COVID-19 and denial

Fighting SARS Memorial, Hong Kong

Today seems to be the day in which the words and numbers that international organizations and national governments used to describe the COVID-19 pandemic increasingly diverged from facts. To begin there was an overall context in which the virus rapidly spread in the Middle East, while cases dramatically climbed in Korea (833). In the Middle East, there were new cases in Afghanistan, Bahrain, Egypt, Iraq, Israel, Lebanon, and the United Arab Emirates. Most of these cases were tied to Iranian travelers.  In Italy the number of cases rose sharply. Venice ended the remaining days of Carnival. Italians in northern Italy rushed to stores, some of which were cleaned out and left with empty shelves. In the United States, ongoing problems with testing for SARs-CoV-2 has meant that health authorities have been unable to test at scale, as in Korea, Singapore and Canada. Finally, in China the rate of increase has slowed, but the nation still has over 77,000 cases. But neither the rising number of cases nor other problems caused corresponding expressions of concern by WHO or the Iranian government.

First, Dr. Tedros at the World Health Organization (WHO) said at a press conference that the WHO would not call COVID-19 a pandemic. Indeed, the WHO has stated that it no longer uses “pandemic” as a category. At the current time, there is ongoing transmission of a novel virus in multiple world regions, with a case fatality rate of perhaps two percent. If this is not a pandemic, what would be? The goal of deleting the term pandemic seemed to be more to avoid causing fear than to accurately describe reality. If the WHO does not play the role of declaring a pandemic, then who does? The risk of this is that the public in different nations may begin to lose confidence in the WHO. The pandemic exists even if the category does not. 

Second, there was coverage of the outbreak. In an article in the Guardian, Iranian authorities denied that there were fifty dead as an opposition lawmaker alleged. Instead, the authorities state that there have been 12 deaths out of 66 infected. Much of what follows comes from the comments of Dr. Benhur Lee on Twitter, as well as an article in the Economist. As Dr. Lee pointed out on Twitter, there is a case fatality rate in many locations of two percent or lower. Why would Iran have a case fatality rate of 18%? So either the virus is unusually lethal in Iran, or there are far more cases than the Iranian government has stated. Given that it seems unlikely that the death rate would be unusually high in Iran, the latter option seems more likely. This would also explain why neighboring countries -from Afghanistan to Iraq, Lebanon to the UAE- have had cases from Iranian travelers.  If this is the case, the lack of Iranian transparency may lead its public to not follow the obvious public health measures -social distancing, hand washing, preparing adequate supplies of food and prescription medicines- that are appropriate in this situation. It also makes it harder for neighboring countries to understand the scale of the challenge for their own peoples.

Of course, it is much easier to comment on problems than to fix them. There is also a swirl of bad or changing information around this virus, which makes it difficult to talk about the pandemic accurately. But it was only a month ago that we realized that there was sustained human to human transmission with this virus. We need blunt honesty and concerted planning if we are to face this pandemic in a prepared and resilient manner. National governments and health authorities don’t have a lot of time.

Lastly, an American man who flew to China felt sick and went for testing after he returned. Although he tested negative for SARS-CoV-2, he now faces a $1,400 bill. This case illustrates why the United States will have more challenges than some other countries controlling the virus. People who fear the costs of testing will not be tested. People who don’t have sick leave will work while sick. People with high co-pays will seek care too late. People with medical debts will return to work too early. With perhaps twelve percent of American adults lacking health care, what will happen if large numbers of these people fall ill? And unlike other countries, the United States has proved unable to test for the virus at scale. We need improved pandemic planning in the United States early, while there is still time not only to prepare, but also to create a public health campaign that will prevent panic when community based transmission starts here. Globally, we also need nations, business, hospitals, universities and other organizations to undertake planning commensurate with a pandemic.

Shawn Smallman, 2020

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