COVID-19 and the “P” Words
“After all it really is all of humanity that is under threat during a pandemic.”
Margaret Chan, director general (2007–17) of the World Health Organization
“This is not a time to keep the facts from the people-to keep them complacent. To sound the alarm is not to panic but to seek action from an aroused public. For, as the poet Dante once said: 'The hottest places in hell are reserved for those who, in a time of great moral crisis, maintain their neutrality.”
No need to Panic or fret
Get some Perspective
It’s hard to believe that it has been only a little over three months since the COVID-19 epidemic erupted in Wuhan, China. Coverage by the news media of the expansion of the epidemic around the world has been relentless, and it has taken our minds off crises that are in much greater need of attention, such as, the 30 million refugees fleeing violence in their home countries, and off of one crisis that is much bigger in the long run—the existential threat of climate change.
This week’s Germ Gem, the fourth on COVID-19, is on “P” words that I believe are particularly instructive.
COVID-19 is a Pandemic. In addition to the capital “P” words, there are several small case “p” words to consider. One is “p” for perplexing. “Why,” many public health experts have asked, did it take so long for the World Health Organization (WHO) to declare this a “Pandemic.” While there are several definitions of the word pandemic, the most common is: “an epidemic occurring worldwide, or over a very wide area, crossing international boundaries and usually affecting a large number of people.”
By the time the WHO officially declared COVID-19 a pandemic on March 11, the coronavirus that causes it, SARS-CoV-2, had made its way to at least 114 countries and killed more than 4,000 people. So it was obvious to many epidemiologists that COVID-19 has been a pandemic for some time.
On March 11, when WHO Director-General Tedros Adhanom Ghebreyesus, recognized the pandemic designation he also pointed out, "This is the first pandemic caused by coronavirus.” At first, I thought this statement was inaccurate as Severe Acute Respiratory Syndrome (SARS), which is caused by a related coronavirus (SARS-CoV), sickened more than 8.000 people and killed 774 in two dozen countries in 2002-2003. But SARS was considered a “Public Health Emergency of International Concern (PHEIC),” a designation coined by the WHO in 2005. (COVID-19 was designated a PHEIC on January 30, 2020. And since 2005 there have been five other PHEICs.)
On March 11, Tedros also commented, “There’s been so much attention on one word. Let me give you some other words that matter much more, and that are much more actionable: Prevention, Preparedness, Public health. Political leadership. And most of all People.” (Strangely, his announcement came on the same day that I was in the early stages of writing this Germ Gem on “P” words.)
I strongly suspect that the main reason the WHO was reluctant to call COVID-19 a Pandemic is because they didn’t want to fan the flames of the second capital P word. And they were right.
COVID-19 causes Panic. During the course of my 43 year career as an infectious diseases specialist, I’ve witnessed the appearance of many of the 140 or more so-called “emerging infections.” COVID-19 is the most recent. Within the context of causing local or worldwide panic, several others come immediately to my mind: HIV/AIDS and Ebola top the list. But the truth is the world hasn’t—within my lifetime—seen anything quite like the panic precipitated by COVID-19.
One of the underlying causes of COVID-19-related Panic is the news media. As the late Hans Rosling, a global health expert at the Karolinska Institute in Stockholm, discusses in his remarkable book Factfulness: Ten Reasons We Are Wrong About the World—and Why Things Are Better Than You Think, because of our innate “negativity instinct” we prefer bad news—and the news media, of course, knows what sells papers and viewing time.
According to Rosling, “Factfulness is recognizing when we get negative news, and remembering that information about bad events is much more likely to reach us. When things are getting better we often don’t hear about them. This gives us a systematically too-negative impression of the world around us, which is very stressful.” I wonder, for example, how many people caught this recent news flash: “The last person in the Democratic Republic of the Congo (DRC) confirmed to have Ebola was discharged from care on March 4, 2020.”
While everyone agrees that accurate communication is crucial, especially at times like this, we have to contend not only with reliable “information overload,” but because of the internet and social media, misinformation is rampant. In a recent article in Lancet titled Infodemic, John Zarocostas states that the “global epidemic of misinformation—spreading rapidly through social media platforms and other outlets—poses a serious problem for public health . . . So it is not only information to make sure people are informed; it is also making sure people are informed to act appropriately.”
Putting COVID-19 in Perspective. As astonishing as the COVID-19 pandemic may be, equally amazing to me is how quickly the world’s scientific and public health communities have responded. (Just imagine for a moment, what it must have been like during The Great Plague of London [1665-66] when an estimated 100,000 people were killed—almost a quarter of London's population. Or from more recent history, the 1918-1919 influenza pandemic that killed 50-100 million people. These cataclysmic events occurred before our major weapons for battling pathogens were fully developed: instantaneous communication [via a properly used internet and telemedicine], vaccines, and antimicrobial drugs.)
It is easy to lose track of how much “p” for progress has been made in such a short period of time. Incredibly, the genome of SARS-CoV-2 was characterized within a month of the onset of COVID-19 in Wuhan, China. And this scientific breakthrough facilitated development of a diagnostic test as well as “p” for promising vaccine and medication candidates.
While much is still being learned about COVID-19, a lot is already known about “p” for prevention that I’m sure you’re already aware of. The main recommendations are:
· Stay home and away from others if you are sick.
· Cover your coughs and sneezes with your elbow or a tissue.
· Wash your hands frequently for 20 seconds with soap and water.
· Avoid touching your face throughout the day.
And I might add: “p” for postpone activities where you would be exposed to crowds as well as non-essential travel.
For more on the “P” for Perspective, I highly recommend the recent article: Coronavirus: how to keep things in perspective by the Spanish microbiologist Ignacio Lopez-Goni.
The final “p” is for politicians: elect those who know that science and public health are of crucial importance for the health and security of citizens. One lesson that this pandemic has made “p” for powerfully clear, is that we all need to know whom we can trust. It’s like the doctor-patient relationship: if you don’t trust your doctor, find another doctor. Clearly, we are in need of political leaders whom we can trust.
In my expert opinion, for matters related to the COVID-19 pandemic, the good news is that we can trust the WHO, CDC, and NIH for guidance. They all have great websites, updated daily, that are devoted to COVID-19. And if you live in a state with an outstanding Department of Health, like mine, you can trust its advice. (The Minnesota Department of Health has set up a COVID-19 public hotline that is open 8 a.m. to 4:30 p.m. Monday through Friday. The hotline number is  201-3920.)
Despite some initial missteps in handling COVID-19 when it hit the shores of the U.S., with renewed federal support our public health infrastructure will reassume its world leadership.
Bottom line: it won’t be easy, and it will take some time but this too will p for “pass.”