and if we do not recognize this link, we will forever have new and increasingly virulent disease to face. Since antibiotics were discovered just over half a century ago, we have suddenly, in the course of only one generation, forgotten the terrible burden that infectious diseases present--at least those of us who are lucky enough to live in the developed world. But this sense of security is an illusion."

We have another avian flu sweeping the world right now, and Danchin explains that,

"the only effective prevention--establishing a controlled slaughtering system, and prohibiting the sale of live chickens at the markets in Hong King--cannot be implemented, simply because people traditionally like to eat freshly killed chicken. This shows vividly that it is impossible to separate infectious disease from our lifestyle or from the structure of our societies, and above all, from venal considerations. Our infections mirror our primary interests, and our way of life." 

He laments the number of parents no longer vaccinating their children 20 years ago, and warns,

"The threat of an epidemic of a disease that would certainly affect their unvaccinated children seem to be too far removed from these well-meaning parents to be taken seriously. The question of what is a tolerable level of infection, alas, is improperly asked. It is not a medical problem, but a social one, and thus asks for political intervention--in its noble meaning--as a consequence."

His solution:

"We have to teach our societies to reconsider our values--it is not the purse that is important, it is lives. We need to trap our societies with their own defects: nothing will happen without financial or economic pressure. . . . The Black Death stopped being a scourge when, after the implementation of sanitary cordons, soldiers had orders to fire on 'rich' people trying to cross the cordon. Using corruption, the rich were able to cross these lines and propagated the disease much more efficiently than rats ever did. We have not learned since. . . . The general consequence of the inertia created by venal interests and the existing strata in society is that rules are badly needed for the collective good. If we do not react fast enough, if we are not able to recreate the much needed sense of fraternity--and we are all equal when it comes to disease and death--then the microbes that we thought we had controlled will haunt us again. Unfortunately, a large number of deaths will probably be the price we have to pay to understand, finally, that true democracy is not representing the freedom of the individual, but that of the City."

Such incredibly prescient words. Such a shame we didn't listen.

Elsewhere today an actuary responded to the question, When will we stop studying the Covid pandemic? He said,

"I remember reading a few years ago a paper published in 2006, and and that paper was called, "Is the 1918-19 Flu Pandemic Finally Over," and essentially what was being recognized and acknowledged and the theory that the author was putting forward is that the generation of people who were young adults when the 1918-19 flu pandemic hit, tragically, had a decades-long elevated risk from cardiovascular causes which stayed with them for the rest of their lives. So it's only now, nearly 100 years later, that that generation are all no longer with us, and we can say that the flu pandemic's behind us. I'm expecting actuaries to be worrying about the long-term impacts of Covid for many decades."

So, only 97 years left, then! Maybe we'll have recognized the vital importance of the collective by then.

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