COVID-19: a Farewell Poem and Unfinished Business

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[This post has been written by Luis Encinas (Doctors Without Borders, MSF) ) and Adelaida Sarukhan (ISGlobal)]

“Farewell to the poor, the sick and the old. The earth has breathed its next-to-last wish.” This jisei no ku (death poem) leaves us stunned, powerless, in a state of shock. Farewell poems or death poems are a Japanese tradition, usually written shortly before the author’s death. In this case, the words evoke a feeling of déjà vu, reminding us of the events we have lived through in recent weeks.

While it is true that these aphorisms have no scientific basis, most of the people killed by the novel coronavirus (also known as SARS-CoV-2) were, in fact, old, chronically ill or socioeconomically disadvantaged. This pandemic has affected us all and continues to do so, but it affects some people more than others. And it has done so at a frenetic pace, spreading at incredible speed in a way not seen since the 1918 flu pandemic. In the little more than four months since the emergence of the novel coronavirus in a Chinese city over 10,000 km away, COVID-19 (the name of the disease caused by the virus) has spread relentlessly in a pandemic that has swept through our societies, forcing one health system after another to launch a desperate SOS as they were overwhelmed by the virulence of the unknown virus.

These two months of confinement have given us time to think about past, current and future epidemics. For example, based on the experience of the most recent Ebola epidemics (in West Africa and the Democratic Republic of the Congo), we can outline the common features of an effective response. The first of these must be the importance of prompt and aggressive action and having a health system with the human and logistical resources needed to detect cases speedily and to identify and isolate their contacts.

These two months of confinement have given us time to think about past, current and future epidemics. For example, based on the experience of the most recent Ebola epidemics, we can outline the common features of an effective response

Another crucial element is clear, coherent and transparent communication with and between communities, adapted to the social and cultural context of each one. The most influential factor in the evolution of an epidemic, particularly when there are no effective vaccines or treatments, is probably the perception of risk on the part of the population and the willingness of people to modify behaviours. The 1918 flu pandemic, for example, demonstrated the effectiveness of social distancing measures when restrictions were imposed promptly by the affected cities.

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Other lessons learned from past epidemics include the need to train sufficient numbers of people (including training for health workers on how to prevent and control infections), logistical planning (temporary infrastructures, simulation exercises, etc.), collaboration between affected countries, and the need to promote and support research and development.

This pandemic will come to an end—sooner or later. Sooner if we can develop an effective vaccine or treatment in the coming months. Later if we only worry about what happens within our own borders and leave other countries or populations with no access to vaccines or treatments. Meanwhile, we are looking at a period lasting several months of “dancing” with the virus, during which we will have to relax non-pharmaceutical interventions or tighten restrictions, including physical (rather than social) distancing measures. Looking ahead, our ability to respond and prepare for new outbreaks of virus—whether known or unknown—will depend largely on “the 3 Cs”: coordination, collaboration and changes in social behaviour:

Coordination of the response going beyond the health sector

The current pandemic is not just a crisis in terms of health, but one that affects every sector of our society. It is crucial, therefore, to establish mechanisms that will ensure a coordinated response across different sectors involving all the actors (political, social and economic) at both the national and international levels to mitigate the effects of this and future crises. At the global level, there is an urgent need to strengthen the role of multilateral agencies, starting with the World Health Organisation (WHO). The WHO should be the principal coordinator of preparedness and response in health crises. The action of the WHO in this and other pandemics has not been perfect; however, it is the only global body with the mission, scope and infrastructure needed to deal with such crises. The WHO’s current problem is more than just a lack of resources; the organisation also suffers from a lack of independence and authority. It is subject to the whims of the countries that fund it—including China and the USA—and its work is hampered by the non-binding nature of its recommendations. To remedy this weakness, the failure of signatory countries to comply with international health regulations should be penalised.

Collaboration

This crisis affects us all and competition is the last thing we need in the race to develop a vaccine or an effective treatment. The good news is that, since the virus was first described in early January, scientific knowledge about it has advanced at an unprecedented rate and platforms have been set up to facilitate the exchange of and open access to all this information . Furthermore, we have seen the launch, in record time, of clinical trials designed to test the efficacy of existing approved drugs against the disease (the WHO is coordinating a global trial to test the efficacy of four treatments) and Phase 1 trials of several vaccine candidates are already underway. We must at all times remain vigilant and on the lookout for pharmaceutical companies trying to market miracle cures for the virus. Finally, we must ensure that, when an effective treatment or vaccine is available, appropriate international mechanisms—such as the global vaccine alliance GAVI—are in place to ensure that it reaches low-income countries in sufficient quantities and at affordable prices.

Changes in Social Behaviour

Eventually the pandemic will be controlled but in the meantime we will learn a lot. We will change the way we interact with others, we will live with omnipresent physical distances in our minds, and our day to day lives will inevitably be different. And what will be the cost? Fear will gain a lot of ground, generating a state of extreme vulnerability.

It is to be hoped that a better understanding of what we want as a society will emerge from all this suffering. We could, for example, envisage a society that invests in health, education and the environment and views these elements as rights and common goods to replace the current model driven by economic interests. To effect that change, however, we need more than an unflagging militancy born of a temper tantrum on a balcony.

It is to be hoped that a better understanding of what we want as a society will emerge from all this suffering. We could, for example, envisage a society that invests in health, education and the environment and views these elements as rights and common goods to replace the current model driven by economic interests

We will have to go all the way. We will have to elect politicians and governments who profess these principles and, above all, we have to demand results from them. Because we deserve it. And, if we do not do that, the alternative is to continue weeping and pay a very high price. And then the farewell poems will become sad realities: the antechambers of social traumas with no escape possible.

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